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GOSS - representing bariatric surgeons in the Gulf
“The growth of bariatric surgery within the Gulf region was rather sporadic with groups of surgeons performing procedures here and there,” explains Dr Al Jarallah. “Over the past ten years, bariatric surgery has become a well established surgical specialty and several obesity surgical societies have been formed in the Gulf regions including Kuwait, Saudi Arabia and the United Arab Emirates, with Bahrain, Oman and Qatar in the process of establishing national societies. As a result, in 2012 an initiative was started to create GOSS and the society was formerly created at a meeting of our Executive Board in 2013.”
There are six member countries of GOSS (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates) and each country has three representatives on the societies Executive Board. The society currently has approximately 200 members and all members of the national societies automatically become members of GOSS.
“The society has several aims,” said Dr Torab. “But its most important achievement is to gather together the knowledge and expertise of all the bariatric surgeons in the Gulf region. This is achieved by consolidating national conferences into a single educational platform - the annual GOSS meeting - for bariatric surgeons, clinicians and allied health professionals.”
Another aim of GOSS is to create unified guidelines for bariatric surgery in the Gulf region including establishing and the accreditation of centres of excellence, which are accepted by surgeons, governments and insurance companies, which will also conform to established international guidelines.
“We are also eager to establish Gulf bariatric surgical registry and gather together our research and knowledge so we can report our outcomes. Surgeons in the region are are performing a lot of cases, but unfortunately we are not reporting the outcomes sufficiently on the international stage,” added Dr Torab. “So, a Gulf bariatric surgery registry would not only assist us in improving patient outcomes but also in publishing our research and findings in scientific journals.”
GOSS is also hoping to establish accredited centres of education in each member country for training the next generation of bariatric surgeons. The society has charged it’s Educational Scientific Committee with the task of establishing workshops and training centres, not only for GOSS members but also for surgeons in the Asia-Pacific Chapter. It recently started the first fellowship programme in the UAE and is currently working towards gaining accreditation.
“We have all the right ingredients for training with vastly experienced surgeons and excellent facilities,” said Dr Al Jarallah. “Instead of sending surgeons to Europe, Asia or America for training we would like to provide them with the training in the Gulf, and there is little doubt there is a demand. We are at the centre of the region with increased demand from Iran and beyond, so training and keeping the next generation of bariatric surgeons is vital to the growth and future of our specialty.”
The society also wants to play a very active role in the Asia-Pacific Chapter of IFSO and Kuwait is going to bid for the honour of hosting the Asia-Pacific Chapter meeting in 2017.
“It is important that we welcome people to the meeting so our colleagues across Asia can see the quality of work we are doing”, Al Jarallah continued. “Now is the time to announce to the world that although we are a young society, as a region we are combating obesity through the highest quality care in bariatric and metabolic surgery.”
Surgery in the Gulf
In contrast to Western Europe and the United States where bariatric surgery procedures have plateaued in recent years, in the last 2-3 years the number of procedures has almost doubled in the region. In 2013, it is estimated that there were approximately 7,000 bariatric procedures in Kuwait, about 4,000 cases in UAE and about 13,000 cases in Saudi Arabia. However, the exact number of cases is actually higher, as some centres did not report the number of cases. Across the Gulf region, there are at least 30,000 cases annually.
Although all governments across the region are very supportive of bariatric surgery and they understand that morbid obesity is a public health issue, only some insurance companies cover bariatric surgery for patients who have BMI 50.
“In the UAE, 8.6% of males and 11.2% of females are morbidly obese, with about 30% of the adult population classified as obese,” said Dr Torab. “In a population of about five million that is some half a million people who are eligible for surgery, so will still lack the resources to make a serious impact. I think the difference in the last few years is that people are no longer afraid to have bariatric surgery, they now know it is safe.”
This significant increase in the quality of bariatric surgery provided has also resulted in patients coming earlier and earlier for surgical treatment. Dr Al Jarallah explained that previously they would only treat patients with very high BMI, long-term type 2 diabetes, hypertension and other co-morbidities. “Now, the younger generation has seen how their families have suffered because of obesity and understand that consequences of inaction.”
“In the UAE, the primary cause of death is cardiovascular disease. Diabetes and obesity play a significant part in increasing the severity of the disease” added Dr Torab. As people have become more aware how obesity can shorten their lives they have sought out treatment earlier so they do not develop such debilitating condition such as hypertension and type 2 diabetes, he explained.
The causes of obesity are the same across the region – lifestyle – from an unbalanced diet to a lack of exercise. The Gulf region has a climate that is not suitable for outdoor sports, fast food has entered society and is available on every street corner.
“Despite growing awareness and support from governments it is still important that we are able to increase awareness throughout society from the government to health authorities and the wider general public,” said Dr Torab. “We know that the effect of bariatric surgery and the subsequent outcomes for patients are better the sooner they have surgery, and that means offering surgery before they present with BMI 50. This is a key message we need to make our governments aware of.”
GOSS will soon be establishing its own offices in the UAE and will appoint a Secretariat to oversee the governance and administration of the society, which will not only provide the society with a means to communicate more effectively with its members but also improve the communication between GOSS members.
“It has taken us a long time from when we first had the idea of creating a Gulf society for obesity surgery to formerly establish it,” added Dr Al Jarallah. “In the beginning there was some scepticism and resistance. Now, everybody is working together and all the members in each country continue to work very hard to ensure GOSS becomes a great success. We are looking forward to the Annual GOSS meeting in December under the leadership of Dr Faruq M Badiuddin, President of EOMSIG.”