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Are You Putting Patients First?

Bariatric Professionals and ASMBS: Are You Putting Patients First?

Surgeons, integrated health professionals, and other weight loss surgery advocates share a common goal: to use weight loss surgery to treat patients with obesity. We all agree that patients do not deserve to feel hopeless in their fight against obesity. They merit the best medical support that we can provide to help them fight obesity and become healthier.

Most surgeons and integrated health professionals are working hard, day in and day out, to help patients meet their goals. However, there is still room for improvement as we work to carry out the mission of the ASMBS. By working together productively, presenting a unified front, and putting patients first, we can make far greater strides towards fighting obesity than treating the field of bariatrics like a competition.

Functions of ASMBS

ASMBS is the leading national body for bariatric surgery whose purpose is “to advance the art and science of metabolic and bariatric surgery by continually improving the quality and safety of care and treatment of people with obesity and related diseases.” It pursues its purpose in the following ways.

  • “Advancing the science of metabolic and bariatric surgery and increase public understanding of obesity.
  • Fostering collaboration between health professionals on obesity and related diseases.
  • Providing leadership in metabolic and bariatric surgery the multidisciplinary management of obesity.
  • Advocating for health care policy that ensures patient access to prevention and treatment of obesity.
  • Serving the educational needs of our members, the public and other professionals.”

But what happens when the ASMBS goes off course? What if we make patient healthcare decisions based on subjective data rather than hard science? What if we stop sharing our experiences with each other and keep our knowledge secret? What if we don’t bother to reach out to other bariatric healthcare specialists to ensure that our patients receive the services they need? If we don’t work together, we might see:

  • Lack of progress in refining and advancing surgical techniques.
  • Stalled growth in our base of scientific knowledge regarding patient outcomes.
  • Poor patient outcomes due to lack of comprehensive support.

A Divided Voice is a Weak One

Unchecked fighting amongst ourselves does a disservice to the field of bariatric surgery and to bariatric surgery patients and candidates. It weakens our collective voice, making us less influential. An inability to present a unified front harms the very patients that we are trying to protect.

  • Mixed messages give the media opportunities to write unsympathetic stories that make patients seem at fault for obesity or make weight loss surgery seem like an irresponsible choice.
  • Patients who are trying to gather information about weight loss surgery don’t know what to believe or whom to trust.
  • Policymakers are less likely to take weight loss surgery seriously and pass policies such as requiring health insurance companies to cover weight loss surgery and employers to be sympathetic to the needs of recovering patients.

Sleeve, Bypass, or Band?

A perennial question in the field of bariatric surgery is which bariatric procedure to perform on a given patient. The answer to this question should be based solely on the interests of the patient, but this does not always seem to be the case. The respective prevalence of the difference procedures seems to come in waves. This is justifiable for some reasons, since increased knowledge and improved techniques make some options obsolete while giving us new viable choices. However, far too much of the decision seems to be based on current popularity than on the patient’s interest.

The adjustable gastric band was all the rage about a decade ago. Since then, many surgeons have soured on it and are more likely to encourage the vertical gastric sleeve. Neither type of surgery is the single “right” solution. Disadvantages of the band include risk of slippage, obstruction, and erosion, while the sleeve in turn is irreversible and can carry risks of staple line leakage. The gastric bypass remains a popular option, but has its own drawbacks, including greater risk for malnutrition, dumping syndrome, and bowel obstruction.

The band, bypass, and sleeve all have the potential to lead to weight loss as long as the patient sticks to the required diet. When it comes to weight loss and maintenance, none of the surgery types is fail-proof, although the gastric bypass may have a slight edge. Weight regain is almost certain if patients remove the band without getting another procedure. And, inappropriate eating habits will lead to weight regain regardless of whether the patient has the band, bypass, or sleeve.

The Patient Comes First

The decision about which procedure a certain patient should receive should never be based on a surgeon’s own comfort in performing a certain procedure. It should have nothing to do with what is currently popular in the surgical community. The only important consideration when choosing a procedure is what is in the best interest of the patient. Which procedure:

  • Can help the patient lose weight?
  • Has a relatively low risk of complications?
  • Is most likely to help the patient keep it off long-term?

You can address these questions by keeping up with the scientific literature and staying in touch with colleagues in the ASMBS community. The decision gets more complicated, though, and two patients of the same age, health status, and weight may not be best off with the same procedure. As an expert in the field, you have the ability and the duty to dig a little deeper and learn a little more about the individual patient. For example, the following discussions are based on patient preference and lifestyle rather than scientific data.

  • If a patient is hoping to become pregnant, you might want to discuss the band because of its ability to be unfilled during pregnancy.
  • If a patient has an uncontrollable sweet tooth, the bypass may be a good tool to aid in the avoidance of sugary foods.
  • If a patient is against the band because it involves placement of a foreign object, you might ask them to consider the sleeve.

Patients Are Entitled to Information

Your patients are entitled to the most accurate, unbiased, and current information on differences between bariatric procedures. This information is more readily available when ASMBS members work together to come to a consensus on best practices, and when you are familiar with current knowledge and trends in bariatric surgery.

You are responsible for making sure patients have access to this information in a form they can understand. Your job is to answer all of their questions, as many times as they want, without pressuring them to rush a decision.

  • They may not know where to find or how to interpret scientific findings or ASMBS position statements, but you do.
  • Also offer your opinion and recommendations based on your experiences.
  • Dig a little deeper to find out why a patient seems to want or not want a certain procedure. For example, a patient might seem adamant about the band, but upon further investigation, you might discover that she is expecting it to be temporary because it is irreversible. In this case, you would need to explain that band patients who remove their bands and do not have another procedure have almost no chance of keeping the weight off.

Stand Together for Patients and for Professionals

This is a very exciting time in bariatric surgery. We are starting to see long-term outcomes of earlier procedures, improvements in current and emerging techniques, and new discoveries about the potential health benefits of bariatric surgery. Weight loss surgery is increasingly becoming accepted as a mainstream treatment for obesity, as evidenced by increasing numbers of patients and more widespread coverage by health insurance companies.

Surgeons, integrated health professionals, and ASMBS have the potential to keep these positive changes going strong, but our loud voice can be threatened. Jumping onto the bandwagon of whichever surgical procedure is currently hot is a surefire way to give patients suboptimal care. Instead, we need to collaborate with and learn from each other to be able to provide the best possible counsel and care to patients, and to make ASMBS an effective advocate for weight loss surgery.