A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/704136
4 Bariatric Times • July 2016 results are often suboptimal. Treatment failures are blamed on the d isease, not the oncologist or intervention. We still have a PR problem. C hanging perceptions. For the past several years, my group and hospital have a "no-refusal policy" In other words, no transfer f rom another hospital or ER would be refused on any bariatric surgery patient for emergency or tertiary care for any reason, be it f inancial or complexity, regardless of the primary surgeon. This year I made it a point to visit every ER in my geographic area with one message: "We will take any bariatric surgical patient—period." I was surprised by their reaction. They thought I was there to garnish more referrals. Instead, they were relieved because I could solve one of their problems: the unassigned bariatric patients that the general surgeon on call did not have the training or knowledge t o care for. This was a step forward. For years, most of us were trying to educate the world as to what we were doing. Our PR p roblem isn't the "what"—it's the "WHY." WWOD. Revisional bariatric/metabolic surgery. Although my interest i n revisional bariatric surgery began around the same time my as interest in bariatric surgery (20 years ago), it wasn't until recently that I had institutional support to host an international consensus conference on revisional bariatric/metabolic interventions (RBMI). Through the generosity of the Fresno Heart and Surgical Hospital and Community Medical Centers, Dr. Eric DeMaria and I directed the The First International Consensus Meeting on Revisional Bariatric/Metabolic Interventions (ICC-RBMI). The objective of the ICC-RBMI was to study, interpret, and discuss available evidence in order to develop and publish expert consensus on the following topics: • Identifying appropriate candidates for RBMI • Identifying interventions that provide benefit for patients and under what circumstances • Define next steps in order to obtain and evaluate collective data regarding RBMI • Explain what evidence is lacking in the scientific literature and what work needs to be done in order to address these deficiencies • Discuss nomenclature for various procedures/interventions in RBMI Over 30 international experts participated in the presentations and discussions. Based on the paucity of available data, little consensus was obtained on most topics. The heterogeneity and complexity of the problem makes it virtually impossible to design or fund randomized trials, so it was unanimously agreed that we should establish standards for each procedure and outcomes from RBMI should be mandatorily submitted to a registry. All agreed to participate in the second meeting early next year. Collaboaration for long-term disease management. Our specialty has come a long way, yet we have a long way to go. My generation of general surgeons looked at each patient as an operation. What bariatric/metabolic surgery has taught us is that we need to go beyond our individual silos of episodic interventions, to collaborate in multidisciplinary team models and to look at long- term disease management as the only viable solution to the health care issues we face today. Someday everyone will be asking: WWBSD—what would the bariatric surgeon do? Sincerely, Kelvin Higa, MD, FACS A Message from Dr. Kelvin Higa continued... A Message from Dr. Christopher Still continued... a chieving this, as all providers are under one roof, communicating frequently. At Geisinger, we spend a lot of time and effort to get all p roviders on the same page. We have regular multidisciplinary meetings to ensure that everyone is educated and up to date on the n ewest guidelines and recommendations. The same lesson can be applied to other disciplines. Just as I hope that providers are relaying a unified message in terms of weight loss expectations, I want to make sure that I'm educated and can reiterate treatment messages that are coming from the nutritionists, exercise physiologist, and other team members. Communication is essential not only in managing patient expectations, but across all aspects of c are. S incerely, Christopher Still, DO, FACN, FACP REFERENCES 1. Wee CC, Hamel MB, Apovian CM, et al. Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA Surg. 2013;148(3):264–271. 2. Heinberg LJ, Keating K, Simonelli L. Discrepancy between ideal and realistic goal weights in three bariatric procedures: who is likely to be unrealistic? Obes Surg. 2010;20(2):148–153. 3. White MA, Masheb RM, Rothschild BS, Burke-Martindale CH, Grilo CM. Do patients' unrealistic weight goals have prognostic significance for bariatric surgery? Obes Surg. 2007;17(1):74–81. 4. Karmali S, Kadikoy H, Brandt ML, Sherman V. What is my goal? Expected weight loss and comorbidity outcomes among bariatric surgery patients. Obes Surg. 2011;21(5):595–603. 5. Price HI, Gregory DM, Twells LK. Weight loss expectations of laparoscopic sleeve gastrectomy candidates compared to clinically expected weight loss outcomes 1-year post-surgery. Obes Surg. 2013;23(12):1987–1993. 6. Foster GD, Wadden TA, Vogt RA, Brewer G. What is a reasonable weight loss? Patients' expectations and evaluations of obesity treatment outcomes. J Consult Clin Psychol. 1997;65(1):79–85. 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