Nashville's Parthenon

Building a Broader Base for Surgery at OW2018

Ever since the first bariatric surgeries emerged in the 1950s, the public has been skeptical. Bariatric surgeons found themselves in a box. Labels were a problem. Conceived as weight loss surgery, surgeons quickly figured out that it was doing more than causing people to lose weight. So they started calling it metabolic surgery, too. ASBS became ASMBS in 2007. But the process of building a broader base for surgery in obesity care is slow.

At OW2018, you can see it progressing in two ways.

Metabolic or Cardiometabolic Surgery?

The metabolic effects of surgery are quite profound. Even outside the rarified space of obesity experts, mainstream medical care is starting to recognize this fact. That is, a person with type 2 diabetes and obesity is far more likely to put diabetes into remission with surgery than with even intensive medical care. Results of the STAMPEDE study made that very clear.

But a metabolic benefit isn’t the end of the story. An OW symposium and multiple other presentations will tell us how metabolic benefits translate into cardiovascular health outcomes. Just before ObesityWeek, new research showed that strokes, heart attacks, and deaths are fewer after surgery. This week, investigators will present data on cardiovascular health markers from the STAMPEDE study.

Perhaps we could argue that it’s really cardiometabolic – not just metabolic – surgery. But not yet.

Building a Broader Model for Care

Surgery is all about procedures. But a successful bariatric surgery program is all about delivering a continuum of care for a chronic disease. Minimally, that means good pre-op and post-op care. In truth, though, that’s a very narrow view.

What’s needed, as we’ve explained before, is an integrated model for medical and surgical obesity care. As better obesity meds come along, this need will become urgent. ASMBS and ABOM are pointing to this at ObesityWeek. Their joint symposium tomorrow will describe how surgeons can grow their programs by building a program to deliver comprehensive care.

Without a broader base for surgery programs, they will likely find themselves ever more stuck in a box. Serving the needs of only a few percent of people living with obesity won’t work for the long term.

The words of William S. Burroughs are apt for considering the future in this context. “When you stop growing, you start dying.”

Click here for more on the cardiovascular benefits of bariatric surgery.

Nashville’s Parthenon, photograph © Allen Forrest / flickr

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November 12, 2018