IFSO: A Closer Look at a Global Network of Bariatric Surgeons, Part 1

| November 1, 2019

Lilian Kow, BMBS, PhD, FRACS
Director Adelaide Bariatric Centre; President International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)

Prof. Luigi Angrisani, MD
Senior Consultant, IRCCS Multimedica, Istituto di Ricovero e Cura a Carattere Scientifico, Sesto S.Giovanni – Milano

Funding: No funding was provided.

Disclosures: Lilian Kow, BMBS, PhD, FRACS, is the President of IFSO. Luigi Angrisani, MD, is Past President of IFSO.


Dear friends and colleagues from around the globe:

We just returned from Madrid, Spain, where we attended the 2019 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) annual clinical congress. The meeting was an absolute success under the leadership of Congress President Antonio Torres. With an attendance of over 3,500 surgeons and allied health professionals from around the world, we thoroughly reviewed and discussed the most controversial topics in our specialty.

As this year comes to an end, we are thrilled to invite you to join us July 28 to August 1, 2020, at the historic Fontainebleu Hotel in North Miami Beach, Florida, where we will host the the 25th Annual IFSO World Congress—Silver Anniversary. This gathering will be joined by the American Society for Metabolic and Bariatric Surgery (ASMBS) Obesity Weekend, and is predicted to be another great success. Among many important topics to be discussed, we will conduct the first consensus conference on endoscopic bariatric interventions.

Do not miss this great opportunity to learn the latest in bariatric and metabolic surgery. Mark your calendars and make your reservations now at www.ifso2020.net! We look forward to welcoming you in Miami.

Sincerely,

Drs. Natan Zundel and Raul Rosenthal


This is Part 1 of a multi-part interview series featuring key members of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), including past presidents, current chapter presidents, and members of the integrated health team. In this edition of BT, we interviewed current IFSO President Lilian Kow, BMBS, PhD, FRACS, and Past President Luigi Angrisani, MD.

Given that all ASMBS members are also members of IFSO, what is the primary value of IFSO to ASMBS members?

Dr. Kow: IFSO is a federation of societies that brings together surgeons and integrated health professionals involved in the treatment of patients with morbid obesity. IFSO has 10,000 members from 66 societies and five chapters from around the world, with each individual society being represented by elected individuals, as well as by defined geographical regions. The ASMBS is part of the North American Chapter, along with the Canadian Association of Bariatric and Physicians and Surgeons (CABPS). IFSO values ASMBS as its largest and most influential society, with over 4,000 members.

IFSO’s main activity centers around its annual World Congress, which provides a forum for researchers and clinicians to meet and exchange knowledge on metabolic treatment of patients with severe obesity, new techniques, updates in research, and innovative concepts. IFSO also produces treatment guidelines for individual surgeons and bariatric centers around the globe. These guidelines are the result of systematic reviews by experts to help all IFSO members. IFSO provides ASMBS members with the opportunity to communicate with bariatric surgeons from other countries so we can all learn from each other.

Dr. Angrisani: The American bariatric surgery community is undoubtedly the largest and certainly one of the most competent group of professionals worldwide in this field. I have attended many ASMBS conferences and postgraduate courses over the years, and I have greatly benefited from meeting and talking directly with outstanding personalities in metabolic and obesity surgery, such as Drs. Edward Mason and Lloyd MacLean, both of whom have made significant historical landmarks on this specialty.

But, I have also encountered some preconceptions among North American bariatric surgeons. For example, at beginning of the third millennium, the Lap Band, which was extensively used in Europe, Australia, and South America entered the US, while the Roux-en-Y gastric bypass (RYGB), which was originally described and routinely used in the States, entered the European continent. At that time, while the experience and the clinical research previously performed in the states on RYGB was rapidly accepted and grasped by the European group, it was not the same in the US. The ASMBS community, in fact, seemed to not accept the results of the experience that was matured in Europe and Australia and went back to also repeat some mistakes that had been clearly recognized and pointed out by most of us.

In other words, North America is a modern rich country with brilliant brains, but, from my point of view, it’s not as open-minded as it should be. Given the opportunity, the IFSO meeting could certainly stimulate ASMBS members to have a more international and wide vision that, at the end of the day, will improve the management and outcomes of patients with obesity.

What’s the best part of IFSO?

Dr. Kow: The best part of IFSO is that all 66 societies share the vision to optimize the control of adiposity-based chronic diseases and to unify the global scientific, surgical, and integrated health communities for the purpose of disseminating knowledge, collaboration, and establishing universal standards of care for the treatment of individuals with adiposity-based chronic diseases.

Dr. Angrisani: When I participated in the first official IFSO meeting in Prague, Czech Republic, in 1996, there were less than 100 surgeons who were trying to create an international community. It felt like it was North America versus the rest of the world. I was there, and it was a concept, and perhaps an ambitious dream, to create interaction between all the bariatric societies and their members worldwide. It has been a long, fantastic journey, but nowadays I can admit without reservations that IFSO could stand on its own without ASMBS, and vice versa. We have reached 66 societies and are one of the largest medical associations around the world. The benefit of putting together different medical systems to surgically treat patients with obesity is helpful.

What was your favorite part of the meeting in Madrid?

Dr. Kow: Madrid for me was a meeting of all the affiliated bariatric and metabolic societies and a wonderful opportunity to reach out to as many members as possible. It is not possible to meet all 10,000 members, but it gave me a chance to show members that IFSO is committed to unifying surgeons and integrated health professionals, including physicians, nurses, dietitians, psychologists, internists, and anesthesiologists, in the global treatment of adiposity-based chronic diseases.

Dr. Angrisani: I very much enjoyed the IFSO talks. I think the session introduced by Almino Ramos and Antonio Torres provided a new communication modality to stimulate participation in the scientific program. I also enjoyed meeting and keeping in touch with both old and more recent friends to share views, problems, and ideas. IFSO is becoming an internationally extended family and a point of reference in our professional and social life. During the meeting, our spouses also got to meet and visit everyone, which is important considering how important they are in our daily lives. I was also honored to be nominated Chairman of the IFSO Board of Trustees, which includes 22 IFSO Past Presidents

What lessons have you learned from other countries?

Dr. Kow: I learned that not all societies are equal in terms of their healthcare programs and clinician training. Hence, while many established societies, such as the ASMBS, Australia New Zealand Metabolic Obesity Surgical Society (ANZMOSS), and European societies have advanced systems in place, there are many other societies from other parts of the world that need help training bariatric surgeons and healthcare professionals. As a global federation, IFSO is in an excellent position to assist the more developed societies in helping the developing ones. I have also learned that adiposity continues to have a stigma in society and among some healthcare stakeholders, and this will be an ongoing challenge for all involved in the care of these patients.

Dr. Angrisani: When I was IFSO President, I traveled extensively, which provided me with a great opportunity to experience different healthcare realities. It was an extraordinary experience, and I continue to carry inside me pieces of all the countries I visited. The most impressive human and professional adventure for me was operating in different cities and institutions in India. I was completely fascinated by the Dalai Lama in Delhi and his words. I appreciated and admired the flexibility and the wise and appropriate use of resources by the government and by my Indian medical colleagues. I devotedly appreciate the compassion, solidarity and charitable humanitarianism of that country. In my opinion, in India, every patient gets the best and most appropriate treatment he or she can get based on social status. It is simple, it is natural, and it is true. In my opinion, it is also more civilized than some other countries.

What do you hope to accomplish as IFSO President?

Dr. Kow: I hope to continue the good work of my predecessors in reaching out to help optimize the control of adiposity-based chronic diseases. Of course, an IFSO President does not work alone, and I would like to work with all the committees within IFSO to help them achieve their individual goals. For example, the Scientific Committee is already working on next year’s World Congress program in Miami, Florida, which will take place July 29 to August 1, 2020. We strive to have every World Congress be more successful than the previous one. The other committees are working on updating position statements, global registry data platforms, and promoting integrative health support and enhanced recovery after surgery (ERAS). An additional project is the development of a digital bariatric educational platform for surgeons wanting to start a career in bariatric surgery. This will be a fundamental bariatric education program that will include surgical anatomy, gastrointestinal (GI) physiology, fundamentals of nutrition, standardized bariatric procedures, management of postoperative complications and nutrition, and the role of the multidisciplinary team. I believe this basic educational bariatric program should be the first step in clinical bariatric surgical training or fellowship. I am hoping that this IFSO program will help bridge the gap between general surgeons and their clinical training in bariatric surgery. Finally, I would like to reach out to the young IFSO surgeons about mentoring, balanced leadership, and how to thrive in life as a surgeon.

What was the most important issue you addressed as IFSO President?

Dr. Angrisani: During my IFSO presidency, my main target was to bring IFSO together on two issues that I am continuing to pursue. The first was to expand the indication of surgical treatment to patients with a body mass index (BMI) of less than 35kg/m2 even without comorbid Type 2 diabetes. These patients with lower BMI, which are often more amenable to being treated and mostly cured by surgery, are frequently discriminated against and inappropriately excluded from surgical treatment. On the contrary, we spend an incredible amount of energy and resources to treat patients with a BMI over 60 or 70kg/m2 despite more difficult chances for improvement via bariatric surgery. Under my presidency, an IFSO position statement was edited and published by a distinguished group of authors on this specific topic. The second issue I tried to achieve was to emphasize the importance of counting and registering the surgical procedures performed in the IFSO community. In 2014, I was happy to have the opportunity and the privilege to accept Dr. Michel Gagner’s proposal to start the IFSO World Registry, which is one of the largest ongoing studies on the outcome of weight loss operations. Similarly, with my own research group in Italy, and with support and collaboration from IFSO headquarters in Naples, we fully incorporated the Scopinaro and Buchwald Biannual IFSO Worldwide Survey among the IFSO activities and duties. This is a trend analysis of the bariatric and metabolic procedures performed worldwide, essentially informing us on how many operations are performed and which procedures are growing or declining in our universal bariatric community.

This interview has been edited for length and clarity.

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Category: Current Issue, Global Perspectives

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