The Fifth Annual National Obesity Collaborative Care Summit

| November 1, 2018

by Marina Kurian, MD, FASMBS

Dr. Kurian is from New York University Langone Health, Department of Surgery, New York, New York.

Funding: No funding was provided for this article.

Disclosures: The author reports no conflicts of interest relevant to the content of this manuscript.

Bariatric Times. 2018;15(11):10–11.

The National Obesity Collaborative Care Summit is an excellent opportunity to partner and learn from different societies and organizations that share the cost and liabilities in the treatment of obesity. What we have learned is that obesity is continuing to increase in the United States and globally, and that our resources, though shared, can be additive in improvements and durability of treatment for our patients.

The Academy of Nutrition and Dietetics

Lucille Beseler, MS, RDN, LDN, spoke on behalf of The Academy of Nutrition and Dietetics (AND) and the 100,000 members. What we learned is that dietitians are an underutilized asset in the treatment of obesity. Many dietitian visits can be covered by insurance and reasonably reimbursed. With two preoperative and at least four postoperative visits, a registered dietitian (RD could be reimbursed up to $500 per patient in network. Break even could occur for a dietitian with 65 to 130 patients per year depending on the reimbursement and number of follow up appointments. Different employment models exist for the registered dietitian nutritionist (RDN) as well as for a surgical practice. RDNs can also take care of a variety of care models, chronic diseases, wellness in addition to obesity care. Dietitians are close allies to physicians and advanced care providers treating the chronic disease of obesity. This is a powerful association to partner with for messaging and improving outcomes in the patient with obesity.

The American Academy of Sleep Medicine

David Kristo, MD, spoke representing the Board of Directors of the American Academy of Sleep Medicine. Dr. Kristo described the scope of the problem with obstructive sleep apnea (OSA) and how there was no consensus on body habitus type and OSA. He described the effects of weight loss on apnea/hypopnea index  (AHI). Interestingly, patients that are very compliant using continuous positive airway pressure (CPAP), experienced some weight gain from prior to CPAP use. In 2018, there was a Sleep Disordered Breathing Collaboration Summit and the American Society for Metabolic and Bariatric Surgery (ASMBS) participated. Future areas of consensus and collaboration are when to institute preoperative and postsurgical testing. Also, a point of discussion is when to use the home sleep test and CPAP titration and when to refer to a sleep lab. Future ongoing collaboration is planned.

The Obesity Society

Lee Kaplan, MD, presented on pharmaceutical therapies that are available and summarized the studies that led to United States Food and Drug Administration (FDA) approval for lorcaserin HCl (Belviq, Eisai Inc., Eisai Inc., Woodcliff Lake, New Jersey), phentermine/extended-release topiramate (Qysmia, Vivus, Inc., Mountain View, California), liraglutide [rDNA origin] injection (Novo Nordisk, Plainsboro, New Jersey), and naltrexone HCl/bupropion HCl (Contrave, Takeda Pharmaceuticals America, Inc., Deerfield, Illinois). He also discussed medications that are in the pipeline and being tested. Expected weight loss and different models of patient care were described. Overall, obesity treatments are greatly improved compared to prior years because of the options that are available to doctors and patients.

The American Society for Gastrointestinal Endoscopy

Shelby Sullivan, MD, presented on the different endoscopic therapies that are currently available for the treatment of obesity. Dr. Sullivan broke down endoscopic therapies into devices that cause weight loss and affect metabolic change and those that cause metabolic change and may have some associated weight loss. The pivotal trials for intragastric balloon systems Orbera (Apollo Endosurgery, Austin, Texas), Reshape (ReShape Lifesciences, San Clemente, California), and Obalon (Obalon Therapeutics, Inc., Carlsbad, California) were also reviewed as well as the side-effect profile. Not surprisingly, weight loss outside of the trials is better as patients are more invested in their success. Use of concomitant medications to help patients maintain their weight loss after balloon removal was also discussed in this session. The AspireAssist System (Aspire Bariatrics, Inc., King of Prussia, Pennsylvania) was also discussed and the results of the pivotal trial reviewed. Primary adverse effect was peristomal granulation tissues. Patients evaluated were noted to have a different eating behavior and no excessive aspiration of the device was noted. Long-term weight loss was 20 percent total body weight (TBW). Endoscopic sleeve gastroplasty data and technique were also reviewed and two-year weight loss approximated 18 percent TBW. Dr. Sullivan briefly described devices in the pipeline, including TransPyloric Shuttle (BAROnova, Inc., San Carlos, California), duodenal liners and duodenal mucosal resurfacing technique.

American Board of Obesity Medicine

Dr. John Cleek presented on behalf of the American Board of Obesity Medicine (ABOM). A survey was sent out to American College of Surgeons/ASMBS Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) centers to assess knowledge and partnership with obesity medicine specialists. Most of the surgical centers were aware of the ABOM but not all those who responded knew whether their obesity medicine colleague was certified by the ABOM. There will be a course at Obesity Week 2018 on the benefits of ABOM certification and collaboration within practices. Dr. Cleek also detailed the steps to obtain and maintain ABOM certification. The alliance with ASMBS and ABOM is ongoing.

Pacific Business Group on Health

Kelly Klaas, Purchaser Value Manager for Pacific Business Group on Health, discussed the cost-benefit analysis for large employers and what it can mean in savings. Many employer plans don’t cover bariatric surgery. When large employers do cover, they see an immediate savings in medication costs. Large employers have designated Centers of Excellence and send their employees to these centers for bariatric surgery and cost containment. These employers have seen significant savings and improvements in employee productivity. The Pacific Business Group on Health held a symposium this year on “Beyond BMI: Reframing the Obesity Epidemic for Employers,” and ASMBS and the Obesity Action Coalition (OAC) were invited to help frame the discussion. We look forward to more positive interactions with large employers as they realize the benefits to employees and cost savings associated with bariatric surgery.

Cleveland Clinic

Dr. Derrick Cetin discussed the overall philosophy of Cleveland Clinic and how the system streamlines bariatric care. There is a core team that evaluates the patients and there are ancillary service, continuum of care specialists and involvement of facilities and equipment staff to maximize the outcomes for the patients and the system. “Buy in” from across the system is a hallmark to the success of their model. They also have patients have ownership of their preoperative and postoperative appointments. However, having navigators as part of the overall care plan is helpful to keep everyone on track. Having such a well-orchestrated program at such a large health system is a testament to integration at all levels.

Dr. Cetin also discussed different classes of medications that resulted in weight gain and detailed alternatives to their use. This involves different classes of medications, such as antiepileptics, antidepressants, diabetes medications, beta blockers and others. This discussion outlined how important it is for different disciplines to address the potential weight gain that can occur with medications and to put more thought into those choices.

American Society for Metabolic and Bariatric Surgery

Dr. Eric DeMaria addressed the issues of follow up after obesity treatment. He introduced the concept of Bariatric Continuity Partners to address the postoperative follow-up issues that we all face. A surgeon performing eight procedures a week fast outstrips his ability to provide follow-up care to his or her patients at 2 to 4 years. In order to continue to provide care to patients, engaging PCPs, obesity medicine specialists, gastroenterologists, and advanced practice providers is helpful. A variety of methods to develop partnerships with PCPs were discussed, including using the Essentials of Bariatric Surgery app. Interest level on the part of PCPs needs to be gauged as the next step.

National Obesity Collaborative Care Summit

John Morton, MD, described the origins of the collaborative care summit as well as some of the net deliverables which include position statements with the American Association of Hip and Knee Surgeons (AAHKS), the National Lipid Association, American College of Obstetrics and Gynecology, American College of Occupational and Environmental Medicine, American Hernia Society, and the American Society for Clinical Oncology. Future collaborations include but are not limited to electronic medical record (EMR) systems, patient-reported outcomes, telemedicine and use of biometric scales to track outcomes. The National Obesity Collaborative is a very critical initiative to move obesity care with engaged partners.

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