The Year in Obesity

Published in December 2014 Issue             

The Major Events That Marked 2013

ObesityWeek -- The Start of a New Tradition 

What was years in the making had its debut in November -- ObesityWeek. The event, held jointly by the ASMBS and The Obesity Society drew more than 4,700 surgeons, nurses, clinicians, policymakers, integrated health professionals, scientists, researchers and news media. ObesityWeek featured more than 1,000 scientific presentations, continuing medical education courses, live surgery telecasts, symposia and public policy forums. Major data emerged from the sessions including adult and teen “Longitudinal Assessment of Bariatric Surgery (LABS) studies," new data on bariatric surgery as a preventative for heart attack, stroke and diabetes, quality improvement, and new findings on bariatric surgery and its anti-aging affect, among many others. Keynoters included Bruce Spiegelman, PhD, professor of Cell Biology at Harvard Medical School, and Thomas Farley, MD, MPH, the New York City Health Commissioner, both of whom were enthusiastically received by an auditorium full of ASMBS and TOS members.

A.M.A. Declares Obesity
a Disease

When the American Medical Association’s (A.M.A.) officially recognized obesity as a disease in May, many hailed it, including the ASMBS, as a "watershed moment" or "tipping point" for the prevention and treatment of obesity. The ASMBS said in a statement: "Recognition of obesity as a disease by the A.M.A. sends a powerful message that access to evidence-based treatments across the spectrum of the disease are medically necessary and should be treated in similar fashion to treatments for type 2 diabetes, heart disease or high blood pressure." ASMBS President-Elect John Morton, MD, said at the time “the scientific consensus that has been built around the disease of obesity and its treatment cannot be ignored. Now coverage policy must catch up
that consensus.”  

While progress has been made, there is still much work to be done on insurance coverage policy, but media coverage of the announcement was extensive from the Associated Press to The New York Times to virtually every major television newscast in America.

Noted Personal Health columnist Jane Brody from The New York Times wrote, “The A.M.A. has said in effect that it is medicine’s responsibility to provide the knowledge and tools needed to curb this runaway epidemic.” She added that “the designation may change how aggressively doctors treat obesity, foster the development of new therapies, and lead to better coverage by insurers.”

A.M.A. President Ardis Dee Hoven stated, “The purpose of the policy is to advance obesity treatment and prevention. It issues a call for a paradigm shift in the way the medical community tackles this complicated issue.”

Sleeve Gastrectomy Coverage Grows To
Nationwide Coverage

In 2011 the Centers for Medicaid and Medicare Services (CMS) reopened the Bariatric Surgery for the Treatment of Morbid Obesity National Care Determination to consider a request to include laparoscopic sleeve gastrectomy (LSG) for inclusion. That began a collaborative effort between ASMBS and groups including American College of Surgeons, SAGES, TOS, OAC and the American Society of Bariatric Physicians to provide the necessary advocacy and evidence to support the inclusion of the procedure state by state. Two years later, coverage is near complete, as shown in the coverage map of the United States

Guidelines, Guidelines, Guidelines 

Significant new scientific evidence published over the last four years prompted the ASMBS, the American Association of Clinical Endocrinologists (AACE) and TOS to revise clinical practice guidelines originally published in 2008. Among the 74 evidence-based recommendations is the reclassification of laparoscopic sleeve gastrectomy as a proven surgical option, joining laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic biliopancreatic diversion BPD, BPD/duodenal switch as primary bariatric and metabolic procedures for patients requiring weight loss and/or metabolic control. Other changes included surgical eligibility being expanded to include patients with mild to moderate obesity (BMI of 30-34.9) and diabetes or metabolic syndrome.The new guidelines, which also recommend that women should avoid pregnancy before surgery and for 12 to 18 months after surgery; and a team approach to perioperative care "is mandatory with special attention to nutritional and metabolic issues," were published in the societies’ respective official peer-reviewed journals: Surgery for Obesity and Related Diseases, Endocrine Practice and Obesity.          

New obesity guidelines were also released by the American Heart Association (AHA), American College of Cardiology (ACC) and TOS during ObesityWeek 2013. The NIH-commissioned guidelines recommend that doctors diagnose and treat obesity at every clinic visit "the way they would any other chronic disease." The guidelines are geared toward primary care physicians and offer an algorithm for managing obesity. They focus on identifying at-risk patients and prescribing appropriate interventions or referring for bariatric surgery if patients meet BMI criteria. The obesity guidelines were one of four guidelines released, including new guidelines encouraging greater use of statins.

CMS Takes on Accreditation

In July, the Centers for Medicare & Medicaid Services (CMS) announced its proposed decision to eliminate its requirement for certification of facilities that perform bariatric surgery on Medicare beneficiaries, reversing its 2006 decision. The proposal was met with strong opposition from ASMBS and other groups who said a change in Medicare policy could put beneficiaries seeking bariatric surgery in danger. The groups pointed to evidence including two studies by ASMBS President Ninh Nguyen, MD showing in-hospital mortality rates at non-accredited centers were significantly higher than those at accredited centers. Despite the opposition, CMS upheld its proposed decision and made it policy. CMS now stands alone as the only major insurer that does not require surgical procedures to be performed at an accredited facility. This happened while ASMBS was putting the finishing touches on MBSAQIP, which will be fully rolled out in 2014. The program defines best practices and establishes efficient and reliable processes for data collection with the goal of improving patient outcomes.

20 and 30-Year Anniversaries  

ASMBS celebrated its 30th anniversary by recognizing the historic achievements of its members and holding a virtual candle-lighting fundraiser on its special anniversary website. ASMBS recognized surgeon and integrated health members that made a difference, identified the events and achievements that marked each ASMBS presidents’ tenure and developed a document identifying the most significant publications in obesity and bariatric surgery. Members were able to wish the ASMBS happy anniversary by lighting a candle and making a donation to the ASMBS Foundation. This effort raised more than the $30,000 goal -- $1,000 for each year of the society.

2013 also marked the 20th anniversary of the first laparoscopic gastric bypass performed by past ASMBS president Alan Wittgrove, MD, FACS, FASMBS. Dr. Wittgrove was honored during ObesityWeek with the ASMBS Foundation's Outstanding Achievement Award at the L.E.A.D. Awards Lunch. The new procedure ushered in a new era of bariatric surgery, and after 9,000 bariatric operations Dr. Wittgrove remains as committed today to bariatric surgery and treating the disease of obesity as he did on that historic day 20 years ago. Click here to read more about the first laparoscopic gastric bypass.

New Obesity Stats from CDC

In the first decade of the millennium, Americans watched their waistlines gradually expand as the number of people with obesity nationwide grew more than 5 percent. However, in October 2013 the Center for Disease Control and Prevention (CDC) released its latest obesity rate estimates showing the number of people with obesity had remained steady since 2010. The CDC estimates about 78 million adults, or 34.9 percent of Americans had obesity in 2012, compared to 35.7 percent in 2010.