ASMBS News and Update—May 2011

by Robin L. Blackstone, MD, FACS, FASMBS

Dr. Blackstone is President-Elect of the American Society for Metabolic and Bariatric Surgery and Medical Director, Scottsdale Healthcare Bariatric Center, Scottsdale, Arizona.

The ASMBS Nomination Process
The nomination committee, led by Scott Shikora, Senior Past President of The American Society for Metabolic and Bariatric Surgery (ASMBS), and John Baker, Past President of ASMBS, along with four representatives from the membership representing the key areas of the country. ASMBS representatives Wayne English, MD (Michigan), Lloyd Stegeman, MD (Texas), Alfons Pomp, MD (Boston), and Kevin Reavis, MD (California), have been working hard to provide the membership with a robust slate of candidates for open positions on the Executive Council by developing a policy for implementation of the bylaws in the 2011–2012 election. For more information on the policy used to select the slate from the field of nominated candidates, please visit http://www.asmbs.org/html/Private/documents/Election.

The call for nominations was met by the membership with an enthusiastic response and multiple nominations for leadership positions of the Executive Council—President Elect, Secretary-Treasurer, and Member-at-Large.

The initial slate will be finalized. Each person nominated will have an opportunity to submit a 250-word biography/vision statement that will go out on the ballot. The ballot will go out to the membership for a vote the week of May 9, 2011. Based on the enthusiasm of the members for the new process, we are expecting a robust vote. Please make sure your vote counts.

The results of the election will be announced at the business meeting on Wednesday, June 15, 2011 from 5 to 6:30pm, and will be published in the following installment of the ASMBS News and Update.

ASMBS Research Committee
The ASMBS and Surgical Review Corporation (SRC) have agreed to transfer the responsibility for development of the research agenda, data access, and data dissemination to the ASMBS. The decision to transfer the responsibility to ASMBS was a mutual decision made at a recent meeting of the ASMBS and SRC. The three committees of SRC, the Research Advisory Committee (RAC), led by Eric DeMaria, MD; the Data Access Committee (DAC), led by Peter Benotti, MD; and Data Dissemination Committee (DDC), led by William Inabnet, MD, will continue to lead their respective committees and perform their responsibilities under the direction of the ASMBS Research Committee and Chair Ranjan Sudan, MD, working closely with Debbie Winegar, PhD, and her team of analysts at SRC.

The goals of this change are to develop an increase in scientific articles that are based on Bariatric Outcomes Longitudinal Database (BOLD) data, widen the pool of authors using BOLD for publications among ASMBS members and other scientists, and to facilitate grant funding for key bariatric surgical issues like risk adjustment. The committees and their functions will remain intact this year, but will work through the ASMBS committee structure. This change will create an environment for open access to BOLD data by scientists to use the de-identified data for research. This step is a natural outgrowth of the contract between ASMBS and SRC, a process led by ASMBS Past President John Baker, MD, and signed in June 2010.

Keynote Lectures at the Annual ASMBS Meeting
Why Won’t My Patients Do What Is Good For Them? Motivational Interviewing and Treatment Adherence
Tuesday, June 14, 2011 11:45am–12:15pm
Integrated Health Invited Guest Speaker: Allan Zuckoff, PhD
Dr. Zuckoff has conducted research primarily focused on the development and testing of applications of motivational interviewing (MI) to improve treatment engagement and adherence. Dr. Zuckoff graduated from the State University of New York at Binghamton with a degree in philosophy, and received his doctorate in clinical psychology from Duquesne University. He is a dynamic speaker and currently lecturers in psychology and psychiatry at the University of Pittsburgh.

Basic Science/Clinical Research Thursday, June 16, 2011 10:00–10:45am
James Levine, MD, PhD
Dr. Levine is an expert in “inactivity” research. He has a unique lecture style that aims at demonstrating some of the key findings of his work. He was recently featured in the article, “What’s the Most Unhealthful Thing You Do Every Day?” published in New York Times Magazine Health and Wellness section, April 17, 2011. Dr. Levine will challenge your most closely held notions about exercise and its place in the treatment of obesity.

Edward E. Mason Founder’s Lecture: Legal and Policy Approaches to the Obesity Epidemic
Thursday June 16, 2011 10:45–11:30am
Michelle Mello, JD, PhD
The Mason lecture is dedicated to Edward Mason, MD, the surgeon and scientist that many in our specialty view as the “Father” of bariatric surgery. Traditionally chosen and introduced by the President of the ASMBS, this year’s speaker continues with the strong theme of Dr. Bruce Wolfe’s Presidency with an emphasis on access to care. Michelle Mello, JD, PhD, is Professor of Law and Public Health in the Department of Health Policy and Management at the Harvard School of Public Health where she conducts empirical research into issues at the intersection of law, ethics, and health policy. She is the author of more than 100 articles and book chapters on the medical malpractice system, medical errors and patient safety, research ethics, the obesity epidemic, pharmaceuticals, clinical ethics, and other topics.
ASMBS President’s Address    Thursday, June 16, 2011 11:30am–12:15pm
Bruce Wolfe, MD, PhD

Update on the ASMBS Annual Meeting—June 12–17, 2011, Orlando, Florida
The Great Debate in Bariatric Surgery
Tuesday, June 14, 2011 1:30–5:30pm
Course offerings: 3.5 CME
One of the most anticipated sessions at the annual ASMBS meeting will be the Great Debates. The goal is to provide data that challenge the conventional way we look at specific topics. Two experts present each topic with a moderator to referee what will likely be a lively debate. An audience response system will be used to judge the questions and the winners. The following is the schedule for the Great Debates.

Session I
1:30–2:15 pm
Topic #1: Which Approach is Best for Sleeve Gastrectomy? SILS vs. Laparoscopic vs. Robotic
Co-Moderators: Daniel Herron, MD, and Ninh Nguyen, MD, FASMBS
Debaters: Julio Teixiera, MD; Erik Wilson, MD; Raul Rosenthal, MD, FASMBS

2:15–3:00pm
Topic #2:  Chemoprophylaxis for Prevention of DVT: Pro vs. Con
Co-Moderators: Ronald Clements, MD and Marc Bessler, MD, FASMBS
Debaters: Michel Gagner, MD, FASMBS and Scott Shikora, MD, FASMBS

Refreshment Break in the Exhibit Hall
3:00pm

Session II
3:45–4:30pm
Topic #3: Gastric Bypass: Ambulatory Discharge vs. Selective
Co-Moderators: Bruce Wolfe, MD, FASMBS, and Robin Blackstone, MD, FASMBS
Debaters: Titus Duncan, MD, FASMBS, and John Morton, MD

4:30–5:30pm
Topic #4: Which Procedure is Best for Diabetes? Band vs. Bypass vs. Sleeve vs. Duodenal Switch
Co-Moderators: Bruce Schirmer, MD, and Ricardo Cohen, MD
Debaters: Jaime Ponce, MD, FASMBS; Sayeed Ikramuddin, MD; Mitchell Roslin, MD; and Jacques Himpens, MD

Rural Subcommittee Set Time and Agenda for Forum at the ASMBS Annual Meeting
The newly formed Rural Subcommittee of the new Quality/Standards Committee, led by Wayne English, MD, held its first teleconference on Monday, May 2, 2011. The committee worked on the definition of “rural” and decided to make the definition sufficiently broad to include the following:
•    Programs designated as “rural” by standard definitions or Centers for Medicare & Medicaid Services (CMS)
•    Larger cities that are isolated geographically
•    Low volume provisional centers
•    New centers seeking sufficient volume to qualify for Centers of Excellence (COE) status.

The committee discussed the issues of volume requirements for COE designation, additional requirements for personnel or protocols that are particularly difficult for rural programs to meet, and some questioned what the evidence was to support these additional requirements. There was robust discussion about the issues involved with collecting data and some discussion about forming a rural consortium for data collection. A discussion with Debbie Winegar from SRC about data collection issues will be forthcoming.

The group decided to hold a forum at the ASMBS Annual Meeting on Monday, June 13, 2011 from 10:15–11:45am (please check the final program for the final date and time) and invite all interested surgeons and program directors to discuss the issues that are perceived as barriers in bringing their programs to recognition as COEs. The forum will serve as an information-gathering session. The information garnered from the session will be used by the new Quality/Standards Committee as it begins to discuss the evolution of the ASMBS COE program.
Please contact Jennifer at [email protected] if you are interested in attending the forum.

Current Hot Clinical Topics:
A Better Measure for Obesity—  The Body Adiposity Index
Measuring a patient’s level of obesity is central to the bariatric practice. As we become more familiar with the mechanism of disease in the patient with obesity, we begin to understand that body fat is a key to the inflammation, mitochondrial dysfunction, and release of toxic adipokines and free fatty acids in liver, myocardium, and other tissues that may be the primary contributor to the state known as obesity and its related disorders. Our primary method of communicating levels of obesity has been to use the body mass index (BMI).

History of the BMI. The BMI was originally proposed and known as the Quetelet index, published in 1832 by Adolphe Quetelet, a Belgium mathematician, astronomer, and statistician, when he recognized a necessity in correcting for differences in body size when comparing levels of obesity in people.[1] Ancel Keys later renamed it the body mas index in 1972.[2]
Problems with the usage of BMI to measure obesity include the followng:
•    Cannot be measured in places without accurate scales
•    Inaccurate in children[3]
•    Fails to correlate with burden of disease in particular ethnic groups that carry weight in the intrabdominal cavity, like people of Asian descent[4]
•    Inaccurate in people with a higher proportion of lean tissue (e.g., athletes).[5]

Recently, Richard Bergman, PhD, suggested a new measure called the Body Adiposity Index (BAI). The BAI includes height and hip circumference but not weight to calculate the index.

From a practical clinical practice standpoint, measuring body fat percent can be difficult, the gold standard is  dual energy xray absortiometry (DXA) scanning for body fat percent a test that takes special software and is not routinely covered by insurance. Although many programs recommend it after bariatric procedures, there is often no baseline data.

Adopting a simple surrogate for the direct estimation of body fat by using the BAI may be a good addition to what surgeon or primary care practices routinely measure and tie in more closely with the mechanism of disease of obesity.

Formula for Calculating BMI and BAI

Recommended Reading
1.    Bergman RN, Stefanovski D, Buchanan TA, et al. A better index of body adiposity. Obesity (Silver Spring). 2011;19(5):1083–1089. Epub 2011 Mar 3.

References
1.    Eknoyan G. Adolphe Quetelet (1796-1874)—the average man and indices of obesity. Nephrol Dial Transplant. 2008;23:47–51.
2.    Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis. 1972;25:329–343.
3.    McCarthy HD. Body fat measurements in children as predictors for the metabolic syndrome: focus on waist circumference. Proc Nutr Soc. 2006;65:385–392.
4.    Rahman M, Berenson AB. Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women. Obstet Gynecol. 2010;115:982–988.
5.    Garrido-Chamorro RP, Sirvent-Belando JE, Gonzalez-Lorenzo M, et al. Correlation between body mass index and body composition in elite athletes. J Sports Med Phys Fitness. 2009;49:278–284.

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Category: ASMBS News and Update, Past Articles