Bariatric Times

FEB 2018

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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3 Bariatric Times • February 2018 Editorial Messages The Future of Bariatric Surgery: Digitalization, Democratization, and Doctors A Message from Dr. John M. Morton John M. Morton, MD, MPH, FACS, FASMBS, Clinical Editor, Bariatric Times; Chief of the Section of Bariatric and Minimally Invasive Surgery, Stanford University, Stanford, California, and Past President, American Society for Metabolic and Bariatric Surgery. Dear Friends and Readers, One of bariatric surgery's greatest attributes is its ability to adapt and innovate. Bariatric surgery has taken great advantage of the advances we've seen in surgery over the last two decades, namely laparoscopy and quality improvement. The penetrance of laparoscopy in bariatric surgery is greater than 90 percent, while other fields, such as colorectal surgery, lag behind at less than 50 percent. This high rate of laparoscopy has resulted in huge decreases in post-operative pain and incisional hernia. Quality improvement was a clear driver in the growth of bariatric surgery, which is now almost 220,000 cases annually. Through the accreditation model, laparoscopic approach, and collaborative care model, bariatric surgery mortality rates have plummeted from 1/100 to 1/1000! It is clear that researchers, surgeons, and clinicians are always looking for the next big idea to further advance the field of bariatric surgery, as our prime directive is to continually meet the needs of our patients. So, what is next? I believe that the next decade will focus on the three Ds: digitalization of healthcare, democratization of surgery, and doctors in the lead. Rapidly, all healthcare communication is becoming digital through electronic medical records, and patients are very reliant on personal digital measurements, such as Fitbit® (San Francisco, California). We need to take advantage of this trend to help with both long-term follow-up and adherence. We are aware that there is variation in healthcare outcomes. Why can't we have everyone achieve great outcomes? In other words, let's democratize best practices in bariatric surgery so all patients benefit. Finally, doctors need to take the lead in healthcare. While only five percent of hospitals have physicians as their CEO, a large portion of those are the top-ranked hospitals. As physicians and surgeons, we need to be deeply involved in the operational transformational of healthcare, from cost transparency, multidisciplinary service lines, and changing leadership. I am confident that bariatric surgery will meet every challenge and be ahead of any and all trends in healthcare. Why? Because we must. Sincerely, John M. Morton, MD, MPH, FACS, FASMBS BT This editorial message was co-written by James Zervios, Vice President of Marketing and Communications at the Obesity Action Coalition. Dear Readers, "Hello, thank you for coming back for your follow-up. I have your results and unfortunately, you are cancerous." As a healthcare provider, how often have you heard that statement? My guess is probably never! Obesity is one of the last acceptable forms of discrimination in today's society. One of the most prevalent areas of weight bias is in healthcare. This is very unfortunate, as this is the one place where a person in need of medical care should be allowed to feel vulnerable and get the care they need. In obesity medicine, providers are often guilty of perpetuating weight bias, and, many times, they're not even aware they are doing it. One of the biggest culprits of weight bias in the healthcare setting is the use of the word "obese." Typically, when we discuss weight with patients, we'll say "You're in the obese range" or "You're obese." These statements can be extremely harmful because they dehumanize the person with obesity, and they essentially make them their disease. Changing the lexicon when talking about obesity is quite simple, yet it seems to be met with much resistance, which is likely rooted in weight bias and the oversimplification of the disease. When talking about obesity, simple changes such as "patients with obesity" or "patients affected by obesity" allow the patient to be distinguished from their weight issues, whereas "obese" encapsulates the patient and his or her weight all in one. People are not their disease, and we must remember that when discussing obesity. Other words are also perceived negatively when talking to patients, such as "fat," "morbidly obese" and "chubby." The following questions are all constructive ways you can discuss weight with your patients: • "Could we talk about your weight today?" • "How do you feel about your weight?" • "What words would you like us to use when we talk about weight?" Weight bias is a serious priority for society to address, especially in the realm of healthcare. The cycle of weight bias traps patients with obesity in the cyclical journey where they continue to experience bias, delay important medical issues, and cope with the impact of weight bias by engaging in unhealthy behaviors. Fortunately, there is hope for us to diminish, and ultimately eradicate, weight bias through a variety of ways, such as using people-first language for obesity, especially More than a Word —Putting Patients First 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 Research Institute, Geisinger Medical Center, Danville, Pennsylvania. Continued on following page

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