Bariatric Times

MAR 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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The Medical Student Notebook 11 Bariatric Times • March 2018 American and Hispanic patients with obesity. 9 Therefore, the bariatric community has made some progress. Moving forward, it is important to put existing facts and studies into practice to improve access to bariatric care. Clinics must employ creative approaches to recruit and retain patients from the sociodemographic populations disproportionately affected by obesity. SUGGESTIONS FOR MOVING FORWARD Focused public health efforts are needed to equalize and expand access to bariatric care. The health disparities apparent in bariatric care cannot be erased overnight, and possibly not in the next few decades. The roots of the systemic racial and socioeconomic injustice present in the US at large continue to influence bariatric care. While the struggle with inequity in our social system continues, physicians can begin to do their part in the short term to recognize causes of inequity in their own practice and work to eradicate them. Clinicians can identify and address their own implicit biases toward underrepresented sociodemographic patient populations. Individual practices can work to equalize access to bariatric care for sociodemographic minorities by reconsidering insurance options they accept. In addition, steps can be taken to broaden who feels welcome in the clinical space by making professional interpreters available, increasing the diversity of office staff and practitioners, and providing adequate social support networks by coordinating care with nutrition counselors or establishing support groups. Going one step further, the bariatric surgery community could increase access by publishing fliers to hang in communities that would not otherwise be aware of bariatric care, partnering with primary care providers in community health clinics to recruit patients, and working with patients to optimize their access to bariatric care through other channels, including partnerships with hospital social workers. Making small changes on a daily basis will bring the bariatric community one step closer to offering equitable care in this incredibly important area of health. REFERENCES 1. Jackson TD, Zhang R, Glockler D, et al. Health inequity in access to bariatric surgery: a protocol for a systematic review. Syst Rev. 2014;3:15. 2. Bhogal SK, Reddigan JI, Rotstein OD, et al. Inequity to the utilization of bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2015;25(5):888–99. 3. Santry HP, Lauderdale DS, Cagney KA, et al. Predictors of patient selection in bariatric surgery. Ann Surg. 2007;245(1):59–67. 4. Martin M, Beekley A, Kjorstad R, Sebesta J. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis. 2010;6(1):8–15. 5. Hennings DL, Baimas-George M, Al-Quarayshi Z, et al. The inequity of bariatric surgery: publicly insured patients undergo lower rates of bariatric surgery with worse outcomes. Obes Surg. 2018;28(1)44–51. 6. Padwal RS, Chang HJ, Klarenbach S. Characteristics of the population eligible for and receiving publicly funded bariatric surgery in Canada. Int J Equity Health. 2012;11:54. 7. Gregory DM, Temple Newhook J, Twells LK. Patients' perceptions of waiting for bariatric surgery: a qualitative study. Int J Equity Health. 2013;12:86. 8. Pickett-Blakely OE, Huizinga MM, Clark JM. Sociodemographic trends in bariatric surgery utilization in the USA. Obes Surg. 2012;22(5):838–42. 9. Worni M, Guller U, Maciejewski ML, et al. Racial differences among patients undergoing laparoscopic gastric bypass surgery: a population-based trend analysis from 2002 to 2008. Obes Surg. 2013;23(2):226–33. FUNDING: No funding was provided for this article. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. ADDRESS FOR CORRESPONDENCE: Bryn E. Falahee, MPhil; Email: bryn_falahee@hms.harvard.edu. BT Five-year outcomes of laparoscopic sleeve gastrectomy: a comparison between adults and adolescents. Khidir N, El-Matbouly MA, Sarysyan D, et al. Obes Surg. 2018 Feb 11. doi: 10.1007/s11695-018-3139-6. [Epub ahead of print] Synposis: This study included a cohort of 139 adults and 91 adolescents who had laparoscopic sleeve gastrectomy (LSG). The percentage of total weight loss increased in adolescents at the five- year mark, while it generally stayed the same in adults, suggesting LSG had a slightly better impact on adolescents. LSG also resulted in a higher percentage of adolescents being cured of diabetes than the adult subgroup. PMID: 29430596 Clinical and patient-centered outcomes in obese type 2 diabetes patients 3 years after randomization to Roux-en-Y gastric bypass surgery versus intensive lifestyle management: the SLIMM- T2D study. Simonson DC, Halperin F, Foster K, et al. Diabetes Care. 2018 Feb 6. pii: dc170487. doi: 10.2337/dc17-0487. [Epub ahead of print] Synposis: Of the 38 patients in the study, half were randomized to receive Roux-en-Y gastric bypass (RYGB) surgery and the other half underwent intensive medical diabetes and weight management (IMWM). After three years, the RYGB group lost an average of 20kg more weight than the IMWM, as well as had larger decreases in HbA1c levels. The surgery group also experienced greater improvements in overall quality of life, as measured by the Impact of Weight on Quality of Life (IWQOL). PMID: 29432125 Predicting remission of diabetes post metabolic surgery: a comparison of ABCD, diarem, and DRS scores. Ahuja A, Tantia O, Chaudhuri T, et al. Obes Surg. 2018 Feb 12. [Epub ahead of print] Synposis: In a study of 102 patients with diabetes who underwent bariatric surgery, Type 2 Diabetes Remission (DiaRem), Disability Rating Score (DRS), and Age, BMI, C-peptide, and Duration of T2DM (ABCD) scores were used to predict the remission of type 2 diabetes mellitus (T2DM). Just over 70 percent of patients achieved remission of T2DM one year post- surgery. While the DiaRem scores were found to be slightly better at predicting T2DM remission, there was no statistically significant difference between the three scoring systems. PMID: 29435812 Comparative outcomes of bariatric surgery in patients with impaired mobility and ambulatory population. Sharma G, Nor-Hanipah Z, Haskins IN, et al. Obes Surg. 2018 Feb 12. [Epub ahead of print] Synposis: Bariatric surgery patients who required a wheelchair or motorized scooter for at least part of their daily activities were matched in a 1:5 ratio to ambulatory controls. The impaired mobility (WC) group was found to have a higher median operative time and postoperative length of stay. The WC group also had a lower chance of experiencing improvement in their diabetes, hypertension, and obstructive sleep apnea. However, both groups had similar rates of perioperative morbidity and weight loss at one year. PMID: 29435811 Clinical versus patient-reported measures of depression in bariatric surgery. Srivatsan S, Guduguntla V, Young KZ, et al. Surg Endosc. 2018 Feb 12. [Epub ahead of print] Synposis: Researchers investigated depression in patients who had bariatric surgery, comparing their clinical diagnoses to the results of the Patient Health Questionnaire 8 (PHQ-8). While 45.6 percent of study participants (n=4486) had clinically diagnosed depression, only 14.8 percent screened positive for the condition based on PHQ-8 results. Ultimately, the researchers determined that a large percentage of the cohort was either undiagnosed or misdiagnosed with depression, suggesting a better standardization for measuring this condition in the future. PMID: 29435747 BT Journal Watch A quick look at the noteworthy articles in bariatric and metabolic research Bariatric Times. 2018;15(3):11

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