Gastroenterologists Outline Plan of Action to Lead the Fight Against Obesity


Published in May Issue             

The American Gastroenterological Association (AGA) believes gastroenterologists should play more of a role in obesity treatment, suggesting they are in a “unique position to lead the care team.”

To help make that a reality, the AGA has created an Obesity Practice Guide, part of a program to help gastroenterologists manage their patients with obesity and help GI professionals establish a framework focused on the business operational issues related to the management of patients with obesity. The new program includes two white papers: POWER: Practice Guide on Obesity and Weight Management, Education and Resources and Episode-of-Care Framework for the Management of Obesity: Moving Towards High Value, High Quality Care, both published in Clinical Gastroenterology and Hepatology, the clinical practice journal of the AGA.

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), The Obesity Society (TOS), and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) contributed content to the POWER program, which was endorsed with input from the American Society for Metabolic and Bariatric Surgery (ASMBS), American Society for Gastrointestinal Endoscopy (ASGE), American Association for the Study of Liver Diseases (AASLD), Obesity Medicine Association (OMA) and Academy of Nutrition and Dietetics (AND). The ASMBS also contributed to the obesity episode of care framework, along with the American Psychological Association (APA), American Pharmacists Association (APhA), and the Academy of Nutrition and Dietetics.

Andres Acosta, MD

“We created the practice guide on obesity and weight management to help gastroenterologists develop a multidisciplinary team and obesity care model for their practice, including patient goal setting, readiness assessment, evaluation, and treatment with diet, medication, and bariatric endoscopy and surgery,” said Andres Acosta, MD, PhD, lead author of the paper and assistant professor of medicine, Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), division of gastroenterology and hepatology, Mayo Clinic, Rochester, MN. “It is our hope that by working in a team-based approach, gastroenterologists can guide and personalize obesity care for safe and effective weight management for our patients.”

According to a press release from AGA, obesity treatment requires a collaborative approach involving multiple stakeholders. The AGA obesity episode of care model was developed to establish a framework to support value-based management of patients with obesity, focusing on the provision of non-surgical and endoscopic services. The framework will help gastroenterology practices assess their ability to participate in an episode of care for obesity, and understand the essentials of coding and billing for these services.

Sarah Streett, MD, an author of the paper, chair of the AGA Institute Practice Management and Economics Committee, and clinical associate professor and director of IBD Stanford University School of Medicine, CA, said in a press release, “The epidemic of obesity continues at alarming rates with a high burden to our economy and society. The American Gastroenterological Association understands the importance of embracing obesity as a chronic, relapsing disease and supports a multidisciplinary approach to the management of obesity.”

The AGA’s stated goal is to provide gastroenterologists “with strategies to obtain compensation for high value care, in a flexible format that can be adapted to the resources of both large and small practices.” The group says it’s essential that data coordination take place between the multidisciplinary team to “ensure high value continuity of care.”

Gastroenterologists currently treat many obesity-related conditions and diseases, including gallbladder disease, GERD, gallbladder disease, and nonalcoholic fatty liver disease. Further, minimally invasive endoscopic bariatric treatments like intragastric balloons are emerging and gastroenterologists are taking notice, perhaps giving them a better opportunity than ever to enter the field of obesity management.

In a position statement from 2015, the American Society for Gastrointestinal Endoscopy (ASGE) says endoscopic bariatric therapy (EBT) shows superiority over lifestyle intervention in randomized, controlled clinical trials, and that this therapy may be more effective than obesity medications. According to the statement, the EBTs that have been approved by FDA “meet thresholds of efficacy and safety as defined in the ASGE/ASMBS Preservation and Incorporation of Valuable Endoscopic Innovations” and should be included in the obesity treatment algorithm as adjunctive therapies to a lifestyle intervention program as outlined in the 2013 American Heart Association (AHA)/American College of Cardiology (ACC)/
The Obesity Society (TOS) guidelines for the management of overweight and obesity
in adults.

They go on to say, “It is incumbent upon digestive disease specialists who provide EBT in their clinical practice to become educated in the treatment of this complex disease and incorporate a multidisciplinary approach to treatment in their practice.”

Samer Mattar, MD

“I believe the role of gastroenterologists will grow in parallel to the emergence of new and exciting endoscopic and less invasive options for overweight and obesity. The growth in this area, however, must be judicious and closely monitored to prevent the widespread adoption of methods or devices that have not completed rigorous testing,” said Samer Mattar, MD, president-elect, ASMBS and Professor of Surgery at Oregon Health & Science University.

In 2011, the ASGE and ASMBS jointly published a white paper to provide a pathway for bringing endoscopic bariatric therapies, which the group believes fills an important gap in current treatment options.