The World Health Organization (WHO) Issues New Recommendations to Fight Childhood Obesity

| June 13, 2013

Dear readers of Bariatric Times:

In this issue, we first present an interview with Dr. Wayne English in our “Ask the Leadership” column. Dr. English shares with us the most important and up-to-date information regarding the new accreditation standards under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). A thanks and congratulations are in order to Dr. English and all who were involved in producing these new standards for their gigantic effort and significant contribution.

I am privileged to be involved as co-editor and co-author on two contributions to this month’s edition of Bariatric Times. First, in “Surgical Pearls: Techniques in Bariatric Surgery,” Dr. Charles Thompson III discusses chronic staple line disruptions in patients who have undergone sleeve gastrectomy. Though rare, this complication can be a devastating one because it has the potential to become chronic. A high-pressure system and the fact that there is intermittent distal obstruction might be contributing factors. In my opinion, if the fistula persists after 12 weeks, the likelihood that endoscopic treatment modalities will help them close is remote. We advocate to perform a proximal gastrectomy and a Roux–en-Y-esophago-jejunostomy. Our series (n=26), though small, has excellent results with only two re-leaks that closed with drainage and total parenteral nutrition (TPN).

Another rare but important subject that we address in this issue is hypoglycemia after gastric bypass. We explore this topic in this month’s “Checklists in Bariatric Surgery.” We reviewed the literature and found that there is not much published on this subject. We believe, however, that a step approach is warranted before performing a procedure reversal or a distal pancreatectomy on patients experiencing symptoms. We hope that you clip, copy, and file this month’s checklist for your reference.

In this month’s installment of “Anesthetic Aspects of Bariatric Surgery,” Dr. Thomas Hemmerling reviews the use of regional anesthesia in bariatric patients. He concludes that regional techniques applied to bariatric surgery may offer advantages in the context of the management of patients with obesity.

Drs. Joanna Crossett and William Rice share an interesting case report of a patient who developed necrotizing fasciitis after undergoing Roux-en-Y gastric bypass. They share the treatment course they implemented to manage this rare but overwhelming complication and report the patient has had a successful recovery.

In this month’s “Medical Methods in Obesity Treatment,” Heidi Gordon provides a synopsis of the American Society of Bariatric Physicians (ASBP) spring conference. The conference, attended by more than 500 physicians and other obesity treatment-focused healthcare providers, contained many highlights. I am looking forward to welcoming this society’s contributions the American Society for Metabolic and Bariatric Surgery (ASMBS) and of course to Bariatric Times.

Dr. Lloyd Stegemann, ASMBS State Chapter Committee Champion, invites us all to attend and support the Obsity Action Coalition’s second annual Your Weight Matters National Convention, August 15 to 18, 2013 in Phoenix, Arizona. Lloyd has traveled the country establishing state chapters and now he is leading this effort on behalf of the OAC. As stated in his article, “we now have a comprehensive, patient-directed, evidence-based, socially engaging conference to which we can send our patients.” Thank you, Lloyd, for your passion and dedication to the field of bariatric surgery.

I was stunned to read in the news the staggering numbers of childhood obesity.[1] The World Health Organization (WHO) has issued new recommendations to fight childhood obesity. The agency estimates that the number of overweight children younger than five is more than 42 million worldwide, with close to 35 million living in developing countries. The number of overweight children in Africa has almost doubled in the past 20 years. “To avoid a massive explosion of nutrition problems in the next generation, policymakers urgently need to give more attention to improving the nutritional status of pregnant women and adolescent girls who will become mothers of the next generation,” said Dr. Francesco Branca, director of WHO’s Department of Nutrition for Health and Development in an article published by Deseret News.

I close this editorial by highlighting Dr. Sayeed Ikramudin’s article in the Journal of the American Medical Association (JAMA)[2] demonstrating the superior effectiveness of gastric bypass surgery on remission of type 2 diabetes when compared to medical treatment and lifestyle changes. Despite this being a well-known phenomenon in bariatric surgery, it is imperative that we continue to publish these high-quality studies to create more public awareness about the effectiveness and safety of bariatric surgery. This month, the United States Food and Drug Administration (FDA) is releasing two new weight loss drugs to the market, Belviq (Arena Pharmaceuticals, Inc., San Diego, California, and Eisai Inc., Woodcliff Lake, New Jersey) and Qsymia (Vivus, Inc., Mountain View, California)that are joining the already approved Orexigen (La Jolla, California). Weight loss achieved with Qsymia is 9.4 percent when compared to Belviq (3.3 percent). It is possible that these drugs can be taken in tandem, but still, they do not compare to a nice 60-minute sleeve or bypass with 60 percent EWL at one year.

Sincerely,

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

References
1.    WHO issues guidance on emerging double threat of childhood obesity and undernutrition in low- and middle-income countries. http://www.who.int/mediacentre/news/notes/2013/obesity_undernutrition_20130605/en/. Accessed June 6, 2013.
2.    Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240–2249.

Category: Editorial Message, Past Articles

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