Surgeons often become frustrated with the fact that, for various reasons, it can take a long time for research to translate into practice. Consequently, we rarely celebrate our accomplishments and often forget the tremendous progress we have made in our understanding of surgical diseases and how they are best treated. Our heightened awareness of the causes and effects of morbid obesity is an example of an area that has experienced significant improvements in recent decades.
A learning experience
Two pioneers in metabolic and bariatric surgery—Henry Buchwald, MD, PhD, FACS, FRCS(Hon), and Walter J. Pories, MD, FACS—convened a Metabolic Surgery Symposium, August 9−10 in Chicago, IL. The American College of Surgeons (ACS) sponsored the conference, and I participated in both days of the program. The experience was eye-opening and invigorating.
Dr. Buchwald, professor of surgery and biomedical engineering, University of Minnesota, Minneapolis, is renowned for his research into type 2 diabetes and its reduction through bariatric surgery, as well as for the introduction of new approaches to bariatric surgery. Dr. Pories is professor of surgery, biochemistry, and kinesiology at East Carolina University, Greenville, NC. In addition to his seminal work in wound healing, Dr. Pories was the first to describe the full and durable remission of type 2 diabetes following gastric bypass surgery. He is a principal investigator for the National Institutes of Health (NIH) study Longitudinal Assessment of Bariatric Surgery and other research into the mechanisms of diabetes remission supported by the NIH and industry.
The symposium comprised a group of other outstanding leaders in the field of metabolic and bariatric care (see sidebar for list of speakers). They addressed a range of issues, including mechanisms of metabolic bariatric surgery, metabolic surgery to control diabetes, psychiatric treatment for eating disorders, neurologic conditions and metabolic surgery, international metabolic surgery, ACS quality and safety programs in metabolic surgery, and the effects of politics on metabolic surgery.
These speakers showed how our understanding of morbid obesity and its treatment have evolved. Initially, we thought morbidly obese patients could be treated through weight-loss procedures, followed by diet, exercise, and the adoption of healthy lifestyles. But diet and exercise have only a temporary effect. A study of winners of the weight-loss competition television show The Biggest Loser indicated that the contestants usually regain the weight they lost within six years. This return to their previous weight is attributed to two factors. First, their resting metabolisms continued to slow even after they lost the weight and assumed healthy eating habits. Second, their bodies produced lower levels of leptin, which led to increased hunger, cravings, and eating binges. In other words, their bodies actually resisted the change.
Furthermore, many morbidly obese people who have tried to lose weight through diet and exercise often cannot afford or otherwise don’t have access to the full range of caregivers who can help them maintain a stable weight, including psychologists, sleep specialists, trainers, and so on.
Bariatric surgery has proven to be the most effective means of addressing morbid obesity and its comorbidities, including type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular disease, stroke, sleep apnea, gallbladder disease, hyperuricemia and gout, and osteoarthritis. Although many drugs are in development to regulate metabolism, their long-term effect is minimal in comparison with the long-lasting impact of metabolic surgery. These procedures also help people improve their self-image and self-confidence, thereby reducing the risk of depression and anxiety.
Perhaps most importantly, bariatric surgery is safe, has durable outcomes, and is acceptable to patients who are presented with the option. Numerous studies have shown that bariatric operations can be performed as safely and with outcomes that are equal to operations performed to treat gastroesophageal reflux disease.
There was palpable excitement as the speakers at the Metabolic Surgery Symposium shared this information, and on the second day of the meeting, we broke into writing groups to put together a set of articles for future publication.
Training and accreditation
Of course, it is imperative that the surgeons who perform these procedures be appropriately trained to use the new technology that continues to proliferate in this discipline. The ACS Clinical Congress this month will feature several sessions on bariatric and metabolic surgery, including three Scientific Forum Sessions, a Meet-the-Expert Session, and a number of Panel Sessions.
Furthermore, the procedures must be performed in facilities that have been accredited as having the right resources. As many of you know, the ACS and the American Society for Metabolic and Bariatric Surgery (ASMBS) combined their respective national bariatric surgery accreditation programs into a unified program several years ago to achieve one national accreditation standard for bariatric surgery centers, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®). A bariatric surgical center achieves MBSAQIP accreditation following a rigorous review process, during which it must prove that it can maintain certain physical resources, human resources, and standards of practice.
The Metabolic Surgery Symposium reinforced my belief that the College is doing the right thing in helping metabolic and bariatric surgeons to mobilize and provide quality surgical services to Americans in need of care for morbid obesity. It’s the right thing for the profession, and it’s the right thing for patients.