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/788604
Editorial Message 3 Bariatric Times • February 2017 Dear Readers, Friends, and Colleagues, This month we have some wonderful contributions that I would like to highlight. First and foremost, we need to acknowledge the outstanding contribution of Drs. Stephanie and Daniel Jones through the development of the Essentials in Bariatric and Metabolic Surgery application. This educational tool is of great value to all caregivers that participate in the treatment of our patients that are suffering from the disease of obesity. A subsection of the Essentials app is dedicated to anesthesiologists. This month we present an interview with Dr. Stephanie Jones in which she highlights the features and takeaways from this section. In "The Medical Student Notebook," Brian Yang presents an outstanding literature review on the impact of obesity and weight loss surgery on joint disease. More importantly, Mr. Yang presents a clear analysis of the benefits of surgically induced weight loss. Overall, patients experience significant less pain, increased range of motion, and physical function. 1–3 I have always been impressed with the quality of articles written by Dr. Jones's students. Needless to say, Dan has developed a great tool to educate future generations of physicians that will care for patients with obesity. We are proud to present another continuing education article/activity this month under the direction of Tracy Martinez, RN, BSN, CBN, Department Editor of Integrated Health Continuing Education. In this article, Cassie I. Story, RDN, reviews the important subject of micronutrient supplementation following metaboic and bariatric surgery. I recollect writing a book chapter titled "The obesity disease: a type of malnutrition." Although the title might be confusing, I have observed for the last 20 years in practice as a bariatric surgeon that patients with severe obesity are deficient in micronutrients. Such deficiencies can create serious clinical derangements postoperatively and long-term irreversible complications, such as polyneuropathy or Wernicke's encephalopathy. Vitamin D is a common micronutrient in which patients seem to be deficient, specifically postmenopausal women. Everyone on the multidisciplinary care team should be aware of nutrient deficiencies and their potential consequences so we can recognize and help to correct them. As I write this message, I'm preparing for the 16th Annual Surgery of the Foregut Meeting, the 4th International Congress on Fluorescent Image Guided Surgery, and the 2nd Consensus on Reoperative Bariatric and Metabolic Interventions (RBMI), all taking place during Cleveland Clinic Digestive Disease Institute Week 2017, February 14-19, 2017, at the Boca Resort Hotel in Boca Raton, Florida. I am excited that Dr. Higa and Dr. DeMaria have joined their RBMI conference with us, and I am looking forward to an outstanding meeting with two days filled with world experts that will debate re-operative bariatric interventions. Given the state of the United States at the present time, I feel compelled to openly express my pain and anger following the executive orders by the new White House administration that include the building of a border wall with Mexico and a travel ban for certain countries. Dear Readers, In past editorials I have talked about the importance of educating and engaging our referring physician colleagues on the disease of obesity and its available treatments. Recent discussions and findings indicate the need and opportunity for us to reach out to another community—our future physicians. The research. National surveys have been conducted to quantify the number of required hours of nutrition education at United States medical schools and the types of courses in which the instruction was offered. The National Academy of Sciences recommends a 25-hour minimum of required hours of nutrition education for medical school. One study 1 found that between 2008 and 2009, only 27 percent of 105 medical schools met the minimum required hours of nutrition education. What was startling is that this number was actually down from a previous study, 2 which reported that 38 percent (40 out of 104 schools) met the minimum requirements in 2004. As Forbes contributor Bruce Y. Lee points out in a recent article, 3 "Yes, this number actually went down while the obesity epidemic went up." In 2016, Castillo et al 4 published results from an 18-question survey given to medical and osteopathic school graduates entering a pediatric residency program during resident orientation in June of 2011 and 2012. Their findings were in line with the previous cited studies, with incoming interns answering an average of only 52 percent of the questions correctly. All studies arrived at the same conclusion—it is imperative that medical education focuses on preparing physicians to appropriately counsel all populations on proper nutrition. I can add a personal anecdote to this larger story. When I took my re-certification exam for internal medicine in 2015, I observed that there were almost no questions related to obesity. I can recall perhaps one question related to bariatric surgery and vitamin B12 deficiency. Barriers and opportunities for improvement. In his article, Lee pointed out some very important barriers or reasons as to why there is a lack of nutrition and obesity education in United States medical schools. One listed possible reason was the "already overcrowded medical school curricula." While this may be true, I believe we need to examine the fact that obesity is a disease that affects nearly every organ system in the human body. Another possible reason listed: "Doctors assume that nutritionists and dietitians will always be available to help." The multidisciplinary approach is crucial in caring for patients with obesity, and nutritionists and dietitians undoubtedly play an important role, but I think it is the responsibility of everyone caring for the patient to have background knowledge and comfort in addressing this disease. Clinicians can and should take the lead in starting the conversation with patients and guide their treatment. The younger generation does seem to be more aware and have a better understanding of obesity as a disease. While residents may Obesity and Malnutrition: An Important Area of Education for All Members of the Multidisciplinary Care Team Research Shows a Lack of Obesity and Nutrition Education in United States Medical Schools: Barriers and Opportunities to Further Engage the Next Generation of Caregivers A Message from Dr. Christopher Still Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity R esearch Institute, Geisinger Medical Center, Danville, Pennsylvania. Continued on following page... Continued on following page... A Message from Dr. Raul J. Rosenthal Raul J. Rosenthal, MD, FACS, FASMBS, Clinical Editor, Bariatric Times; Chief of Staff, Professor of Surgery and Chairman, Department of General Surgery; Director of Minimally Invasive Surgery and The Bariatric and Metabolic Institute; General Surgery Residency Program Director; and Director, Fellowship in MIS and Bariatric Surgery, Cleveland Clinic Florida, Weston, Florida