DR. NGUYEN'S BLOG-

Bariatric Surgery Remains
Significantly Underutilized

Published in May 2014 Issue             

The good news is the number of bariatric procedures grew by about 15 percent in the U.S. between 2011 and 2013, according to new estimates from the ASMBS. The bad news is bariatric surgery remains one of the most underutilized treatments for disease the world has ever known. It is estimated that bariatric surgery is only being performed on approximately 1 percent of surgically eligible
patient population.

How could this be, particularly in a country plagued by the twin epidemics of obesity and diabetes and where the leading cause of death for both men and women is coronary artery disease? Imagine if only 1 percent of diabetes and heart patients were being treated. It would be scandalous.

Yet for some reason, it is okay to basically ignore obesity, particularly severe obesity, in favor of treating the consequences of the disease. This makes no medical or economic sense.

It is not uncommon for primary care physicians to treat the diseases associated with obesity without treating the underlying disease of obesity. This must change. More primary care physicians must directly address obesity and treat it for the disease that it is and provide patients with options, not silence. This was clearly stated in the recent ACC/AHA/TOS Clinical Practice Guideline on the management of adult obesity.

Specifically, the guideline recommends identifying patients who need to lose weight by measuring BMI and waist circumference; counseling obese adults with cardiovascular risk factors that weight loss of 3-5% can produce meaningful health benefits; discussing dietary strategies for weight loss; advising individuals with obesity to participate in >6 months comprehensive lifestyle intervention and counseling; and advising adults with BMI>35 with obesity-related conditions that bariatric surgery may provide significant health benefits.

The publication of the guideline itself will not produce the results we seek. To this end, we are planning several initiatives to reach primary care physicians, insurers and
patients themselves.

Primary Care
We are planning to hold a summit this summer with our medical and surgical colleagues who participate in the care of adults with obesity. Our main goals are to delineate a needs assessment for the provision of obesity care across all disciplines and show opportunities for better coordination of care. We will have more details on the event in the next
several weeks.

Insurers and Policymakers
Currently, only 22 of 50 states have bariatric surgery listed as a covered benefit within the Affordable Care Act. The ASMBS Access to Care Committee, ASMBS leadership and our state chapters are working hard to change this, so that where you happen to live does not dictate whether or not you can get treated for disease.

Patients
We continue to make strides in improving patient understanding of bariatric and metabolic surgery, but old notions or misperceptions still exists among patients. While the safety of bariatric surgery has improved significantly over the past decade, some patients consider surgery overly dangerous even though the mortality rate is now even less than that of laparoscopic cholecystectomy and hip replacement, two of the most common operations performed in the United States.

Surgery is not an easy decision. However, we hope to make the decision more informed by educating patients not only on the pros and cons of surgery, but on the dangers and risks of obesity itself.

The ASMBS is producing a new patient video featuring several bariatric surgery patients who made decisions about their obesity that changed the course of their lives. The video will delve into their thought processes as they overcame their fears, not just of surgery, but also of failure failure to lose weight and get healthy even after surgery. We will learn what finally led them to make the decision to have surgery, despite the many barriers they faced. We hope patients who watch this video will see themselves in these patient stories and be inspired to take action on their own disease. We hope to debut the video
at ObesityWeek2014.

Ive listed here just some of the projects the ASMBS is doing to improve understanding and access to obesity treatments. Id love to hear your thoughts on what we can do to help the millions of patients who need treatment, but either avoid or are denied an effective solution. Please send me your thoughts at asmbspresident@asmbs.org.