2013 was a banner year. The ASMBS commemorated its 30th anniversary, held its first ObesityWeek, the Affordable Care Act was enacted, sleeve gastrectomy gained more traction, Governor Chris Christie had gastric band surgery and the ASMBS reasserted its commitment to accreditation in the face of challenges from Medicare. Your news magazine, connect, was there for all of it, plus brought you features on the celebrity effect on bariatric surgery, obesity in the digital age and the rise of integrated health, and so much more. We've put together a recap of highlights that marked the year that was 2013.
The Affordable Care Act and You
Back in May, months before the HealthCare.gov website was on everybody’s lips, many Americans, including health care professionals, were still unsure about the impact of one of the largest pieces of legislation to date – the Affordable Care Act (ACA). For patients suffering from obesity, and the health care professionals that treat them, the question was, will access to obesity treatment improve?
The answer was not so simple. For people in some parts of the nation, yes, for others…well, maybe not so much. Twenty-two state health care exchanges ended up covering bariatric surgery while 28 did not include it as a benefit.
“There is a real geographic disparity,” said now-ASMBS President-Elect John Morton, MD, Associate Professor of Surgery at the Stanford University Medical Center. “And it's sad to say that many of the states expected to exclude obesity treatments can be found in the South, where the highest rates of obesity can also be found.”
There was a silver lining to be found. Even in those states that excluded metabolic and bariatric surgery in their exchanges, ACA still calls for coverage of obesity screening and counseling regardless of what obesity treatments are covered or not covered.
”We believe that with more focus on obesity, there will be better access to evidence-based solutions like surgery, now and tomorrow,” Dr. Morton said. ”Prevention and screening alone cannot solve the obesity crisis, nor can surgery or other stand-alone interventions. The future solution will be a continuum of care, complementary to the many challenges of obesity. The sooner we marry prevention and intervention, the sooner we will be able to save more lives and turn back the twin epidemic of obesity and diabetes, an epidemic that is spiraling out of control.”
When Celebrities Have Bariatric Surgery: Help or Hindrance?
When well-known public figures elect to tell the world about their bariatric procedures, it’s a “double-edged sword,” according to David Sarwer, PhD, professor of Psychology in Psychiatry and Surgery at the Perelman School of Medicine at the University of Pennsylvania and ASMBS Integrated Health member. “Without question celebrities can play a great role in bringing bariatric surgery to light and potentially motivate others to consider surgery. When they’re candid with their experiences, they communicate the importance of weight loss to their health and quality of life. However, it can be dangerous when we look at them as role models. We forget how different their lives can be from ours.”
In the world of bariatric surgery, perhaps no one made as many headlines in 2013 as N.J. Gov. Chris Christie, the Republican Party’s current star, who announced in May he had gastric banding surgery in February.
These headlines and the ensuing media coverage put bariatric surgery in the celebrity spotlight again. Did it help or hurt the public perception of surgery? According to world-renowned communication expert Irving Rein, PhD, professor of Communication Studies at Northwestern University and author of 12 books, including “High Visibility,” a groundbreaking study of image making, the answer depends on individual circumstances.
"Where a person is on his or her journey determines the level of influence of the celebrity,” Dr. Rein said. “For some, it could be a tipping point, for others it may cause additional consideration and for others, it could be absolutely meaningless.”
The ASMBS Turns 30 -- The Presidents Look Back
In 2013, the ASMBS marked its 30th Anniversary – 30 years of research, treatment, advocacy and progress for patients suffering from obesity. The path was not always an easy one. In the 1980s, obesity was considered the “end result of gluttony and sloth,” and those who treated it were “tolerated,” but “just barely,” according to J. Patrick O’Leary, MD, past-president of the ASMBS. Three decades later, however, he noted, the tide has
“It is amazing to me, to reflect on those 'hard times' when compared and contrasted to the current environment, where laparoscopic bariatric procedures represent the second most common intra-abdominal operation performed by today’s surgeons in the United States. It is remarkable to see the enormous advances that are now discussed and published in every venue.”
One of the primary drivers of such change was the ASMBS, its members, and, in particular, its leadership. In the formative years of the 80s, the society’s presidents focused on bringing together surgeons from different schools of thought to get behind one mission -- providing the most effective treatment for severe obesity and related conditions to more patients who could benefit.
In the 90s, ASMBS leadership headed to the NIH to present data on bariatric surgery, eventually leading to guidelines that established patient criteria and identified surgical therapies that could be considered. This decade also saw Walter Pories, MD, put forth the first study finding surgery had a positive impact on type 2 diabetes, and Alan Wittgrove, MD, perform the first laparoscopic gastric bypass, helping to reduce complications and improve patient outcomes.
These achievements led to what was described as a “golden age” of surgery in the 2000s with an increase in the awareness and understanding of the safety and effectiveness of bariatric surgery. preponderance of bariatric surgeries.This decade would also mark the emergence of "metabolic surgery" and a new name for the ASMBS.
"From its inception 30 years ago, the ASMBS continues to make strides in realizing its vision of improving public health and well being by lessening the burden of the disease of obesity and related diseases throughout the world,” said Immediate Past-President, Jaime Ponce, MD. “Who would have thought when Dr. Edward Mason met with colleagues back in 1983, the procedures they discussed and the society they would ultimately form would change the landscape of obesity treatment forever?"
Obesity in the Digital Age
This meteoric rise of digital and social media has forever changed the way people communicate and obtain information about everything from what kind of shoes to buy to what to do about obesity. Information about both is just as easy to get.
A Google search for bariatric surgery yields more than 5 million results, and so, medical professionals, including metabolic and bariatric surgeons and other integrated health professionals, have navigated the digital divide to improve patient engagement, education and awareness.
“Social media has brought down some of the barriers,” said Kevin Pho, MD, and internal medicine physician and health care social media guru. “Five, 10 years ago, there was more of a wall, more of a paternalistic model where doctors would prescribe and patients would listen. Now, I think there’s more of a partnership between patients and doctors.”
This ‘partnership’ has grown to include many in the medical community, including Pamela Davis, a certified bariatric nurse and bariatric program director at TriStar Centennial Center for the Treatment of Obesity in Nashville, Tennessee, who posts surgery-friendly recipes on Pinterest, and Martin Binks, PhD., C.E.O, Binks Behavioral Health PLLC, who uses his blog to “balance out the unhealthy messages” and provide context to sensationalized health and medical stories in a 24/7 media environment.
The Rise of Integrated Health
Between 2000 and 2012, the Integrated Health Section within the ASMBS has experienced explosive growth. During this time, the number of Integrated Health members has grown from 113 to 1,683 -- a nearly 15-fold increase. But the numbers alone do not tell the story of the rise of Integrated Health in terms of its significance to bariatric and metabolic surgery and patient care.
"When we started there was no science of integrated health. We were just doing what we thought was right for the patient and paving the road as we went along,” said Tracy Martinez, RN, BSN, who was the first-elected Chair of ASMBS’ (then-named) Allied Health Committee in 2000. “Now we have data on nutrition, exercise, behavioral health, specialized nurse training and many other topics that support our role. We have and we continue to raise the bar on pre- and post-operative care and our voices are being heard.”
Mission Accomplished: ObesityWeek Draws More than 4,700
After several years of planning, ObesityWeek 2013 has come and gone in a whirlwind of a week. More than 4,700 surgeons, nurses, clinicians, policymakers, integrated health professionals, scientists, researchers and news media converged in Atlanta for the inaugural event that included over 1,000 scientific presentations, continuing medical education courses, live surgery telecasts, symposia and public policy forums.
Data and discussion took center stage at the Georgia World Congress Center in Atlanta. Studies were presented on a wide range of topics including risk prediction of complications of metabolic syndrome before and six years after gastric bypass, insurance-mandated medical weight loss programs, sleeve gastrectomy and the antireflux barrier, the BOLD data, long-term diabetes remission in Swedish Obese Subjects (SOS), the impact of accreditation in bariatric surgery and revision surgery. Symposia included "Decreasing Readmissions – The First MBSAQIP Quality Collaborative" and a joint ASMBS/TOS session on the management of adolescent obesity.
The research that emerged from ObesityWeek was not confined to the convention center. National and local news media including the Associated Press, Wall Street Journal , CBS and NBC News, NPR, MedPage Today, Telemundo, Reuters Health, Los Angeles Times, Medscape and HealthDay all aired or published stories on the data. Headlines included “Researchers Study How Excess Fat Cells
Interfere With Organ Function, Metabolism,” “Weight-Loss Surgery Yields Lasting Improvement in Health, Studies Say,” “Weight-loss Surgery As Fountain of Youth? For Some Patients, Yes” and “Current BMI Cut Offs May Miss Metabolic Disease Risk.”
News reports also noted that long-term data presented at the meeting showing the durability of health improvements “may make weight-loss surgery a more appealing treatment for insurers to cover, and for obese patients with health concerns to seek out.” ASMBS leadership and members including Doctors Ninh Nguyen, Jaime Ponce, John Morton, Stacey Brethauer, Philip Schauer and Francesco Rubino were widely quoted in news reports. Reporters from the Wall Street Journal, Associated Press, Medscape and Reuters Health were among the more the press attending data presentations and working in the ObesityWeek media room, where they found ASMBS generated seven news releases on the major studies and fact sheets that provided background on obesity, metabolic and bariatric surgery, type 2 diabetes and the ASMBS.