March 2007 Letter to the Editor

| March 25, 2007

Bariatric Times • March 2007

Letter to the Editor

Dear Bariatric Times Editor:

The face of bariatric surgery has changed considerably over the past 10 years. Interest in weight loss surgery is at an all time high, the procedures have never been safer, our collective understanding of the short- and long-term health benefits have never been more rigorously studied or reported on, and the search for even better therapeutic alternatives is beginning to yield novel approaches. Despite this, access to these lifesaving therapies has become increasingly limited. I believe that education can play a vital role in securing the future of bariatric surgery. While a majority of perspective patients or referring physicians may look at weight loss surgery as a step that is simply too drastic, others have been simply misinformed of the risks or the outcomes. This holds true for health plans and malpractice insurance companies as well. It is therefore incumbent upon each of us as physicians, allied healthcare professionals, and patients to educate each other as well as relative outsiders about the safety and efficacy of bariatric surgery in 2007 and beyond.

Comprehensive patient education plays a primary role in our practice. There is little question that an educated patient is our best patient and spokesman. All surgeons have seen the impact that good patient outcomes have on future patient-driven referrals. It is my opinion that the need for long term-patient compliance and follow- up after bariatric surgery mandates a high level of commitment and understanding. To better preserve the safety and efficacy of weight loss surgery, many practices, including ours, have added several levels of informed consent and education to their preoperative routines. Examples of this can include the use of a basic quiz, comprehensive “checklist” consent forms, or web-based utilities. We recently hosted an internet webcast entitled, “Understanding the risks of gastric bypass surgery,” which patients can move through at their leisure (available at no cost to patients and physicians at www.obesityhelp.com). At the conclusion, a certificate of completion can be printed, signed by the patient, and placed in the medical record. There are many patient education resources (including anatomic charts, posters, and handouts) that serve as good examples of positive, unbiased, collaborative efforts between industry and healthcare professionals for the betterment of patients. Physicians and patients alike should seek to take advantage of these resources and to develop their own versions and concepts to share for the future.

Continuing medical education is also of paramount importance. Our practice was centrally involved in the advanced bariatric surgical training efforts of recent years. We have seen firsthand the successful and safe transition of many a “general surgeon” into a full-fledged “bariatric surgeon.” The need for basic continuing education and training of these individuals and their practices has now transitioned into the desire for more detailed advanced knowledge of issues like long-term follow-up, novel approaches such as sleeve gastrectomy, revision procedures, practice management, and treatment of complications. The web continues to provide a plethora of educational resources in this regard. Websites like www.surgeryCME.com and www.websurg.com provide online continuing education in bariatric surgery on topics ranging from technical considerations to insurance reimbursement. The medical device world has provided several web-based educational resources, including www.bariatricedge.com and www.lap-band.com. In addition to its valuable practice management resources, additional industry websites like www.autosuturebariatrics.com highlight the newly recognized importance of educating primary care physicians about bariatric surgery. Over the past few years, this important group of physicians has been left out of the educational loop and has largely been mislead about the relative safety and efficacy of weight loss surgery. A recent survey from the state of Connecticut confirmed that a majority of primary care physicians don’t consider bariatric surgery as a viable treatment option because of the dangers involved. Perception is reality and we must focus our collective efforts on utilizing the wealth of credible data on bariatric surgery to change these unsubstantiated opinions. The same logic applies to issues surrounding limitations on insurance coverage, physician reimbursement, and malpractice coverage.

I find great irony that at the same time bariatric surgery possesses its greatest scientific credibility, the field remains so threatened. The worldwide experience with weight loss surgery over the past 5 to 10 years should only serve to expand its availability. While many challenges and roadblocks exist, we should all make good use of the educational resources available today to protect and preserve bariatric surgery for tomorrow.

Best regards,
Michael Tarnoff, MD, FACS

Dr. Tarnoff is Assistant Professor of Surgery, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts

Bariatric Times welcomes letters for possible publication. Letters should be no more than 500 words and five references. Type with double spacing. Letters that comment on a Bariatric Times article will be considered if they are received within two months of the time the article was published. All letters are reviewed by the editors and are selected based upon interest, timeliness, and pertinence, as determined by the editors. There are no guarantees a letter will be published. Letters that are not intended for publication by the authors should state this in the body of the letter. Published letters are edited and may be shortened; tables and figures are included only selectively.

Send letters to: Colleen Hutchinson, Managing Editor, Bariatric Times, chutchinson@matrixmedcom.com or mail to:

Colleen Hutchinson,
Managing Editor, Bariatric Times,
Matrix Medical Communications,
4975 West Chester Pike, Suite 201, PO Box 445, Edgemont, PA 19028-0444.

Include the following statement with the letter:

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Category: Letters to the Editor, Past Articles

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