Bariatric Surgery Section July 2010 Newsletter

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Bariatric Surgery Section Newsletter
July 2010
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Dear Bariatric Section Members,

We hope our members are enjoying a healthy and productive summer.  We are happy to provide a number of updates since our last newsletter in April.  We are including an update on our program committee, and a preview of upcoming events of interest at Obesity 2010, the 28th Annual Scientific Meeting, in San Diego, CA.  Last newsletter we introduced "Just Published..." a review and/or brief editorial of a recent article of interest to our section members.  In this issue, Leslie Heinberg, PhD (our Secretary/Treasurer) has written this installment.  
As a reminder, our section's website has been launched.  Please visit it at
We look forward to comments, suggestions and ideas for future topics for the next publication of the Bariatric Surgery Section Newsletter.  Please send these to our Secretary/Treasurer, Leslie Heinberg.  
As a reminder, we'll be holding our annual section meeting Monday, Oct. 11 from 12:00 - 2:00pm.  Our program committee is working on an interactive and exciting agenda for this meeting.  We are looking forward to seeing you there.
Best Regards,
Phil Schauer, MD
The Obesity Society
Chair - Bariatric Surgery Section
TOS Bariatric Section Program Committee
Based on your feedback from the March 2010 membership survey, we have formed our first committee: the Bariatric Section Program Committee.  Lee Kaplan, MD has agreed to serve as chair and Anthony Fabricatore, PhD has taken the position of Co-Chair of this committee.  They will oversee a group of TOS Bariatric Section members that will represent all relevant disciplines and a mix of trainees, academics, clinicians, etc.  They have been challenged with working on our 2010 Section Meeting content, the 2011 ASMBS/TOS joint-sponsored programs, overall program content for Obesity 2011 and, in the future, the content for Obesity Week in November, 2013 which will combine the annual scientific meetings of TOS and ASMBS.  We are very pleased to have their input and expertise and look forward to their contributions to future TOS meetings. 
Obesity 2010, 28th Annual Scientific Meeting - Content of Interest to Section Members
CORE Seminar:

Debate: Bariatric Surgery: Which Procedure Do you Recommend for Whom?
Saturday 10/9/10: 1:45-2:45pm
Symposium: Troubleshooting After Bariatric Surgery
Sunday 10/10/10: 3:30-5:00pm 
Symposium: Childhood Obesity: What to do?
When to Consider Bariatric Surgery
Tuesday 10/12/10: 8:00-9:30am
Friday 10/8/10: 8:00am-4:45pm
This didactic session will cover practical topics in obesity management including the peri-operative management of surgical patients. Click here for more information. 
Just Published...
This month we review the recent publication, "Beyond the BMI: The search for better guidelines for bariatric surgery" by Walter J. Pories, Lynis G. Dohm & Christopher J. Mansfield published in the May issue of Obesity. (2010;18(5):865-71).
The BMI (kg/m2) is a simple metric for measuring degree of adiposity and has shown research utility for use in epidemiologic studies.  Dr. Pories and colleagues argue that its use for population-based studies remains critical.  However, its adoption for clinical use and by Medicare, Medicaid and most private insurers for determining appropriateness for bariatric surgery has been largely detrimental.
This research review and proposal outlines the development of the BMI as a measurement tool, its appropriate uses and alternative measures of adiposity (most of which has been tried and abandoned due to feasibility concerns).  BMI as a guideline for bariatric surgery access worked well in the early years of weight loss surgery when most surgical cases exceeded BMIs of 50.  In contrast, it has proved less than adequate in the following years as mounting evidence demonstrated the safety and efficacy of bariatric surgery in less clinically severe populations.
Pories and colleagues provide strong empirical evidence to demonstrate that simplistic BMI cut-offs (e.g., BMI ≥ 40 or a BMI ≥ 35 with at least one co-morbidity related to obesity) discriminates against: 1) people of color; 2) older patients; 3) male patients; and 4) patients who are fit.  Further, BMI fails to account for distribution of adiposity or confounding medical factors such as the edema of cardiac failure or the severity of obesity-related co-morbidities.
The authors argue that our current guidelines need to be revisited and they propose an innovative and useful "adjusted BMI" metric that considers demographic and clinical factors.  They propose that "adjusted BMI" should be calculated as follows: kg/m2 + 3 (for Asians, African Americans and Hispanics) and + 1 for each of the following co-morbidities (diabetes, hypertension, sleep apnea, polycystic ovary disease, asthma, Pickwickian syndrome, hyperlipidemia, limiting arthritis of weight-bearing joints, and pseudotumor cerebri).  The strengths and limitations of the "adjusted BMI" are reviewed.  Although the utility of this method needs to be established in randomized, prospective trials, the need to move beyond the current BMI cut-offs is strongly demonstrated by this review. 
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