The Presidents Look Back
The 80s -- The Formative Years
Before there ever was a society for bariatric surgery, a small group of surgeons with an interest in the field began meeting every year in the mid-1970s at the University of Iowa for the Bariatric Surgery Colloquium, a post-graduate course led by the man who would come to be known as the "father of bariatric surgery." In 1983, seven years later, meeting registrants became members and Dr. Edward E. Mason became the first president of the American Society for Bariatric Surgery (ASBS). But the inspiration for the ASBS came to Idaho by way of Japan.
As Dr. Mason tells it: "I had been invited as an honorary guest for a meeting to be held in Tokyo in 1983 to form a Japanese obesity society. I had read that one could see that obesity was a problem in Japan by watching children leaving school at the end of the day. I decided that if the Japanese thought increasing obesity required a society, then we certainly needed one."
Thus a post-graduate course at the University of Iowa became the ASBS with little fanfare and hardly any resistance. "There was some disagreement regarding use of bariatric instead of obesity in the ASBS name. I wanted to lessen patient unjustified self blame for obesity. I don’t remember any objections to forming the society except for one person who claimed that there were too many surgical societies," said Dr. Mason who is now 93 years old. About 60 surgeons attended the first meeting.
Dr. Mason served as the president of the fledgling ASBS for the first two years. Dr. John D. Halverson took over in 1985 and brought the meeting to St. Louis where it was co-sponsored by Washington University. In 1987, Dr. J. Patrick O'Leary became the third and last ASBS president to serve a two-year term. Each ASMBS president that followed would serve for one year.
Dr. O'Leary said the ASBS attracted a diverse group of individuals, but that two schools of thought emerged during the formative years. "First; there was a group of anecdotalists, who looked upon events as singular. The other camp, made up of a small number of young, clinically active, academic surgeons, sought to apply a modicum of scientific rigor to the meetings. Although affability reigned, there were always certain tensions between these groups."
It seemed though that the greater tensions on obesity and surgery existed not among those inside the ASBS, but rather among those on the outside.
Dr. O'Leary recalls, "The general tenor of the times was that obesity was the end result of gluttony and sloth, and the established surgical community tolerated those of us who had an interest in this condition, but just barely. The prejudice ran so deeply that virtually no papers on the subject were presented at national meetings, unless they were an exploitation of the complications that occurred postoperatively. Little credence was given to the results that were published, and most of the surgeons that were involved in the specialty were virtually ostracized from academic promotion and membership in certain societies. 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."
The 90s -- Stand Up and Fight
In 1991, the National Institutes of Health (NIH) convened a consensus conference on "Gastrointestinal Surgery for Severe Obesity." Past and future ASBS presidents including Dr. Mason, Dr. Halverson and Dr. O'Leary and Dr. Walter Pories, Dr. Robert Brolin and Dr. Harvey J. Sugerman all presented at the conference that would eventually issue guidelines that established patient selection criteria and identified the "new surgical therapies" that could be considered (vertical banded gastroplasty and gastric bypass procedures) for severe obesity.
Dr. John H. Linner, the ASBS president at the time of the NIH conference also presented. Today at the age of 95, he remembers both the science and sentiment of the time.
"Morbidly obese patients were seriously disadvantaged in our society. Prejudice against these individuals was rampant. Not only were they afflicted by the diseases associated with morbid obesity, but they also were ostracized by society. My heart went out to them. As we began to understand the results of our procedures better, I became more and more an advocate for surgical intervention. Not only did the patients experience weight loss, but their comorbid conditions improved remarkably. They were better and lived a happier, more productive life. The ASBS (now the ASMBS) was one of the instruments that facilitated our appreciation that morbid obesity was a disease, and that surgical intervention had a remarkable therapeutic effect."
On the heels of the NIH consensus statement, Dr. Boyd E. Terry became ASBS president in 1992, at a time that he said the ASBS "needed to rise as the champion for the care of the severely obese. We needed to stand up and fight on many fronts to make our goals possible." He said the society needed to strengthen its membership and communicate its standards and guidelines to the public. "The need for quality data and performance relative to risk became a maxim."
About seven years before he became an ASBS president, Dr. Walter Pories, pioneered research into the effect of bariatric surgery on type 2 diabetes in a landmark paper published in the Annals of Surgery in 1995. The paper titled, “Who Would Have Thought It? An Operation Proves to be the Most Effective Therapy for Adult-onset Diabetes Mellitus" concluded "gastric bypass is now established as an effective and safe therapy for morbid obesity and its associated morbidities. No other therapy has produced such durable and complete control of diabetes mellitus."
Reflecting on the findings, Dr. Pories said, “Twenty-five years ago we were astonished by the curative effect the surgery had on type 2 diabetes. Today it’s one of the main reasons people have surgery and I’m confident new research into metabolic surgery will lead to further advances.”
Throughout the 1990s, the ASBS would continue to focus on developing data supporting bariatric surgery, but according to Dr. Henry Buchwald, ASBS president in 1998, "We continued the struggle to obtain the respect and recognition by medical school curricula, appointments to chairs of departments, prestigious general surgical societies, credentialing bodies, government regulators, private insurance, industry payers, the media, and the public in general."
The Year 2000 - The Golden Era Begins
That would change somewhat in the year 2000. Dr. Robert E. Brolin was ASBS president during a time he calls the "golden era" because it was the "dawn of the laparoscopic bariatric surgery era."
"The first two or so years of the new millennium and lap era were characterized by a large and refreshing amount of positive publicity in both medical and lay literature. This, of course, was in great contrast to what we had collectively endured in prior years in which bariatric surgery was for the most part scorned and ridiculed by our peers and occasionally the lay press," Dr. Brolin said.
Dr. Kenneth B. Jones, Jr. said his presidency in 2001 was defined by a "re-examination of who we were, where we were going, the risks of getting there, and the benefits of our destination and completed journey. 9/11/2001 had a profound effect on ALL of us in this respect." He said "weekend quickie courses sprung up everywhere, aimed at practicing surgeons who thought they could go home and do bariatric surgery laparoscopically, resulting in a plaintiff attorney heyday. This 'perfect storm' of paucity in med/mal insurance coverage opportunities and the practicing surgeons' 'learning curve' produced a near disaster for our sub-specialty."
Dr. Alan C. Wittgrove, who did the first laparoscopic gastric bypass in 1993, became ASBS president in 2003. It was under his reign that SOARD ("Surgery of Obesity and Related Diseases") was started and the ASBS Consensus Panel was held in Washington, DC.
"During the time I was honored to serve the ASBS as its president, we were in somewhat of a transitional time. Our membership was increasing at a significant and envious rate. ASBS was increasingly building national name recognition. Our society identified the need for more training for its members and course opportunities grew significantly. My board was a dynamic group of forward thinking individuals who worked collaboratively to build the future of our society but had a respect for the past as well. I had the good fortune to follow Dr. Pories who not only served as a mentor to me personally but also a visionary for the future of our society."
SOARD editor-in-chief since its inception, Dr. Harvey J. Sugerman was ASBS president in 2004, the same year the Centers of Excellence programs began and the first issue of the journal was published. Dr. Sugerman said he emphasized the importance of Quality Analysis and Improvement (QAI) in patient care. "Over the course of time we bariatric surgeons have shown the effectiveness of surgically induced weight loss, initially with the effects of paired pre- and post-weight reduction studies on numerous obesity co-morbidities, and more recently with Level I randomized control trials. Perhaps, with time, there will be a greater acceptance by the insurance industry that support of this surgery will not only improve our patients’ lives and longevity, but ultimately decrease the cost of health care."
Give Me an 'M'!: The ASBS Changes its Name
In 2006, the drums were banging loudly around surgery's effect on metabolic disease, particularly, type 2 diabetes. ASBS president Dr. Philip Schauer led the effort to change the society's name to reflect an expanding and evolving view of surgery. ASBS members were asked to vote on a new name for the society. With overwhelming support, members voted to change the society's name to the American Society for Metabolic and Bariatric Surgery (ASMBS). Twenty-five years after it started, the society had a new name.
With a new name and a greater focus on metabolic disease, Dr. Kelvin Higa became president in 2007. He commented at the time, “Surgery for severe obesity goes way beyond weight loss. This surgery results in the complete remission or significant improvement of type 2 diabetes and other life-threatening diseases in most patients. The society’s new name and mission reflects this expanded and evolving view of surgery. People generally don’t think of surgery as a treatment for diabetes or high blood pressure, but it is, and we expect metabolic surgery to play an ever increasing role in managing these diseases.”
The society made front page news in The Wall Street Journal as it publicly turned its focus on type 2 diabetes. This was more than a name change. This was a movement backed by science.
Dr. Scott Shikora was the next president. He helped establish the Obesity Compendium, a web-based interactive, e-learning, CME program covering most of the components of bariatric surgery that became a major source of educational materials for bariatric clinicians. Dr. John Baker and Dr. Bruce Wolfe followed each helping to build bridges to other entities concerned for people with obesity. Dr. Baker re-established ties with the American College of Surgeons (ACS). “The divergence and separation by the leadership of both societies was not helpful,” Dr. Baker said. Dr. Wolfe forged closer alliances with The Obesity Society, Obesity Action and the American Academy of Nutrition.
In 2011, Dr. Robin Blackstone became the first female president of the ASMBS. Her tenure was marked by the beginnings of a process to unify the ASMBS Bariatric Surgery Center of Excellence Program and ACS Bariatric Surgery Center Network accreditation and quality programs into MBSAQIP: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.
Dr. Blackstone voiced what drives ASMBS members. "The ASMBS is a unique, diverse group of individuals driven by the passion of caring for those people whose burden of obesity leaves them the victim of discrimination and prejudice. It is to these people and their burden that we dedicate our service. There is no higher calling.”
The Future -- Standing on the Shoulders of the Past
The ASMBS continues to push forward on behalf of patients and advance the science and understanding of obesity and its treatments. ASMBS President Dr. Jaime Ponce is helping to drive MBSAQIP and will preside over the first ever "ObesityWeek." Dr. Ninh T. Nguyen follows him as president, fresh off his role as program chair for ObesityWeek. Dr. John Morton becomes the president in November 2014.
Dr. Ponce recently commented, "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. 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?"
This article was based on the recollections provided by the ASMBS presidents, which can be found in the Presidential Gallery on the ASMBS 30th anniversary website.