IFSO: A Closer Look at a Global Network of Bariatric Surgeons, Part 2
Estuardo Behrens, MD, MACG, FACS, FICS, FASMBS
President IFSO Latin America Chapter; Advanced Laparoscopic Surgery, Bariatric and Metabolic Surgery, New Life Center, Guatemala, Guatemala.
M. Khalid Mirza, FRCS
Director of Bariatric Surgery Center, Dammam Medical Complex Hospital, Dammam, Saudi Arabia; President of IFSO Middle East and North Africa Chapter (MENAC)
Kazunori Kasama, MD, FACS
President of IFSO Asia Pacific Chapter (APC); Director, Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
Gerhard Prager, MD
Associate Professor of Surgery, Medical University of Vienna, Department of Surgery, Wien, Austria; President IFSO-European Chapter
Raul Rosenthal, MD, FACS, FASMBS
Professor of Surgery and Chairman, Department of General Surgery; Director of Minimally Invasive Surgery and The Bariatric and Metabolic Institute; General Surgery Residency Program Director; and Director, Fellowship in MIS and Bariatric Surgery, Cleveland Clinic Florida, Weston, Florida; President IFSO North America Chapter
Funding: No funding was provided.
Disclosures: Estuardo Behrens, MD, MACG, FACS, FICS, FASMBS, is the President of IFSO Latin America Chapter. M. Khalid Mirza, FRCS, is the President of IFSO MENA Chapter. Kazunori Kasama, MD, FACS, is the President of IFSO AP Chapter. Gerhard Prager, MD, is the President of IFSO European Chapter. Raul Rosenthal, MD, FACS, FASMBS, is the President of IFSO North America Chapter.
Bariatric Times. 2020;17(1):12–13
This is Part 2 of a multipart interview series featuring key members of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), including past presidents, current chapter presidents, and members of the integrated health team. In this edition of BT, we interview Estuardo Behrens, MD, MACG, FACS, FASMBS; M. Khalid Mirza, FRCS; Kazunori Kasama, MD, FACS; Gerhard Prager, MD; and Raul Rosenthal, MD, FACS, FASMBS.
What is unique about your chapter?
Dr. Behrens: The IFSO Latin America Chapter (LAC) is one of the biggest chapters of IFSO, with almost 3,500 active members. It includes 17 countries together that share the same passion—bariatric and metabolic surgery. We have an IFSO LAC WhatsApp chat that includes the present and past presidents of each society member. Thanks to the social media, we are close to each other. Our Facebook group has 603 members.
Dr. Mirza: The IFSO Middle East and North Africa (MENA) chapter is a large integrated community, unified language, closely related culture, and lifestyle, making it easy to move for work, marriage, building families, and medical tourism. All these factors create similar eating habits and behaviors, resulting in one unified obesity pathophysiology. Addressing these factors through education, prevention, and treatment of obesity are major missions of IFSO. It also makes it easy to create bariatric surgery training programs between these countries.
Dr. Kasama: The Asia Pacific Chapter (APC) consists of 11 countries now and will increase to 15 in the near future. The majority of APC countries are from Asia. The obesity ratio in Asia is not as high as other countries, but the continent has a large number of patients with diabetes. Approximately 60 percent of all patients with diabetes mellitus (DM) in the world are located in Asia, and most of them have a body mass index (BMI) less than 35kg/m2. So, we need to focus more on metabolic surgery rather than bariatric surgery.
Dr. Prager: The European Chapter was founded in 2004 and now consists of 29 national societies with more than 2,500 members. Within Europe, we have very different levels of development in bariatric/metabolic surgery, as well as a very strong public healthcare system in most countries, which covers bariatric/metabolic surgery. On the other hand, we also have countries that just started a few years ago and need support to establish a reimbursement system for this kind of treatment.
Dr. Rosenthal: It is the largest chapter in the world. We have also the largest number of attendees in the annual meeting.
What’s the best advice you received?
Dr. Behrens: Keep your love for your Latin roots. Never forget where you come from.
Dr. Mirza: One of the best pieces of advice I have received is to strive to unify the treatment program and educational training among countries, and create structured guidelines and rules and regulations to present a competent treatment plan and better patient safety.
Dr. Kasama: I have received three great pieces of advice that changed my life as a surgeon. One of the best pieces of advices I received was from my mentor in Japan during my fellowship. The medical center I worked for was located in a suburb in Japan; however, he advised me to aim to be international, not stay in a local practice. Following his advice, I am now a chairperson on the international affair committee of Japan Society of Endoscopic Surgery (JSES), which has more than 14,000 members. Another piece of advice I was given that influenced me was when I visited the United States and watched bariatric surgery cases of a famous bariatric surgeon in California. He was very skillful, and I was very impressed—moreover, shocked—by his skill. I whined that I was not a genius like him, and I did not think I could do surgery like him. But, he advised me, “It is not a matter of talent; it is just a matter of practice.” After coming back to Japan, I bought my own suturing training box and trained every day and night. I became more skillful and was put in charge of laparoscopic suturing training courses for JSES. And finally, the third best piece of advice I received was from a great bariatric surgeon in Taiwan. He is a pioneer of bariatric and metabolic surgery in Asia, and he has had more papers published in the field of bariatric/metabolic surgery than anyone in the world. I wondered why he was so scientific and able to publish so many papers. He advised me to research what I really wanted to know and love clinical research, then respect science. He made me notice that one piece of evidence can change the world. Following his advice, my colleague, Dr. Yosuke Seki, and I have published many papers from my center. From the experience I learned from them, I establish my theme as a president of IFSO APC to make “double E” important. “Double E” means “evidence and education in Asia” Asian metabolic surgery is a bit different from that of Western countries because of Asian ethnicity. We need to establish our own Asian evidence and international training system among APC countries.
Dr. Prager: In a multinational society, it is very important to listen to the voices of different nations and different stakeholders before making decisions.
Dr. Rosenthal: The best advice I received was to engage with other chapter leaders and lead by example. We need to make sure we are inclusive when accepting members regardless of where they are from.
What’s your best memory of IFSO?
Dr. Behrens: We in IFSO are like a huge family—no matter from where you come from, we will be treated as brothers and sisters. I love that.
Dr. Mirza: One of the happiest memories I have from IFSO World Congress that I will never forget is the day IFSO MENA was introduced, which was done with the great effort of board members and the help of the head people of IFSO.
Dr. Kasama: I have attended almost every IFSO World Congress since 2003. I have really enjoyed IFSO activities and have learned a lot, and I have so many great memories with my friends and mentors in IFSO. But, I must say the best memory I have was in 2004. Prof. Isao Kawamura, the pioneer of bariatric surgery in Japan, held the World Congress in Tokyo. At that time, bariatric surgery in Japan was still new, and only a few surgeons did bariatric surgery. Prof. Kawamura showed great leadership to make the congress successful, and I learned a lot from him. I was secretory general at the second IFSO APC Congress in Hokkaido, Japan, and managed the first IFSO APC consensus to establish Asian guidelines for bariatric/metabolic surgery with help from friends all over Asia Pacific regions in 2011. From the experience in IFSO, I have made many friends all over the world, and they are the best things I receive from IFSO.
Dr. Prager: Meeting the Dalai Lama in 2012 in New Delhi was a very impressive personal experience, but each World Congress and European Chapter Congress is a highlight on its own.
Dr. Rosenthal: Every IFSO conference is a special one and has unique memories.
How can we interact more internationally?
Dr. Behrens: In these precious days, everything has a cost; everything is money. IFSO has the power to make our meetings more accessable to its members, providing more affordable prices for the symposia and meetings. Traveling overseas is not cheap. If we can have more international interaction, if we achieve more audience.
Dr. Mirza: We at IFSO did many scientific activities—the first congress was held in Kuwait in 2018, and the second one was in 2019. We also have programs and scientific activities for researchers on an international basis to attend that allows them to communicate, compare results, and collaborate to create new guidelines that could positively impact obesity treatment based on race and eating habits.
Dr. Kasama: The most important thing is to attend international congresses as many times as possible and to try to make many friends. Do not hesitate to talk to someone near you and always aim to be international, then enjoy the relationship of IFSO members.
Dr. Prager: In the last year, IFSO’s social media channel was introduced. This offers a fantastic chance to share experiences and to exchange information. From a chapter’s point of view, we should look for an even closer collaboration with other organizations, such as the World Health Organization (WHO), International Diabetes Federation (IDF), and The Obesity Society (TOS). In Europe, we intensified our cooperation with the European Association for the Study of Obesity (EASO) and participated in informative meetings for representatives of the European Commission. Another thing we need to do is to make uniform guidelines for reimbursement, at least within the chapters or in countries with similar developed healthcare systems. We need to strengthen the integration and voice of patients—politicians tend to listen to patient groups more than to healthcare professionals. Additionally, we need to intensify the cooperation with other stakeholders (e.g., internists, diabetologists, hepatologists, dietitians, psychologists) and publish guidelines together. IFSO has achieved a lot over the years thanks to its dedicated members and representatives, but there are still patients living with obesity who need help getting access to the best available treatment.
Dr. Rosenthal: People should participate in conferences and webinars, sharing care paths and best practices. The world has become global and communications are today easier than ever before.
These interviews have been edited for length and clarity.
Category: Interviews, Past Articles
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