Surgery and Incentive Programs May Help in Preventing Obesity Rates from Rising Worldwide, but Lifestyle Changes will Always Play a Role

Dear friends, colleagues, and readers of Bariatric Times:

I hope you had a great start in 2013. This year promises to be an exciting one for the American Society for Metabolic and Bariatric Surgery (ASMBS). First, 2013 brings the implementation of the ASMBS and American College of Surgeons (ACS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Second, the ASMBS joins forces with The Obesity Society to debut the first annual Obesity Week. The ASMBS regular annual meeting will take place during Obesity Week in Atlanta, Georgia, November 11 to 16, 2013. Beginning with this issue, Bariatric Times will be counting down to Obesity Week with a special interview series. We will feature interviews with the Obesity Week Board of Managers, who are working to make this event happen. In the first interview, Dr. Philip Schauer, ASMBS Past President, explains the history and concept of Obesity Week.

In this issue, we present an excellent article by Dr. Amy Windover titled “Tobacco Use in Bariatric Patients,” in which she reviews the research examining tobacco use and bariatric surgery. Obesity, alcohol consumption, gambling, and tobacco use are all addictive behaviors with a hormonal background that we do not yet clearly understand. I always recommend that both pre- and postoperative bariatric patients who use tobacco enroll in our tobacco cessation program. The great majority do not enroll in the program, but many individuals do. Should we deny them from having a procedure because they did not enroll in those programs? How successful are those programs and who will pay for them? I personally do not have the right to prevent a human being from achieving remission of diabetes, hypertension, sleep apnea, and so forth just because he or she does not achieve tobacco cessation, but I do limit his or her surgical choices to adjustable gastric banding or sleeve gastrectomy. I do so because in my experience it is not the wound healing, pulmonary embolisms, or deep vein thrombosis that cause problems after gastric bypass, but the marginal ulcerations, perforations, and gastrogastric fistulas for which smoking is a significant risk factor. This article also contains a handout of Cleveland Clinic’s Tips for Quitting Tobacco.

In this month’s “Hot Topics in Integrated Health,” led by column editor Karen Schulz, Barbara Click reminds us of a well-known problem in bariatric patients—vitamin B1 or thiamine deficiency. Seven years ago, my colleagues and I published a manuscript on this subject stating that 13 percent of our patients were deficient in thiamine preoperatively.[1] We recommended that bariatric patients be routinely tested in the preoperative stage for B1 deficiency. In fact, all our patients that come in postoperatively complaining of nausea and vomiting receive an infusion bag of multivitamins, including B1, regardless of the levels obtained in blood testing. Obesity is, in our opinion, a form of malnutrition.[2] Thank you Karen and Barbara for an excellent review.

Also in this issue, we present another installment of “Anesthetic Aspects of Bariatric Surgery,” led by column editor Dr. Stephanie Jones. This month, Dr. Yigal Leikin reviews the multidisciplinary approach to managing a parturient patients with obesity, which is, in my opinion, one of the most delicate clinical scenarios with a 200-percent mortality risk.

We present another installment of “The Hole in the Wall,” with Dr. Samuel Szomstein. Drs. Zuberi, Nguyen, and Schweitzer from Johns Hopkins Bayview Medical Center provide an excellent article on endoscopic component separation.

In closing, I would like to highlight two interesting articles I read in the Journal of the American Medical Association (JAMA)[3] and The Economist[4] that relate to trends of obesity. A study from the Centers for Disease Control and Prevention (CDC) carried out in 30 states and the District of Columbia showed that the prevalence of childhood obesity in infants 2 to 4 years old has declined from 15.2 to 14.9 percent.[3] Although the decrease seems modest, the fact that we are seeing a downtrend is encouraging.

The Economist published an interesting article as well showing the rising obesity trends in Brazil, the United States, and the United Kingdom.[4] The article begins with a quote by George Orwell who in 1937 suggested that “changes of diet” might be more important than “changes of dynasty or even of religion.” The authors further discussed their belief that governments can intervene to preventing rising obesity rates by implementing educational programs and giving the population financial incentives (e.g., tax breaks), much like an incentive program in the UK called Pounds for Pounds. They concluded that while incentives might help, in the end, it is the individual who has to make the decision to change his or her lifestyle.

I hope you enjoy this issue of BT.

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

Raul J. Rosenthal, MD, FACS, Clinical Editor, Bariatric Times, Professor of Surgery and Chairman,  Department of General Surgery; Director, The Bariatric and Metabolic Institute; Director, General Surgery Residency Program and Fellowship in Minimally Invasive and Bariatric Surgery,  Cleveland Clinic Florida, Weston, Florida

References
1.    Carrodeguas L, Kaidar-Person O, Szomstein S, et al. Preoperative thiamine deficiency in obese population undergoing laparoscopic bariatric surgery. Surg Obes Relat Dis. 2005;1(6):517–522; discussion 522.
2.    Kaidar-Person O, Rosenthal RJ. Malnutrition in morbidly obese patients: fact or fiction? Minerva Chir. 2009;64(3):297–302.
3.    Pan L, Blanck HM, Sherry B, et al. Trends in the prevalence of extreme obesity among US preschool-aged children living in low-income families, 1998–2010. JAMA. 2012;308(24):2563–2565.
4.    Obesity: Fat chance. The state can do some things to encourage people to eat less, but not a lot. The Economist. December 15, 2012. http://www.economist.com/news/leaders/21568389-state-can-do-some-things-encourage-people-eat-less-not-lot-fat-chance

Tags: Dr. Raul Rosenthal

Category: Editorial Message, Past Articles