Defining Success and Failure after Bariatric Surgery and Exploring Patterns that Predispose Patients to Obesity

| October 16, 2012

Dear Friends and Colleagues,

I just returned from Chicago, Illinois, where I attended the 100th Annual Clinical Congress of the American College of Surgeons. This gathering was a milestone for the ACS and I feel privileged to have been a part of it. The highlight of the meeting was the announcement of Dr. Carlos Pellegrini as the new president of the ACS. Coming from the same small town and school of medicine in Rosario, Argentina, as Dr. Pellegrini, I have a unique perspective and understanding of the dimension of his achievement. Dr. Pellegrini is one of Argentina’s greatest surgeons and ambassadors and we are all proud that he will be leading American surgery in 2013. For those of you who are not current with surgical history, Dr. Pellegrini, together with the legendary Dr. Juan Acosta, described the physiopathology of biliary pancreatitis. This nomination is a well-deserved award for a master scientist and human being who has devoted his life to medicine and human kind. Congratulations, Carlos!

This issue of Bariatric Times contains several important articles beginning with the one written by Drs. Peter Bertin and Marc Costa on per-oral endoscopic removal of eroded gastric bands. This technique was standardized and developed by Galvao and Ramos in Brazil, (published in our magazine and in SOARD) and it allows surgeons to safely remove this band provided that the buckle and 80 percent of the band has eroded into the gastric lumen. Unfortunately, due to the excessive use of banding in the last 10 years, we will need to use this endoscopic procedure more often in the future.

In this month’s installment of “Medical Methods in Obesity Treatment,” Dr. David Bryman presents a nice review of the growth and change of the American Society of Bariatric Physicians (ASBP). I believe that bariatric physicians will become a “must have” in accredited bariatric centers.

Dr. Terrence Fullum addresses the topic of he at-risk gastric remnant, which used to be a serious problem until recently when double-balloon endoscopy was developed. Nevertheless, with the great majority of our post-bariatric surgery patients having had a Roux-en-Y gastric bypass (RYGB), it is important for us to keep in mind all the potential problems that might develop in the gastric remnant.

Dr. David Provost, current president of American Society for Metabolic and Bariatric Surgery (ASMBS) Foundation) describes in detail how and why we should all host a “Walk from Obesity” event. I am privileged to be part of the ASMBS Foundation where I have witnessed its members spend a considerable amount of their time trying to develop new programs aimed to help support our annual meeting, recognize outstanding physicians, and, more importantly, support research and education. The Foundation is a mirror of our society and as such we should always want to look good. I urge all BT readers and ASMBS members to contribute to the ASMBS Foundation so that we can continue to help grow our society and make “your” dreams come true.
In my favorite column, “Ed Mason at Large,” edited by Ms. Tracy Martinez, Dr. Mason answers several important questions on the following topics: indications for surgery in patients with body mass indices (BMIs) 30 to 35kg/m2, the use of Qsymia as an anorexigenic drug, reasons for the obesity epidemic, and most importantly, the future of bariatric surgery. As always, it is a must read.

In this month’s Symposium Synopsis, we spotlight the 17th World Congress of The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), that occurred September 11 to 15, 2012, in New Delhi, India. Unfortunately, I was not able to attend, but I heard great comments about the meeting, including the presence of His Holiness the Dalai Lama during the opening ceremony. I congratulate Dr. Luigi Angrisani, the new president of IFSO and I wish him the best of luck in his coming year as the federation’s leader.
I urge you to check out the second installment of “Checklists in Bariatric Surgery.” This month’s topic is failure of weight loss or weight regain after bariatric surgery. How can we define failure and success after bariatric surgery? What are the patterns that predict the one or the other? Is it gender, BMI, procedure type, age, errors in technique, or is our genome and metabolism what predisposes patients to be overweight? I recommend an article recently published on nonexercise activity thermo genesis or NEAT that presents an interesting theory why humans with similar characteristics might end up either being slim or obese.[1] The authors conclude that it is our lifestyle and specifically technological progress that might result in the obesity pandemic. Without previously knowing this term (NEAT) and research done in this field, I always advocated to use stairs and not elevators, to exercise on a daily basis, and to avoid sedentary behaviors. It will probably take several hundred years for society to change their habits. In the meantime, I hope that this checklist might help us to better select and prepare our patients for reoperative surgery. Please send comments and or recommendations to Bariatric Times if you have criticisms or additions to our checklists.

As 2012 is coming to an end, we begin the countdown to the next ASMBS Annual Clinical Congress in Atlanta, Georgia, November 11 to 15, 2013. Make sure to mark your calendars and together we will celebrate what will be the most complete and sophisticated gathering of obesity experts.

For those who will be in attendance at the ASMBS annual Fall Meeting, I will see you there!

Sincerely,

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

References
1.    McCrady-Spitzer SK, Levine JA. Nonexercise activity thermogenesis: a way forward to treat the worldwide obesity epidemic. Surg Obes Relat Dis. 2012;8(5):501–506.

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