Looking Forward to a New Year and Hoping that Healthcare Reform Includes More Access to Care for Individuals with Obesity

Dear Friends and Colleagues,

First, I would like to commend Dr. Michel Gagner on the success of the Fourth Annual International Consensus Summit for Sleeve Gastrectomy (ICSSG-4), which took place in New York, an outstanding venue for the event. Highlights of the summit included live surgery sessions that featured surgeons from all over the world demonstrating different approaches on how to perform, revise, and convert a sleeve gastrectomy procedure. The lectures and discussions were also first class. I was not surprised at the excellence of this event as Dr. Gagner is a leading surgeons of our time who pioneered not only the laparoscopic approach of sleeve gastrectomy as a bariatric treatment modality,  but also many other techniques, such as the laparoscopic approach to proximal and distal pancreatectomy, biliopancreatic diversion and duodenal switch, and endoscopic  thyroidectomy and  parathyroidectomy. In this month’s issue of Bariatric Times, we present an interview with Dr. Gagner. He describes his experiences in restructuring a bariatric center in Qatar’s largest hospital, Hamad General Hospital, and relays the message that this model shows that the restructuring bariatric programs for improved outcomes around the world is possible. I hope you enjoy learning more about this interesting and important endeavor.

Drs. Robert B. Lim and William V. Rice present an outstanding review discussing the bariatric surgery experience of the United States Military forces. Three past presidents of the American Society of Metabolic and Bariatric Surgery (ASMBS), who are also members of the BT Editorial Advisory Board, share a history of serving in the United States military. Dr. Walter Pories, one of the fathers of bariatric surgery, retired from the United States Army as a Colonel, Dr. Alan Whitgrove performed the first laparoscopic Roux-en-Y gastric bypass (RYGB) as a Navy surgeon, and Dr. Robin Blackstone, immediate past-president of the ASMBS, achieved the rank of Major in the United States Army. Thank you Robert and William for this excellent contribution.

In his first installment of “ASMBS News and Update,” Dr. Jaime Ponce provides a thorough review of all activities created by the ASMBS committees. Probably one of the most concerning pieces of news delivered by Dr. Ponce in this article is that the total number of bariatric cases performed in the United States in 2010 (150,000–160,000) are significantly less than what we all thought. We always relied on databases telling us that we were conducting only 250,000 cases a year, which represented less than one percent of the affected population. Now, we receive the news that we are not even close to the one percent. How can we get these numbers to increase? Is the lack of insurance coverage the only reason for this or is it that patients fear surgery? Do physicians know about the safety and efficacy of our procedures? In a study published in Surgery for Obesity and Related Diseases (SOARD) in 2010,[1] my colleagues and I examined the barriers to bariatric surgery under the working hypothesis that the lack of insurance coverage was the main reason patients did not undergo surgery. To our surprise, we found that patients’ denial of obesity was the number one reason patients did not consider bariatric surgery. Other reasons included patients’ fear of surgery and doctors not recommending surgery to their patients. Denial means that patients do not see themselves as obese subjects and candidates for bariatric surgery. This proved that insurance coverage is not the main reason why we conduct so few procedures annually. We need to work together and educate the authorities as well as the public. Another recent study published in the Medical Journal of Australia[2] looked at hospital data for 49,364 individuals with obesity and found that those with an annual household income of $70,000 or more were five times more likely to undergo surgery than those who earned less than $20,000 a year. Another study[3] found that individuals with private health insurance are nine times more likely to have weight loss surgery than those without private health insurance.We should hope that one of the positive developments of the new healthcare reform is to give our patients access to bariatric surgery. If you did not have the chance to read Dr. Bruce Wolfe’s ASMBS presidential address, which was publised in the September 2012 issue of SOARD, I urge you to do so and learn more about obesity discrimination and what we can do about it.

In this month’s “ASMBS Foundation News and Update,” Dr. David Provost announces upcoming Walks for Obesity that will be supported by the ASMBS Foundation and reminds readers that the deadline (December 31, 2012) to submit nominations for the 2012 Purpose, Passion & Pledges (P3) Award is fast approaching.

In this month’s “Surgical Pearls: Techniques in Bariatric Surgery,” Dr. Mal Fobi explains how to place a pre-anastomotic ring when performing gastric bypass. Although this procedure is not widely performed, I felt it should be included in our column and presented by the master himself.

In our fourth installment of “Checklists in Bariatric Surgery,” we discuss the most important steps to be followed when a patient develops a gastrojejunal anastomic leak after a gastric bypass. I still follow the advice of my fellow Dr. Bob Marema who said,  “The best treatment for a leak is first drainage, second drainage, and third drainage.” I add to Bob’s legacy the concept of using a simple approach in emergencies. While most of us know well that placing sutures on anastomotic leaks are futile efforts, some ignorant lawyers believe that surgeons should do so when re-operating  these patients.

As this year comes to an end, the team of BT would like to extend to all our readers and supporters best wishes for a happy holiday season. Merry Christmas, Happy Kwanza, Happy Chanukah, and a happy and healthy 2013.

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

References
1.    Afonso BB, Rosenthal R, Li KM, Zapatier J, Szomstein S. Perceived barriers to bariatric surgery among morbidly obese patients. Surg Obes Relat Dis. 2010;6(1):16-21. Epub 2009 Oct 3.
2.    Korda RH, Joshy G, Jorm LR, et al. Inequalities in bariatric surgery in Australia: findings from 49 364 obese participants in a prospective cohort study. Med J Aust. 2012; 197 (11): 631-636.
3.    Wolfe BM. Presidential address—obesity discrimination: what can we do? Surg Obes Relat Dis. 2012; 8(5):495–500.

Tags: Dr. Raul Rosenthal

Category: Editorial Message, Past Articles