Bariatric Times

MAY 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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Editorial Message 3 Bariatric Times • May 2017 Dear Friends and Readers, Welcome to this new and special edition of BT. This month, we feature my American Society for Metabolic and Bariatric Surgery (ASMBS) exit interview. I am grateful to BT for allowing me to express my appreciation to the ASMBS membership and highlight achievements during my term as President of the society. I am also appreciative to Bob Dougherty, President of Matrix Medical Communications, who invited me to help develop Bariatric Times, 14 years ago. I love being a part of this journal that I believe we all cherish so much. In this issue of BT we provide an update from ASMBS Integrated Health President Karen Flanders, MSN, CNP, CBN. She highlights the latest happening within ASMBS IH, including an increased social media prescence via the Twitter account @ASMBSIH and two webinars, and provides a comprehensive update on past and upcoming initiatives. John D. Scott, MD, who serves as chair of the ASMBS Access Committee, and Natalie Heidrich explain the process and phenomenal work in South Carolina by a collaborative that included physicians, industry consultants, medical devices stakeholders, societies, and patients to improve access and get the South Carolina Department of Health and Human Services to expand program coverage for bariatric surgery to include sleeve gastrectomy for South Carolinians with fee-for-service Medicaid benefits. The ASMBS has been working on an important initiative— increasing communication with membership and creating awareness. Haris A. Khwaja, MD, DPhil., FRCS, and Richard M. Peterson, MD, MPH, FACS, FASMBS, have done a monumental job leading the social media campaign for Surgery for Obesity and Related Diseases (SOARD) and help develop what has become an extremely successful SOARD Journal Club. This month, we highlight this online forum, which is broadcast through the social media platform Facebook, its 2016 discussions, and future directions. Congratulations to Harris and Rich on the success of the club. Also in this issue, Wayne J. English, MD, FACS et al commemorate the loss of our colleague and dear friend, Ronald "Ronnie" H. Clements, MD, who passed on January 19, 2017. I followed Ronnie's fight for survival very closely and talked to him on the phone frequently. I was always impressed with Ronnie's courage and attitude toward life and death and his endless love for his family and God. It was because of his family and faith that Ronnie was prepared to face loss. In his book titled, Man's Search for Meaning, author Viktor Frankl talks about what is important in life for us humans. He explains that life is not primarily a quest for pleasure (Freud's school of thought) nor is it a quest for power (Adler's school of thought), but it is rather a quest for meaning. The greatest task for a person is to find meaning in his/her life. Frankl states that there Dear Readers, We now have another alarming fact about the disease of obesity—according to recent research; it is the top cause of preventable life-years lost among the United States adult population. Data presented by a team of researchers from Cleveland Clinic and New York University School of Medicine ranks obesity number one among causes of greatest number of preventable life-years lost. Diabetes came in second with tobacco use, high blood pressure, and high cholesterol following in order from greatest to least. 1 This finding may not be surprising, as we know having obesity is associated with numerous health consequences, including type 2 diabetes mellitus, hypertension, and obstructive sleep apnea. What is worth addressing is the terminology used in news coverage of this research, which refers to these causes as "modifiable behavioral risk factors." While I agree that obesity is "modifiable," I question the inclusion of the word "behavioral" because we know obesity is a complex disease with many factors involved in its causation. We now have evidence of genetic, physiologic, and environmental influences on obesity, and, as I discussed in a previous editorial message, evidence of drug-induced weight gain/weight loss hindrance. The message that obesity is a complex disease that is caused by more than individual behavior is spreading. For instance, a quick internet search on "causes of obesity," returns a result from the National Institutes of Health National Heart, Lung, and Blood Institute stating: energy imbalances, some genetic or endocrine medical conditions, and certain medicines are known to cause overweight or obesity. 2 The Centers for Disease Control and Prevention website on overweight and obesity also includes a section addressing adult obesity causes and consequences. It states that obesity is a complex health issue to address, resulting from a combination of causes and contributing factors, including individual factors such as behavior and genetics, and contributing factors in our society, including the food and physical activity environment, education and skills, and food marketing and promotion." 3 I would add to this discussion the set-point theory, which suggests that body weight is maintained at a stable range (i.e., set- point) despite the variability in energy intake and expenditure. Evidence on set-point shows that the body works to protect against weight loss during caloric deprivation compared to conditions of weight gain with overfeeding. 4 This knowledge that our bodies try to defend adiposity and fight against weight loss despite behavioral modifications, such as diet and exercise, makes it even clearer to us that adjunctive therapy is often needed. Life-years lost in any patient population is difficult to measure as a number of outside influences may impact conclusions, such as whether the patient smokes, where he or she lives, and again, genetics. Research on life expectancy after surgical and non- surgical weight loss is mounting, however, and the results are Reflecting on My Term as ASMBS President, Updates from the Society, and Remembering Ronald "Ronnie" H. Clements, MD Obesity and Diabetes Take Top Spots in Study on Preventable Life-years Lost in the United States Population 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; Professor of Surgery and Chairman, Department o f 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

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