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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24 Ask the Leadership Bariatric Times • March 2018 operate on their patients. These are undeniable forces that compel legislators and administrators to accept that metabolic surgery is indeed the most effective solution for their employees, thereby rendering coverage decisions that will continue to align with scientific facts. I predict that we will soon witness a tidal wave of coverage by states for their employees. What a happy day that will be! Are there actions that patients can take to help pressure insurance companies to cover bariatric surgery? If not, who holds the biggest responsibility in getting these companies to offer coverage? Dr. Samer Mattar: Definitely patients, family members, and their friends can play a decisive role in influencing these types of decisions. This is exactly what it will take. We need a tumultuous grassroots groundswell of a movement that will result in a seascape change in the minds of insurance executives. Another group we should target is employers who are charged with purchasing coverage for metabolic surgery. These administrators and owners need to be educated on the countless benefits that can be achieved through metabolic surgery, resulting in reduced absenteeism, reduced workplace accidents, reduced sick days, increased productivity, and increased retention of happy employees. 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: Samer Mattar, MD, FACS, FRCS, FASMBS; Email: samer.mattar@swedish.org. BT ASMBS ADDS INTRAGASTRIC BALLOON TO APPROVED DEVICES The American Society for Metabolic and Bariatric Surgery (ASMBS) announced that it has officially approved the intragastric balloon for use in bariatric surgery. The device was originally approved by the United States. Food and Drug Administration in 2015 for patients with obesity and a body mass index between 30 and 40kg/m 2 . The device remains in patients for six months and is then removed. * For more information: https:// www.healio.com/endocrinology/ obesity/news/online/%7Bd99b90d5- 8fe8-4ea6-abda-b39c4718423e%7D/ society-adds-intragastric-balloon-to- approved-devices BIOHIT GASTROPANEL ® TEST HELPS REDUCE UNNECESSARY GASTROSCOPIES IN PREOPERATIVE EVALUATION OF PATIENTS REFERRED FOR BARIATRIC SURGERY A careful preoperative evaluation is necessary for all patients to assess the status of their stomach, usually done by gastroscopy and biopsies. A recently published study from Tartu University Hospital in Estonia shows that almost one-third of these preoperative gastroscopies can be replaced by noninvasive biomarker testing with GastroPanel. * For more information: https://globenewswire.com/news- release/2018/02/22/1379683/0/ en/Biohit-GastroPanel-test-helps- reducing-unnecessary-gastroscopies- in-pre-operative-evaluation-of-the- patients-referred-for-bariatric-surgery. html BARIATRIC SURGERY AND CENTRAL PAIN SENSITIZATION Results published in the Arthritis Care & Research found that bariatric surgery resulted in significantly less knee pain for patients, as well as pain sensitivity in the wrist. The researchers came to the conclusion that bariatric surgery might have resulted in a change in central pain sensitization. * For more information: https://www.medscape.com/ viewarticle/891852 LOSS OF CONTROL EATING AND BARIATRIC SURGERY SUCCESS Thomas H. Inge, MD, PhD, of the Bariatric Surgery Center at Children's Hospital Colorado conducted a study on bariatric surgery in adolescent patients, focusing on ages 13 to 19. The results showed a decrease in "loss of control" eating by patients directly after bariatric surgery, but this slowly increased over a four-year span after that. * For more information: https://www.sciencedaily.com/ releases/2018/02/180215141644.htm BARIATRIC SURGERY ENABLED STOPPING DIABETES MEDICATION A study in France that was published in JAMA Surgery found that nearly 50 percent of patients who had bariatric surgery were able to discontinue their diabetes medication after six years. Additionally, other patients who were unable to completely stop their diabetes medication were still able to simplify their treatment, such as switching to monotherapy. * For more information: https://www.medpagetoday.com/ endocrinology/diabetes/71151 WEIGHT LOSS INTERVENTIONS THAT WORK: SURGERY This article highlights three main steps that patients can use to lose weight: lifestyle changes, medications, and surgery. It also notes how bariatric surgery can improve other issues that patients might be dealing with, such as Type 2 diabetes, sleep apnea, high blood pressure, and joint pain. * For more information: https:// www.cnn.com/2018/02/07/health/ weight-loss-surgery-drayer/index.html SURGEON OFFERS FREE WEIGHT-LOSS OPERATION FOR 500-POUND MAN REJECTED BY INSURER Dr. Hooman Shabatian offered a patient with obesity free bariatric surgery after he read that the patient's insurer had denied his claim to cover the surgery. The insurance company cited the gastric bypass as a "cosmetic procedure" but was still willing to pay for other obesity-related treatments, even if they were more expensive than the cost of the gastric bypass. * For more information: http:// www.latimes.com/business/lazarus/ la-fi-lazarus-wight-loss-surgery- 20180221-story.html BARIATRIC SURGERY REDUCES CARDIOVASCULAR DISEASE RISK FACTORS IN ADOLESCENTS Research published in Pediatrics found that adolescent patients who underwent bariatric surgery have a slight decrease in cardiovascular disease risk factors. Investigators noted that among the cohort used in the study, patients saw "normalization in dyslipidemia, elevated blood pressure, hyperinsulinemia, diabetes, and elevated high-sensitivity C-reactive protein." * For more information: https:// www.endocrinologyadvisor.com/ obesity/cvd-risk-factors-after-bariatric- surgery-in-adolescents/article/740020/ NEW GLUCAGON DELIVERY SYSTEM REDUCES EPISODES OF POST-BARIATRIC SURGERY HYPOGLYCEMIA According to research published in Diabetes Technology & Therapeutics, a "smart" glucagon delivery system can help patients with hypoglycemia who have had bariatric surgery. The device beeps when a patient is at risk for hypoglycemia and subsequently delivers a dose of glucagen to counteract it. * For more information: https:// medicalxpress.com/news/2018-02- glucagon-delivery-episodes-post- bariatric-surgery.html BT News and Trends Exploring the latest in bariatric and metabolic medicine in the media Bariatric Times. 2018;15(3):24

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