Medical and Surgical Under One Roof: How Obesity Medicine Specialists and Surgeons Work Together

| April 1, 2015

A Message from Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania. Dr. Still is also a board member of the Obesity Action Coalition, Tampa, Florida.


Dear Colleagues,
In my February 2015 editorial, I described how I became interested in the field of Obesity Medicine. This month I would like to expand upon the specialty and hopefully provide food for thought on how an Obesity Medicine Specialist may fit into your practice or institution.

Obesity Medicine Physician (OMP)
•    Has expertise in the sub-specialty of obesity medicine. This sub-specialty requires competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity.
•    Employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy.
•    Utilizes a comprehensive approach, and may include additional resources, such as nutritionists, exercise physiologists, mental health professionals, and bariatric surgeons, as indicated to achieve optimal results.
•    Maintains competency in providing pre-, peri-, and post-surgical care of bariatric surgery patients.
•    Promotes the prevention of obesity, and advocates for those who suffer from obesity.

At our institution, we provide both medical and surgical treatments for obesity. Patients interested in bariatric surgery complete a comprehensive 4-to-6-month preoperative process encompassing nutrition counselling from dietitians, behavioral medicine evaluations by clinical psychologists, physical function assessment from an exercise physiologist, and medical clearance from obesity medicine physicians and mid-level providers. Once the patient completes this process, they are referred to the bariatric surgeon for consultation. Perioperatively, an obesity medicine provider manages patient’s medical issues and adjusts medications. Our department then follows the patient indefinitely at regularly scheduled intervals postoperatively.

Long-term medical and nutritional care is key. I believe that around nine months after bariatric surgery patients become “medical management” patients requiring frequent follow up. This is true for weight loss, and most importantly, amelioration of comorbid medical problems. It is not that surgical practices can’t provide this care adequately, but rather the more mature the surgical practice becomes, it becomes harder and harder to get all patients back for required visits. In addition to screening and supplementing any nutritional deficiencies, a lot of our time and resources are spent on medical adjustment, relapse prevention, and postoperative weight gain. Even the best surgeons, like Raul, will have patients that fail to meet their expected weight loss or have weight regain. The recent approval of the four weight loss medications has helped postoperative weight loss in struggling patients and as an early intervention in patients with weight regain.
Another benefit of a comprehensive program that encompasses both medical and surgical weight loss is the “fluidity” between the two programs. Initially, some patients are not interested in surgery because it is “too drastic” and may seek assistance with conventional weight management. However, often times they are not satisfied with the modest weight loss achieved with medical means, and then “transfer” over to the surgical program. This may happen about 40 percent of the time in patients who meet criteria for bariatric surgery. Similarly, but not nearly as frequently, patients present requesting surgery, but once instructed and kept accountable with diet, exercise, behavior modification, and, if appropriate, weight loss pharmacotherapy, they meet their goals without the need for surgery.

I hope I have adequately described what obesity medicine physicians do or at least what I do. I may have sparked your interested in recruiting or collaborating with an OMP. The problem is, to date, there are currently too few OMPs, however, efforts are being put forth to grow the specialty. The American Board of Obesity Medicine (ABOM) has a certification that a physician can obtain. Currently there are around 1,180 board certified diplomats and the number is growing each year. More information can be obtained from hhtp://www.abom.org. If you have further questions or want to share your own insights about this specialty, I encourage you to write us letter to the editor (send to asaba@matrixmedcom.com).

Sincerely,
Christopher Still, DO, FACN, FACP

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