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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4 Bariatric Times • September 2017 p atients at the top of our agenda and improves their outcomes. As a former die-hard rugby player, I must acknowledge that, until today, I was familiar with Waikato, New Zealand, mainly because of their g reat tradition of outstanding rugby teams and all black players (Sivivatu, Allina, Barlow, Mc Kenzie, Brown), and not because of their outstanding bariatric center. I am glad to hear they are excelling in both areas. D id you know that 60 percent of the ASMBS membership is comprised of integrated health professionals? This month, Nevins and Davidson provide an update from the ASMBS Integrated Health S upport Group Committee. I thank the authors and column editor Karen Flanders, MSN, CNP, CBN, current IH president for keeping us abreast of the happenings within ASMBS Integrated Health. As we prepare for another ObesityWeek, I am looking forward to t he upcoming Surgery for Obesity and Related Diseases (SOARD) publication on the findings of the recent ASMBS/NORC survey, which was aimed to gauge public perception of obesity, its risks, and available treatment methods. 4 ,5 It will be a real eye-opener. I also l ook forward to two events occurring this month: the 14th Annual Bariatric Summit for the Comprehensive Management of Severe Obesity, in Savannah, Georgia, and the Fourth Annual National Obesity Collaborative Care Summit in Chicago, Illinois. Sincerely, Raul J. Rosenthal, MD, FACS, FASMBS REFERENCES 1. Capella JF, Capella RF. Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction. Obes Surg. 1999;9:22–27 2. Capella JF, Capella RF. An assessment of vertical banded gastroplasty- Roux- en-Y gastric bypass for the treatment of morbid obesity. Am J Surg. 2002;183(2):117–123. 3. Fobi MAL, Lee H. The surgical technique of the Fobi-Pouch operation for obesity (the transected silastic vertical gastric bypass). Obes Surg. 1998;8(3):283–288. 4. American Society for Metabolic and Bariatric Surgery (ASMBS), NORC at the University of Chicago. Obesity Rises to Top Health Concern for Americans, but Misperceptions Persist. October 2016. MBS%20NORC%20Obesity%20Poll.pdf. Accessed August 21, 2017. 5. American Society for Metabolic and Bariatric Surgery (ASMBS), NORC at the University of Chicago. New Insights into Americans' Perceptions and Misperceptions of Obesity Treatments, and the Struggles Many Face. MBS%20NORC%20Obesity%20Poll.pdf. Accessed August 21, 2017. A Message from Dr. Raul Rosenthal continued... A Message from Dr. Christopher Still continued... M easured outcomes of this program show it is an effective and promising intervention; parents who received counseling consumed more fruits and vegetables at follow-up, and parental exposure to m essaging at children's school events was associated with higher water consumption. 4 I like this approach because it is simple and can be applied to individuals of all ages. I always add to these recommendations. I think b everage consumption is important to overall diet, so I add "zero sugary drinks." I also add that three meals per week should be as a family unit. I feel this is an important factor in childhood obesity b ecause, unlike adult obesity, the available food, habits, and other possible lifestyle contributors to a child's health are largely controlled by the family unit. It makes sense that a program focusing on educating the parents/caregivers is successful in bringing about change. While r eaching everyone in the family represents a challenge, I believe it also presents a great opportunity to encourage all family members to adopt a healthy lifestyle. In terms of treatment, we of course have comprehensive lifestyle i ntervention programs that aim to achieve weight loss and healthy habits through counseling, diet, and exercise. Pharmacotherapy for obesity treatment in children and adolescents is currently being studied. The medication orlistat is approved by the United States Food and Drug Administration (FDA) for use in the management of obesity in adolescents ages 12 to 16 years, though available research emphasizes careful patient selection and risk stratification in prescribing it in this patient population, which I believe is essential when weighing all treatment options. The risk/benefit equation must be weighed when considering any patient who might be a candidate for bariatric surgery. Surgical treatment in this patient population remains controversial, though the current long-term outcomes data are promising with two recent studies 5,6 showing improvement in weight and comorbid conditions in patients aged 13 to 21 following surgery. I think that bariatric surgery has a place in treating obesity in this patient population given they are good candidates based on risk stratification and that the surgery is performed at centers specialized to perform surgery in these patients. Sincerely, Christopher Still, DO, FACN, FACP REFERENCES 1. The Trust for America's Health and the Robert Wood Johnson Foundation. The state of childhood obesity. Accessed August 21, 2017. 2. Wagner IV, Sabin MA, Pfäffle RW, et al. Effects of obesity on human sexual development. Nat Rev Endocrinol. 2012;8(4):246–254. 3. Consortium to Lower Obesity in Chicago Children. Health Promotion and Public Education. promotion-and-public-education/5-4-3-2-1-go/ Accessed August 21, 2017. 4. Evans WD, Christoffel KK, Necheles J, Becker AB, Snider J. Outcomes of the 5-4-3-2-1 Go! Childhood obesity community trial. Am J Health Behav. 2011;35(2):189–198. 5. Inge TH, Jenkins TM, Xanthakos SA. Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis. Lancet Diabetes Endocrinol. 2017;5(3):165–173. 6. Olbers T, Beamish AJ, Gronowitz E, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol. 2017;5(3):174–183. Letter to the Editor Submissions Bariatric Times welcomes letters for possible publication. Letters should be no more than 500 words and five references. Letters that comment on a Bariatric Times article will be considered if they are received within two months of the time the article was published. All letters are reviewed by the editors and are selected based upon interest, timeliness, and pertinence, as determined by the editors. Send letters to: Angela Saba at or mail to: Angela Saba, Bariatric Times, Matrix Medical Communications, 1595 Paoli Pike, Suite 201, West Chester, PA 19380. Include the following statement with the letter:"The undersigned author transfers all copyright ownership of the enclosed/attached letter to Matrix Medical Communications in the event the work is published. The undersigned author warrants that the letter is original, is not under consideration by another journal, and has not been previously published. I sign for and accept responsibility for releasing this material on behalf of any and all co-authors."

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