Editorial Message—Patient Follow Up: A Critical Component of Bariatric Surgery

| November 11, 2010

Patient Follow Up: A Critical Component of Bariatric Surgery

Dear Colleagues:
Welcome to the November issue of Bariatric Times. This month, we are pleased to feature two articles on nutritional deficiencies and their side effects following bariatric surgery: a review article by Faria et al on hair loss and a brief report by Goldenberg on pica, which happens to be the first installment of a new, regularly featured column on nutrition. These articles both highlight the importance of making clear nutritional recommendations to our patients following bariatric surgery in order to avoid distressing side effects such as hair loss and iron deficiency anemia. These articles also further demonstrate a critical component of bariatric surgery: patient follow up.

Unfortunately, in this current economy, patient follow up is becoming more and more difficult. Patients are moving out of state to seek new job opportunities, others are losing their health insurance coverage, and some patients are unable to travel. We are sometimes stunned when patients show up in our office two years after an adjustable gastric banding procedure and share that they have never had a follow-up visit for an adjustment.

This brings me to Dr. Ponce’s article this month on fluoroscopy-guided band adjustments. I cannot agree more with Dr. Ponce that fluoroscopy-based adjustments have only advantages over the office-based adjustments. As Dr. Ponce states in his article, fluoroscopy-guided band adjustments provide information regarding the anatomical position of the band and allow the physician to clearly visualize the grade of adjustment achieved with the new fill. I personally want to see the esophagus completely empty of contrast material with not more than three contractions. What needs to be emphasized once again, however, is the indication for new adjustments. Patients sometimes come to us seeking tighter band adjustments without changing their lifestyle. If I see that patients have not maximized their exercise capabilities and are not sticking to a healthy diet, I will not do the adjustment. In my opinion, patients should earn the fill!

Also in this issue, we present an interview with Drs. Kaplan and Seely, principle investigators in the Metabolic Applied Research Strategy (MARS) initiative. The MARS initiative is aimed to achieve the following objectives: 1) a better understanding of the mechanisms of bariatric surgical procedures on obesity and diabetes, 2) an identification of promising new approaches that harness this understanding, and 3) an identification of strategies to predict outcomes after these procedures so as to improve the risk-benefit and cost-benefit relationships for these most effective interventions. There is important work being done in the MARS initiative, and we are in desperate need to get as much information as possible to achieve a better understanding of how our operations work. As long as the metabolic syndrome is associated with obesity, weight loss is our primary endpoint. What remains to be demonstrated are all the physiological changes that happen under the umbrella of “weight loss.” The big question is, “Do our operations work in metabolic syndrome that is not associated with obesity?” I do not know what research will show us, but for now, I consider all operations being performed in patients with low body mass index (BMI) and metabolic syndrome “experimental.”

I hope you enjoy this issue, and as always, we welcome your comments, letters, and article submissions.

Sincerely,

Raul J. Rosenthal, MD, FACS
Editor, Bariatric Times

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