Bariatric Times

MAR 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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24 News and Trends Bariatric Times • March 2017 AMERICAN GASTROENTEROLOGICAL ASSOCIATION RELEASES OBESITY PRACTICE GUIDE Gastroenterologists should address obesity with their patients and provide early therapy. Bethesda, Maryland—Patients with obesity need a multidisciplinary approach to achieve a healthy weight, and the american Gastroenterological association (aGa) believes that gastroenterologists are in a unique position to lead the care team. to provide gastroenterologists with a comprehensive, multi-disciplinary process to guide and personalize innovative obesity care for safe and effective weight management, including a model for how to operationalize business issues, aGa has created an Obesity Practice Guide. the program includes an obesity program to help gastroenterologists manage their patients with obesity, as well as a framework focused on the business operational issues related to the management of obese patients, which are published in Clinical Gastroenterology and Hepatology, the clinical practice journal of the american Gastroenterological association. "the epidemic of obesity continues at alarming rates with a high burden to our economy and society," said sarah streett, Md, an author of both papers, chair of the aGa Institute Practice Management and economics Committee, and clinical associate professor and director of IBd stanford University school of Medicine, Ca. "the american Gastroenterological association understands the importance of embracing obesity as a chronic, relapsing disease and supports a multidisciplinary approach to the management of obesity." Obesity is a major modifiable cause of diseases of the digestive tract that routinely goes unaddressed. Gastrointestinal disorders resulting from obesity are more frequent and often present sooner than type 2 diabetes mellitus and cardiovascular disease, which means gastroenterologists have an o pportunity to address obesity and provide effective therapy for their patients. Patients who are overweight or obese are often seen by gastroenterologists due to g astroesophageal reflux disease (GeRd) and its associated risks of Barrett's esophagus and esophageal cancer, gallstone disease, non- alcoholic fatty liver disease and non- alcoholic steatohepatitis, and colon cancer. as internists, specialists in digestive disorders and endoscopists, gastroenterologists are in a unique position to play an important role in the multidisciplinary treatment of obesity. the society of american Gastrointestinal and endoscopic surgeons (saGes), the Obesity society (tOs), and North american society for Pediatric Gastroenterology, hepatology and Nutrition (NasPGhaN) contributed content to the POWeR program, which was endorsed with input by the american society for Gastrointestinal endoscopy (asGe), american society for Metabolic and Bariatric surgery (asMBs), american association for the study of Liver diseases (aasLd), Obesity Medicine association (OMa) and academy of Nutrition and dietetics (aNd). the treatment of obesity needs a collaborative approach involving multiple stakeholders. aGa established an obesity episode of care model to develop a framework to support value-based management of patients with obesity, focusing on the provision of non-surgical and endoscopic services. the framework will help gastroenterology practices assess their ability to participate in and implement an episode of care for obesity, and understand the essentials of coding and billing for these services. the goal of episode framework is to provide gastroenterologists with strategies to obtain compensation for high value care, in a flexible format that can be adapted to the resources of both large and small practices. It is essential that data coordination take place between all members of the multi-disciplinary team who are providing therapeutic services to the p atient to ensure high value continuity of care. the american society for Metabolic and Bariatric surgery ( asMBs), american Psychological association (aPa), american Pharmacists association (aPha), and academy of Nutrition and dietetics (aNd) contributed to the obesity episode of care framework. to read the full press release, visit http://www.gastro.org/press_releases/ aga-releases-obesity-practice-guide NEW ENGLAND JOURNAL OF MEDICINE PUBLISHES FIVE-YEAR DATA FROM ETHICON-FUNDED STAMPEDE STUDY The STAMPEDE study builds on the mounting evidence that supports the long term benefits of bariatric surgery as treatment option for control of diabetes in obese patients. CINCINNatI, Ohio—ethicon* announced the New England Journal of Medicine (NEJM) publication of the final five-year data from the ethicon-funded staMPede (surgical treatment and Medications Potentially eradicate diabetes efficiently) study that demonstrates bariatric surgery with intensive medical therapy is a better long-term treatment option than intensive medical therapy alone for obese patients, BMI ≥ 27, with uncontrolled type 2 diabetes. Patients who underwent bariatric surgery experienced sustained improvement in glycemic control with less diabetes medications, the five- year follow-up, randomized data concluded. the staMPede trial, conducted by the Cleveland Clinic was led by Philip schauer, Md, director of the Bariatric and Metabolic Institute at the Cleveland Clinic and who is a paid consultant for ethicon. 1 "the landmark staMPede study along with other studies supported by ethicon provide the high level evidence that inform and influence treatment options," said elliott Fegelman, Md, therapeutic area Lead for Metabolics at Johnson & Johnson Innovation. "the american d iabetes association's (ada) newly updated standards of Care in diabetes is the most recent example of how research matters, and how studies like staMPede are i mpacting the standard of care." the staMPede study is foundational to the mounting research and evidence that supports bariatric surgery as treatment for those suffering with severe obesity and related diseases. "staMPede was recently recognized by the american College of Cardiology as one of the top 10 cardiovascular studies of 2016. In addition to staMPede, ethicon recently supported the diabetes surgery summit (dss), a consensus conference that involved representatives of diabetes, obesity and surgery societies from around the world. On the back of available evidence including staMPede, the dss global clinical guidelines for surgical treatment of diabetes promoted the new ada guidelines. "With the new guidelines from ada and other major diabetes organizations type 2 diabetes becomes, officially, an operable disease and bariatric/metabolic surgery a standard-of-care treatment. this is truly a historic development," said Francesco Rubino, Md, Chair Metabolic and Bariatric surgery, King's College London and one of the organizers of the dss. "It is crucial that primary care physicians, policy makers and the public at large be made aware of the new guidelines so that appropriate surgical candidates can have access to a clinically proven and cost-effective form of diabetes treatment." to read the article, visit http://www.nejm.org/doi/full/10.1056/ NeJMoa1600869#t=article News and Trends MARCH 2017

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