Bariatric Times

SEP 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 • September 2017 Dear Friends and Readers, I just returned from the United Kingdom after attending the 22nd World Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) in London. There were close to 3,200 attendees, and the weather was magnificent. The conference was terrific, with live surgeries from around the world, a sleeve consensus meeting orchestrated by Michel Gagner, MD, and many presentations on diabetes surgery and single anastomotic procedures. I would like to congratulate IFSO Congress President Richard Wellborn, MD, and Scientific Committee Co-Chair Cynthia Borg, MD (Malta), MD (London), FRCS Ed (GenSurg), on a job well done organizing the conference. I also congratulate Kelvin Higa, MD, on a great year serving as president of IFSO, and I wish incoming IFSO President Jacques Himpens, MD, luck and success during his tenure. In this issue of BT, Zorrilla et al present a case series describing the use of the Capella-Fobi interposition of jejunum as an option to treat chronic staple line disruptions after laparoscopic sleeve gastrectomy (LSG). 1–3 While I personally favor a proximal gastrectomy with a Roux-Y esophagojejunostomy to treat this serious complication, I believe that this technique can be used as an alternative option to another approach that anastomoses the area of the leak to a loop of jejunum. My long-term concern with both approaches is the potential for bile reflux into the esophagus if a fistula matures at the upper level of the gastric sleeve. Don't miss the accompanying video to this case series. I encourage you to send us your interesting case reports and videos. It is wonderful to see work from our colleagues from around the world and learn from each other. Also in this issue, we present a review and case study on the clinical and economic implications of "bariatric readiness" by Temple et al. Bariatric readiness refers to a facility's level of preparation in caring for with patients with obesity, from the proper equipment to knowledge of this unique patient population. Using their own facility—Waikato Hospital in Hamilton, New Zealand—as an example of success, the authors discuss how implementation of a bariatric care team helped to improve the care quality and outcome for one bariatric patient. They emphasize a criteria-based protocol that facilitates, in a timely manner, training and equipment in order to support the principles of early progressive mobility. The authors conclude that readiness and available equipment are paramount to improving outcomes and decreasing costs. They also highlight the importance of accreditation programs, such as the American Society for Metabolic and Bariatric Surgery (ASMBS)/American College of Surgeons (ACS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) program. While some might see accreditation programs as both a barrier to practice and an additional expense, I am convinced that implementing an accreditation system keeps our Dear Readers, September is National Childhood Awareness Obesity Month, and although many of us do not treat children and adolescents, awareness and prevention of obesity in early age is an important piece in solving the obesity epidemic as a whole. The most recent report puts the childhood obesity rate in the United States at 17 percent, which is alarmingly high considering the comorbid disease burden of obesity. 1 We are fortunate to have many available safe and effective options to treat obesity, but no one can argue that the ultimate solution is prevention. It is never too early to think about prevention as mounting research suggests that obesity risk begins even before conception. Recent studies suggest that maternal and paternal obesity are predictive of obesity risk in their offspring, and a direct relationship has also been established between infant birth weight and body mass index (BMI) in later life. Most studies have found that individuals who have obesity in childhood and adolescence, especially those in the higher range of BMI percentiles, are more likely to have obesity as adults. We can see through the ample research conducted, screening tools, and health/fitness initiatives, that the medical community as well as the general public recognize that childhood obesity is a top concern. The healthcare community takes great care in evaluating for obesity early. The American Academy of Pediatrics recommends screening BMI in children ages 6 to 18 years for obesity and referring them to programs to improve their weight status. Though controversial, many schools also send home BMI reporting to parents with information on obesity risk. I believe BMI reporting to parents/caregivers is important because you cannot fix a problem if you are not aware is exists. While the public is becoming more aware of the comorbid conditions associated with obesity in adults, we must also emphasize that these comorbidities do not elude children. Unfortunately, this patient population is not protected from the devastating effects of this chronic and relapsing disease. Known comorbidities of obesity that were previously only seen in adults, such as type 2 diabetes mellitus (T2DM), nonalcoholic fatty liver disease (NAFLD), and hypertension, are now growing among this younger generation. Obesity also has an effect on the time and tempo at which boys and girls go through puberty. 2 In terms of prevention, I am a believer in a modification of the "5-4- 3-2-1-0 Go! ® " counseling program developed by the Consortium to Lower Obesity in Chicago Children (CLOCC). 3 This program advocates the following steps for a healthy lifestyle: • 5 servings of fruits and vegetables per day • 4 servings of 8oz of water • 3 servings of low-fat dairy. • 2 hours or less of screen time a day • 1 or more hours of physical activity per day Preparing to Care for the Bariatric Patient, Especially through an Accreditation Program, Keeps Our Patients at the Top of Our Agenda and Improves Their Outcomes Addressing Childhood Obesity through Prevention and Treatment Strategies Remains an Important Piece in Improving the Current Obesity Epidemic 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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