The 5th Annual Bariatric Summit…

Dear Bariatric Times Editor:
The Fifth Annual Bariatric Summit was held at Amelia Island Plantation in Florida from September 20 through 22, 2008. The summit, which is both informal and interactive, was developed to address the educational needs of the entire bariatric team.

The Bariatric Summit Course Directors are Scott A. Shikora, MD, FACS, Professor of Surgery, Tufts University School of Medicine, Chief, Bariatric Surgery, Director, Obesity Consult Center, Tufts Medical Center; Kenneth G. MacDonald, Jr., MD, FACS, Director, Southern Surgical Associates; and Michael Tarnoff, MD, FACS, Assistant Professor of Surgery, Tufts University School of Medicine, Tufts Medical Center.

For three days, the audience of 125, which comprised general surgeons, bariatric surgeons, primary care physicians (PCP), nurses, dietitians, managed care, and allied health professionals from all over the US, spent time listening to experts discussing the leading-edge clinical and technical innovations related to the advanced management and treatment of severe obesity. Individual talks from well-known leaders in bariatric surgery focused on the most relevant issues. These topics included decision-making, operative strategies, advanced technical details, controversies, management of complications, and the essentials of a successful bariatric program. The keynote address was presented by Lee Kaplan, MD, and focused on the physiology of the various surgeries.

Some discussions on new techniques included the following:

Sleeve gastrectomy. One of the newer procedures, but first described in 1988, the “sleeve” may be the first surgical step for the super morbidly obese followed by Roux-en-Y gastric bypass (RYGB) or biliopancreatic diversion (BPD). It is considered a valid surgical option for weight loss with excellent short-term outcomes.

Neuromodulation. This is a procedure (different from pacing) that is attractive to patients because there is no stapling, partitioning, banding, or anastomosing and it does not rely on restriction or malabsorption. It can stimulate or block normal physiologic activities by sending impulses to target tissues in the stomach, intestines, brain, nerves, or hormones.

Endoluminal duodenal bypass. Will this be the future surgery for non-obese type 2 diabetes patients? Current research continues.

Other summit discussions included the following:
Metabolic syndrome. In case you have not heard, the latest term used daily in the bariatric and PCP community is metabolic syndrome. What is the cost of this epidemic? Sixty to 70 percent of all PCP visits are a direct result of it, one quarter of 40-year-olds cannot work due to its disabling effects, and the 20- to 40-year-old generation will be the first to lead a shorter lifespan than their parents because of it. What tool can be used?

Bariatric surgery. “There is an unquestionable, direct, antidiabetic effect,” states Chris Sorli, MD, Director of Endocrine Services at Billings Clinic in Montana.

Transfer addiction. The true incidence of addiction transfer is unknown; however, preoperative binge eaters have the greatest rate of alcohol dependence post-RGBP. Although not all experts agree that food is a drug, there are less dopamine receptors in obese versus non-obese patients.

Screening. How can your program successfully identify patients with numerous psychological issues? Ask screening questions that identify past or present issues, provide a formal psychological assessment, and provide comprehensive preoperative training and postoperative support.

Patients need to move. Whether it is 10,000 steps a day or a more formal exercise plan 4 to 5 times a week, research indicates that exercise is the key to long-term postoperative success. We should find creative ways to get even the most non-motivated patient to move.

Nutrition/vitamins. The American Society for Metabolic and Bariatric Surgery (ASMBS) recently created integrated nutritional guidelines for the surgical weight loss patient. Visit their website, www.asmbs.org, for more details. Supplements…are they good, bad, or indifferent? Clinicians should be up-to-date on the latest supplements but must keep in mind that they are not government-regulated. Most important to note is that preoperative nutrition preparation reflects postoperative success; ask yourself—Am I doing enough for my patients before surgery?

Lost and found. We all have them in our practice—patients who come to all preoperative appointments, have surgery, show up a few times postoperatively, and then disappear. Some live a long distance and have their PCPs provide follow-up care, but others call five years later asking to have another procedure because they have gained much of their weight back. Building relationships and instilling the importance of postoperative care is what keeps patients coming back. If they do not see the value in continuing follow-up, they will not return. Educate them preoperatively to the essentials of postoperative follow-up and support and reiterate it during every interaction and group meeting. Outreach consistently to patients via cards or calls to keep them coming back.

The Bariatric Summit at Amelia Island is known for its laid-back atmosphere, beautiful weather, fantastic outdoor activities in down time, and—most importantly—its valuable course content.

Best regards,

Lindsay Dowd, RN
Operations Manager
Tufts Medical Center

For more information on this meeting, please visit www.bariatricsummit.com.

Category: Past Articles, Symposium Synopsis