Bariatric Times

APR 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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16 Interview Bariatric Times • April 2017 The Dynamic and Evolving Field of Metabolic and Bariatric Surgery: Current Perspective Bariatric Times. 2017;14(4):16–17. Why was it important to provide a comprehensive update? Drs. Nguyen & Varela: Bariatric surgery is a dynamic and evolving field. It is necessary that we update our medical colleagues on the current state of bariatric surgery as well as the latest level 1 evidence for the role of bariatric surgery compared to intensive medical therapy (Tables 1 and 2), as well as offer insight into the new endoscopic bariatric interventions that may bridge between medical therapy and bariatric surgery. Why publish in Nature Reviews Gastroenterology & Hepatology, which encompasses a wide range of disorders and diseases—not solely obesity research and treatment? Drs. Nguyen & Varela: It was important to publish this review article in a journal that reaches a broad audience of medical specialists that treat millions of patients with obesity and diabetes yearly. In the article, you say that the landscape of bariatric surgery has changed dramatically since its introduction more than 50 years ago. Drs. Nguyen & Varela: Yes, the most notable changes in bariatric surgery are the development and adoption of laparoscopic bariatric surgical techniques. Primary open bariatric operation, for the most part, has become obsolete. The laparoscopic approach offers improved surgical outcomes, including lower morbidity, reduced postoperative pain, and faster recovery, and has become the standard of care. Additionally, bariatric surgery as a field has evolved to be very safe with a mortality rate that is now similar to that that of common general surgical operations, such as cholecystectomy and antireflux surgery. Your article includes a section on indications for bariatric surgery. Why is it important that bariatric surgery be included in medical guidelines, such as the American Diabetes Association and International Diabetes Federation? Why is it important to determine patient selection criteria for bariatric surgery? Drs. Nguyen & Varela: The guidelines 8–11 are commonly used by clinicians who treat obesity and T2DM. They provide important guidance on who would be appropriate candidates for bariatric surgery, and when to refer these patients to surgery. What emerging trends are you seeing in the field? Drs. Nguyen & Varela: Sleeve gastrectomy is now the preferred bariatric surgical option; however, emerging endoscopic devices and procedures will likely be developed to be more durable and effective and provide an alternative treatment option. The number of metabolic and bariatric procedures performed in the United States and worldwide is currently less than one percent of the eligible population with severe obesity. How can healthcare professionals increase awareness among the healthcare community and public about the current state of bariatric surgery? Drs. Nguyen & Varela: The number of patients who undergo bariatric surgery is still exceedingly low. Increasing obesity awareness and decreasing the barriers at all levels in the spectrum of care for the patients with obesity and diabetes is critical. A good start is to educate our patients and our medical colleagues regarding the available treatments. However, this is only a start! We need to do so much more, including improving coverage for obesity treatments and more extensive research that examines other obstacles to treatment. Obesity remains a public health problem. How can we continue to progress in tackling the obesity epidemic? Drs. Nguyen & Varela: There has been significant progress in both the prevention and medical and surgical treatments of obesity; however, a lot more work remains as only a small proportion of individuals with obesity obtain any type of the currently available therapy. Given the ample amount of scientific evidence, we must work as a team with our multidisciplinary obesity colleagues to educate patients on the available treatments, discuss any barriers to treatments, and refer these patients to appropriate providers for evaluation and treatments. A n I n t e r v i e w w i t h ESTEBAN VARELA, MD, FACS, FASMBS Professor of Surgery at University of Central Florida and Chair of Surgery at HCA Medical Center, Orlando, Florida NINH T. NGUYEN, MD, FACS, FASMBS Professor of Surgery and Interim-Chair at University of California Irvine Medical Center, Orange, California I n a recent article published in Nature Reviews Gastroenterology & Hepatology titled "Bariatric surgery for obesity and metabolic disorders: state of the art," Drs. Ninh T. Nguyen and Esteban Varela provided an update on the current state of bariatric surgery, summarizing the epidemiology of obesity, history of bariatric surgery, and current state of procedure safety and efficacy. They reviewed procedure advantages and disadvantages and discussed the recent data comparing bariatric surgery to medical therapy for outcomes of weight loss and comorbidity improvement. The review also included a discussion on newly approved, minimally invasive and endoscopic procedures, including intra-gastric balloon systems and the vagal nerve blockade device. Bariatric Times interviewed Drs. Nguyen and Varela to learn what this paper means to the field of obesity treatment and the medical community.

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