The Centers for Medicare and Medicaid Services Endorse Sleeve Gastrectomy as a Valid Treatment Modality for Patients with Morbid Obesity; United States FDA Approves Prescription Weight Loss Drug Lorcaserin

Dear Readers,

What a great start of July 2012—the Centers for Medicare and Medicaid Services (CMS) announced that they endorse sleeve gastrectomy (SG) as a valid treatment modality for patients with morbid obesity. Now, we can make decisions based on what surgeons consider to be the best treatment modality without limitations. I personally consider SG as “the platform” in bariatric surgery for patients with body mass indices (BMIs) less than 50kg/m2. If at three years, 30 percent of patients experience failure of weight loss, those are the ones we should offer a gastric bypass as a second step. It is, however, our responsibility to make sure this operation is delivered in a standard fashion so that we can maintain best outcomes.

More great news to share with you is that finally after 13 years of research, the United States Food and Drug Administration (FDA) has approved a weight loss drug. Lorcaserin was approved for individuals with a BMI of 30kg/m2 or more or 27kg/m2 or more with an overweight related comorbidity. It works by blocking the appetite signals in the brain creating early satiety. Treatment should be stopped if patients do not lose five percent excess body weight (%EBW) at 12 weeks of daily use. It will be commercialized by Arena Pharmaceuticals (San Diego, California) and Eisai Inc. (Woodcliff Lake, New Jersey) under the brand name Belviq. At least six FDA monitored long-term follow-up studies will determine if it will stay on the market.

In this issue of Bariatric Times, we present another installment of the column “Ed Mason at Large.” In this column, Dr. Mason discusses the metabolic syndrome, surgery for diabetes, and more importantly his personal opinion on the newly launched American College of Surgeons (ACS)/American Society for Metabolic and Bariatric Surgery (ASMBS) Metabolic and Bariatric Surgery Quality Improvement Program (MBSQIP). One key aspect mentioned by Ed is the hope to achieve better long-term follow up on our patients after surgery, and that I believe is the most important question when it comes to future developments.

Drs. Jain-Spangler and Portenier present an article on the role of bariatric surgery in pre- and post-transplant candidates. I was privileged to be published on both subjects, and our experience has been outstanding. Bypass after renal transplant has shown to have no impact on the dosage of immunosupression, and, as mentioned by Jain-Spangler and Portenier, weight loss and obesity remission does prolong graft survival.

In this month’s “Surgical Pearls: Techniques in Bariatric Surgery,” Dr. Gagner presents his technical pearls on how to fashion a duodeno-jejunostomy, which is probably the Achilles heel of a biliopancreatic diversion with duodenal switch (BPD-DS).
In this month’s “Medical Methods in Obesity Treatment,” Dr. Scinta gives us a wonderful and succinct overview on the different calculation methods used to report weight loss success, such as %EBW. I wish someone at the FDA would read this article so that we could stop using outdated methodology.

Also in this issue, Mr. Cavender reviews the important topic of website development and successful marketing of a bariatric center. I am a strong believer that best outcomes, good orientation, and support groups are the key to success.

There is a new FDA trial taking place on the intraabdominal balloon. This is an exciting one, and I look forward to seeing the results that will be obtained with totally new treatment modality. For more information, please visit www.vibrynt.com.

In closing this month’s editorial, I would like to highlight to all readers the great successes of the 29th annual meeting of the ASMBS in San Diego, California, which boasted the highest attendance in ASMBS meeting history. Kudos to Ms. Georgann Mallory and her team for managing this conference, and best of luck to Dr. Jaime Ponce in his term as ASMBS President.

Sincerely,

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

Tags: Dr. Raul Rosenthal

Category: Editorial Message, Past Articles