Bariatric and metabolic care is increasingly complex. While patients with obesity once had a limited range of options for weight loss, they now may choose from medication-based approaches, endoscopic interventions, and laparoscopic surgical procedures. This year’s Great Bariatric Debates will deliberate how these options are best deployed—and how their use may change the work that bariatric surgeons do.
Ali Tavakkoli, MBBS, FACS, a bariatric surgeon at the Brigham & Women’s Hospital in Boston, Massachusetts, will comoderate the session with Ann M. Rogers, MD, FACS, a bariatric surgeon from Hershey Medical Center and Pennsylvania State University College of Medicine in Hershey and the current president of the American Society for Metabolic and Bariatric Surgery.
The session, PS201, will begin at 8:00 am today, in Room W-375b.
The session will tackle two questions. The first debate will focus on whether the use of increasingly efficacious anti-obesity medications will decrease or even eliminate the need for bariatric surgery in the future. The second debate will explore the role of primary bariatric endoscopic interventions in obesity management and discuss the appropriate body mass index threshold for these procedures.
Dr. Tavakkoli said he proposed the session because “the field, I think, feels a little bit threatened by these new medications. There is a sense that these medications are or these endoscopic interventions are going to replace surgeons.”
Neither Dr. Tavakkoli nor Dr. Rogers endorse that view. Both acknowledge the possibility of the opposite outcome, in which anti-obesity medications function as “gateway drugs,” in the words of Dr. Rogers, to help more of the 40% of US adults with obesity seek out metabolic and bariatric surgery, a procedure few currently pursue.
The session, therefore, will address how the rapid increase in options has altered the work of bariatric surgeons and how the new array of options may impact patient needs over time. The debate format is a chance for opinionated discussion on the selection and sequencing of multimodal clinical and surgical care, particularly as many patients undergo multiple kinds of care for this chronic condition.
Bariatric surgeons Gregory F. Dakin, MD, FACS, who is chief of gastrointestinal, metabolic, and bariatric surgery in the Department of Surgery at NewYork-Presbyterian/ Weill Cornell Medicine in New York, New York, will deliver the argument that anti-obesity medications will substantially reduce the need for bariatric surgery. Paulina Salminen, MD, PhD, FACS(Hon), professor of surgery and gastrointestinal surgery at the University of Turku and Turku University Hospital in Finland, will argue the “no” side.
The second debate will focus on the question “Should primary endoscopic bariatric procedures be offered to those with body mass index (BMI) >35?”
The debate, Drs. Tavakkoli said, will tackle the appropriateness of this procedure for patients with very high BMIs, as a “bridge procedure” to reduce weight and facilitate the safe completion of laparoscopic surgeries that can more substantially reduce body mass.
Dr. Rogers further explained, “The main device that is FDA approved is for BMI 30 to 40. But what a lot of people would love to see is it being offered for patients with an exceedingly high BMI, which it's currently not.”
Bariatric surgeon Michael Ujiki, MD, FACS, from Northshore Hospital in Evanston, Illinois, will provide the “yes” presentation. His talk will focus on endoscopic sleeve gastroplasty, a procedure that uses sutures to reduce stomach size, because “that seems to be the primary procedure” in use at this time, per Dr. Tavakkoli.
Monali Misra, MD, FACS, FRCSC, who is associate director of the Bariatric Program at Cedars-Sinai Marina del Rey Hospital in Los Angeles, California, will provide the “no” presentation.
Each of the two debates in the session will begin with brief presentations reviewing the current state of options within anti-obesity medication and endoscopic care. Dr. Rogers noted that the session is distinct from other educational options because insights of frontline clinicians will augment quantitative data that, while useful, cannot offer up-to-the-minute accuracy about the ongoing rapid shifts in this area of clinical care.
While the session is primarily about bariatric surgery, both moderators suggested that surgeons from several disciplines would benefit from a broad understanding of the treatment options for patients with obesity.
“I think that weight optimization is a topic that impacts most surgical specialties, including orthopaedics, hernia surgery, and oncological surgery,” Dr. Tavakkoli explained. “It's important for every surgeon to be well-informed about the options that are available and their pros and cons. I think this will be important for how they interact or cancel their patients who need weight management. We have broad applications to everyone.”
