Bariatric Surgery Section April 2010 Newsletter

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The Obesity Society
Bariatric Surgery Section Newsletter
April 2010
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Dear Bariatric Section Members,

Greetings!  We are happy to provide a number of updates in our April newsletter.  We are including the results of our first survey with information on how we're using your feedback.  We're also introducing a regular feature-"Just Published...".  This is a review and/or brief editorial of a recent article of interest to our Section members.  Adrienne Youdim, MD (our Chair-elect) has written our first "Just Published..." review.  
 
We are also very pleased that our Section's new website has been launched.  Please visit it at http://www.obesity.org/about/Sections/Bariatric_Surgery.asp.
 
 Please forward content suggestions for inclusion, editorials for "Just Published" or other topics for the next publication of the Bariatric Surgery Section Newsletter to our Secretary/Treasurer, Leslie Heinberg.
 
Finally, I encourage members to take advantage of the Early-Bird Registration April 1 - June 30, 2010 for Obesity 2010 in San Diego, CA.  We'll be holding our annual Section meeting Monday, Oct. 11 from 12:15 - 2:15pm and I look forward to seeing you there.
 
Best Regards,
 
Phil Schauer, MD
The Obesity Society
Chair - Bariatric Surgery Section
2010 Bariatric Section Survey Results Summary
 
As discussed at our annual meeting, we surveyed our membership to better identify goals and needs of the group as well as identify individuals interested in increased involvement on various sub-committees. 

We would like to offer our sincere thanks to the 77 out of 309 members (25%) that took the time to complete our online survey. Although this response rate may not meet criteria for publication in Obesity, we are pleased that so many of our busy members provided such valuable feedback. 95% of those who responded identified email updates as their preferred form of communication. As such, we're including the results in this month's email newsletter to members.

We learned that 40% of respondents are unsure whether they were registered members of the Bariatric Section. Although those individuals provided their contact information, we encourage any members to join by clicking the link on our website. Our membership is markedly diverse with 27.2% of members specializing in medical management, 20.7% specializing in Psychology/Mental Health, 11.6% identified as basic scientists, 10.3% surgeons and a myriad of other specialties including: Nutrition, Physical Activity, Industry, Anesthesia, Public Health and Policy, Pharmacy, Education, Health Care Administration and Biostatistics. 

Almost half of the respondents are also members of ASMBS and 1/3 are members of the Academy for Eating Disorders. In all, participants reported cross-membership in 52 different professional societies.

We are the voice of bariatric surgery to TOS leadership. Respondents were asked to identify their top choices for how our Section should interface with TOS. The most commonly selected were: development of clinical guidelines (66.6%); professional networking (65.3%); publications (e.g., special issues of Obesity, 48.0%); TOS program development (44.0%); and education of other TOS members (41.3%). A number of other excellent recommendations were made that we will be reporting on in upcoming newsletters.

Our respondents were interested in committee organization that related to goals more so than specific disciplines. Given our diverse membership and interest in professional networking, such committees may be fruitful areas for trans-disciplinary collaboration. We will be in touch shortly with individuals who have volunteered for committee membership/leadership.

Finally, the top projects you'd like the Bariatric Surgery Section to pursue include: 1) Program topics for 2010 TOS annual meeting; 2) Cosponsored symposia with ASMBS; and 3) Update of TOS/ASMBS/ACE Guidelines.

Because of your feedback, our first committee will be the Bariatric Section Program Committee. The primary goal of this working group will be working on bariatric content for the TOS program in 2010 and the years beyond. We'll be in touch with those who expressed an interest on the survey. However, if you would like to be involved and did not complete the survey, please email Leslie Heinberg with your contact information.

A strong interest in professional networking was also identified. Beyond our annual section meeting on October 11th, there are a number of electronic networking opportunities. In addition to our website and newsletters, TOS members will soon be able to participate in discussions, post questions, and solicit input from colleagues through a listserv for bariatric section members.
CALL FOR VOLUNTEERS: Contribute to the COMP examination item bank
 
The Obesity Society is working with twelve other professional groups toward development of a Certified Obesity Medical Physician (COMP) program.    Thus far, the COMP Steering Committee has established the body of knowledge that an expert in obesity medicine should possess. The next phase of the program will generate a question item bank for the examination.  The Bariatric Section is hoping to assist this phase by identifying item writers with expertise and experience in severe obesity and weight loss surgery.  
 
It is hoped that each item writer would submit 8 to 10 exam questions over the next few weeks. Items will be submitted online using a Remote Item Writing (RIW) tool. In order to familiarize you with the tool, you will need to participate in a 45-minute webinar that will show you how the RIW system works. 
 
I hope that you agree to participate in this exciting initiative.  If you are interested in serving as an item writer for the COMP program exam, please email Bill Scott ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ) at the national office. Please do not hesitate contacting any of the Section officers should you have any further questions or wish to discuss in more detail.
 
Just Published...
 
As previously mentioned, we will provide an educational topic pertinent to bariatric medicine part of our quarterly newsletter. This month we will review the recent publication, "Nonsurgical Weight Loss for Extreme Obesity in Primary Care Settings, Results of the Louisiana Obese Subjects Study" by Ryan et al published in the January issue of the Archives in Internal Medicine. (Arch Intern Med. 2010;170(2):146-154)
 
The magnitude of individuals affected by obesity and the chronic nature of this disease place primary care physicians in a pivotal position to treat obesity. Furthermore the anticipated health care reform will reinforce the role of primary care physicians in managing chronic diseases such as obesity and in providing practical approaches to weight loss. Yet barriers exist to implementing effective weight loss strategies in this setting. In this study by Ryan et al, the authors examine whether primary care physicians, instructed in the principles of weight management, can effectively induce weight loss in subjects with severe obesity.
 
The study randomized 390 participants with BMI of 40 to 60 in 8 primary care sites to intensive medical intervention (IMI) using meal replacements, pharmacotherapy and behavioral modification or to usual care condition (UCC) in which patients were instructed to use an internet based weight management program. The IMI arm was divided into three phases. The first employed a very low calorie diet using liquid meal replacements for 12 weeks. The second phase incorporated one conventional meal in conjunction with 2 meal replacements daily, pharmacotherapy (sibutramine, orlistat or diethylpropion) and behavioral modification in the form of weekly then bimonthly support groups. Patients were seen by the treating physician monthly. Finally phase 3, occurring during months 8 to 24, consisted of one meal replacement daily, pharmacotherapy and monthly group sessions.
 
At 2 years, IMI showed a mean weight loss of 4.9% compared to 0.2% in the UCC group. Among the 51% that completed the intensive medical intervention, mean weight loss was 9.7% compared to 0.4% in participants (46%) who completed the usual care condition at two years. Among completers of IMI, 61%, 41% and 14% of individuals achieved weight loss of 5%, 10% and 20% or more respectively compared with 20%, 6% and 1% among the UCC participants. Other studies have demonstrated this degree of weight loss to result in significant improvements in co-morbid conditions such as reductions in total cholesterol and LDL, fasting blood glucose and HbA1c, high blood pressure and apnic events in sleep apnea among reductions in other co-morbidities. (1-5) In this study participants reached a nadir weight loss of 15.5% at approximately 9 months which translated into significant improvements in fasting blood glucose, HDL, TG, uric acid and liver function tests some of which were mitigated at 2 years likely related to weight regain.
 
This study demonstrates the feasibility of implementing effective weight management programs in the primary care setting in patients with extreme obesity. It also reinforces the challenges of long term weight loss and maintenance with non-surgical weight loss. Weight loss surgery currently provides the most durable treatment for severe obesity and can result in significant reductions in obesity related co-morbidities as well reduction in mortality (6-7). However patients may be limited by access, contraindications to surgery or financial constraints. In these instances, the practical model put forth in the LOSS study provides practitioners a viable approach to non-surgical weight loss in the severely obese population.
 

References:
1. Wing RR. Arch Intern Med. 1987;147:1749-1753.
2. Mertens IL. Obes Res. 2000;8:270-278.
3. Blackburn G. Obes Res. 1995;3 (Suppl 2):211S-216S.
4. Ditschunheit HH. Eur J Clin Nutr. 2002;56:264-270
5. Peppard . JAMA 2000;284:3015.
6. Sjostrom. NEJM. 2007; 357:741-52.
7. Adams. NEJM 2007;357:753-61.
For questions about this communication or about The Obesity Society, please contact Sadie Campbell, Governance and Executive Assistant at: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .  
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