An Interview with ASMBS’s Georgeann Mallory, RD

For how many years have you been the executive director of ASMBS?
It will be 13 years as of January 1, 2009.

How did you evolve to this position?
I started my career in bariatric surgery as a dietitian working for a bariatric surgeon in private practice. I became involved in the American Society for Bariatric Surgery (ASBS) shortly after joining the practice and in 1990 was the first appointed chair of the Allied Health Committee. In 1995, the Society was seeking a new Executive Director and offered me the opportunity based largely on the work I had done with the Allied Health Committee. I was thrilled! January 1, 1996 was my first official day as Executive Director. I continued my full time work as a dietitian (at the time the ASBS only had about 250 members). As the ASBS began to grow, I could no longer manage it as a part time job, much less a second job and eventually had to make a choice. To this day, I miss working with patients but I love the work I do with the American Society for Metabolic and Bariatric Surgery (ASMBS), the professional and caring people I get to work with, and that I still can help make a difference.

Tell us about the history of the society.
Many years ago, a small group of surgeons with an interest in bariatric surgery met annually at the University of Iowa campus for the Bariatric Surgery Colloquium led by Dr. Edward Mason. In June 1983, the registrants voted to form the American Society for Bariatric Surgery (ASBS), and thus began our official journey to educate on best practices for optimal outcomes and advocate for patient access to a life-saving treatment. Dr. Edward Mason, considered the father of gastric bypass surgery, was the first president of the ASBS. In an effort to represent all of its membership, the presidency rotates each year between an academic and private practice surgeon to serve as president.

The ASMBS’s Integrated Health Section (formerly the Allied Health Committee) also began with a small group of interested professionals. Our first official meeting was a roundtable discussion with only about 15 members. We had a fantastic exchange of information. What was interesting about that group is that it was very representative of the membership today—there were nurses, dietitians, a psychologist, a program director, an insurance specialist, and an operating room technician. Thanks to the remarkable leadership of the chairs who followed, the Integrated Health Section now has over 1,300 members and conducts outstanding programs throughout the year.

Two years ago, the members of the American Society for Bariatric Surgery voted to change the society’s name to the American Society for Metabolic and Bariatric Surgery to better reflect the fact that surgery goes far beyond weight loss and to recognize surgery’s significant effect on metabolic disease, particularly type 2 diabetes, and other comorbid conditions. This year, we celebrated our 25th Annual Meeting. It was more than 10 times the size of our first one in 1983. The annual conference remains the pre-eminent program of the ASMBS and the primary source for leading-edge research and pertinent information on bariatric surgery. It is also a place where great collegial friendships are formed and a spirit of camaraderie fosters interesting discussions and debate. This year, we had the special opportunity to participate in the Walk from Obesity on Capitol Hill that was hosted by the ASMBS Foundation, formed in 1997, and the Obesity Action Coalition (OAC). It was a huge success and great way to advocate for our patients.

The meaningful events and cornerstones discussed here further create a more complete picture of our history.

What are the most meaningful events that you remember as cornerstones of this field’s history?
Through the years, new techniques and devices have brought great change and growth to the field. When Drs. Wittgrove and Clark performed the first laparoscopic gastric bypass, it changed the face of bariatric surgery. The number of surgeries performed around the country grew tremendously, as did the membership of the ASMBS. The FDA approval of the laparoscopic adjustable band in 2001 also brought more attention and patient interest to the field.

I remember the excitement of the day we hit 1,000 members. Today, we have over 3,300 members. But we are not about numbers; we are about helping people. With the rapid growth of the society came concern about a potential decline in quality. To help assure safety and quality, in 2004 the ASMBS initiated a Bariatric Surgery Centers of Excellence (BSCOE) program and assisted in the formation a separate organization, the Surgical Review Corporation (SRC), to administer the program. Today, there are 363 facilities and 620 surgeons throughout the United States that are an ASMBS BSCOE.

In 2005, the ASMBS began to publish its own journal, Surgery for Obesity and Related Diseases (SOARD). We achieved citation status with Index Medicus within 2.5 years after the start publication and Current Contents this year. SOARD is published every other month and has had very intensive critical reviews with stringent criteria for publication of original research, case reports, and review studies.

A very important event in our history was adding the word metabolic to our name. It may only be one word, but that one word change is a reflection of the expanding role of the organization and emphasizes bariatric surgery’s effect on metabolic disease. Recently, CBS’s 60 Minutes did an entire segment on the beneficial effects of bariatric surgery on type 2 diabetes, featuring several ASMBS members and their patients. Just a few years ago, no one could have imagined such a story taking place. The ASMBS and bariatric and metabolic surgery have come a long way.

Serving as the first chair of the Allied Health Committee and being instrumental in formalizing this group within the society was very meaningful to me personally. Later, the Allied Health Committee further developed into a section of the ASMBS, became more formalized with elected officers, and continued to develop its programs. This year, the Allied Health Committee changed its name to the Integrated Health Section to better represent all of the disciplines involved and the importance of integration of care.

The ASMBS started out as a small group of professionals who represented a field most of their medical community peers did not understand or respect and patients for whom most medical professionals harbored a horrible prejudice and cared little about. Despite this, we soldiered on with persistence, determination, and confidence that we were doing the right thing for the patients we cared about. That we are still going strong 25 years later is a meaningful event and cornerstone in and of itself. We still have a lot of work to do and will continue to face our challenges and move forward.

Do you think that the ACS and ASMBS will one day join to have one single center of excellence accreditation society/system?
The ASMBS has always valued its relationship with the ACS and was very disappointed that, despite our best efforts, we were not able to find a workable solution to have a joint center of excellence designation. Things always change, so the possibility of working together on this important endeavor remains open, but I do not see any changes in the immediate future. In the meantime, we will work together on goals where we have more common ground and continue our efforts to collaborate with the ACS and other organizations to advance the quality of care and access for those suffering with the disease of obesity.

How is the collaboration between ASMBS and IFSO, historically and now?
The ASMBS is a charter member of International Federation for the Surgery of Obesity (IFSO) and remains actively involved in the organization. We have representation on IFSO’s council and likewise IFSO has representation on our council. The current IFSO president, Dr. MAL Fobi, is a founding member of the ASMBS and past president of the ASMBS Foundation. Membership in the ASMBS includes membership in IFSO and members are entitled to membership privileges such as reduced meeting fees.

Two years ago, the ASMBS held its first international meeting in conjunction with the IFSO meeting in Porto. This was well received by IFSO and ASMBS members and is an endeavor we plan to continue. The ASMBS and IFSO currently have separate journals. For the first time, IFSO will offer the ASMBS journal to all IFSO members at member rates and the ASMBS will offer the IFSO journal, Obesity Surgery, to its members at IFSO rates. The door is open for further collaborations in the future.

Where do you see ASMBS in the next 10 years?
I would love to say “out of business” because we found a cure! However, that doesn’t seem to be on the foreseeable horizon, although one never knows. The changes in the world over the past 25 years, especially in technology, are mind boggling. There are some exciting and promising new bariatric surgery technologies in the works, many of which are less invasive than what is commonly practiced today. This will most likely bring new partners to our field. As the field grows and the disease spreads and more and more of our young people suffer from obesity and other related diseases, we cannot let the enormity of the problem nor the diversity of caretakers divert us from our core values.

It is important for the ASMBS to remain at the forefront of education, research, technology, and promoting optimal patient care to fulfill our mission: to improve public health and wellbeing by lessening the burden of the disease of obesity and related diseases throughout the world.

How would you characterize the development of the Integrated Health component of ASMBS?
Tremendous! Integrated Health members have always been recognized as an important component of the ASMBS. The patient is at the core of everything we do; therefore, the interdisciplinary team is a key element. The Integrated Health members, although always represented, had a small voice in the organization 20 years ago compared to today. They have gone from a committee providing a half day of educational programming at the annual conference with no ancillary courses to a section providing three full days of education, in addition to directing several courses throughout the year. In addition, they have progressed from having one non-voting member on the Executive Council to two voting members, providing a nurse certification program, and continuing with many other accomplishments. The Integrated Health section is now a vital, sophisticated, professional section in its own right.

Where does ASMBS stand now with regard to accreditation/guidelines for the different disciplines involved in bariatric care?
Bill Gourash, Chair of the Integrated Health Section, and the credentialing team have done an outstanding job creating the respected and important Certified Bariatric Nurse designation. Other disciplines within the Integrated Health section are considering similar certification, but none have progressed beyond a feasibility study at this point. We are also working with The Obesity Society to establish a certification for bariatric primary care physicians.

In regard to our guidelines, the list of projects is a quite long and getting longer. Writing ASMBS guidelines requires a great amount of consideration and research, which means time. The Clinical Issues committee is working diligently on these. All members are given an opportunity to comment on the guidelines, so watch your e-mail and the website (www.asmbs.org) for upcoming documents.

Who would you identify as the most influential surgeons who have helped steer the direction of the society and the field in general?
Our founder, Dr. Edward Mason, and all our presidents who have given far more time, effort, leadership, and dedication than most will ever realize are those who automatically come to mind. In truth, it is impossible to name everyone who has contributed and made a difference for our patients and our field. Every member of the ASMBS can take pride in our many achievements over the years. For me, the opportunity to work with all of them has been the absolute highlight of my job.

Category: Interviews, Past Articles