Bariatric Surgery: Hot Topics & Biggest Opportunities

Stacy Brethauer, MD, a staff physician in Cleveland Clinic’s Bariatric and Metabolic Institute, has been serving for the past eight months as president of the American Society of Metabolic and Bariatric Surgeons (ASMBS), a term which ends in November. Below, he reflects on his efforts in this prestigious role.

Q: What has been your main priority as president of ASMBS?

A: My primary focus has been to advance the broad implementation of enhanced recovery (ER) pathways in bariatric surgery. We are currently running a national pilot that involves 37 centers, all of which are following an ER pathway that was devised by experts within the ASMBS. By enhanced recovery, we mean standardizing procedures and practices and improving the way we manage pain with a focus on opioid-sparing strategies. Enhanced recovery efforts have been emphasized for some time in other specialties, like colorectal surgery and orthopaedics, but such efforts have not been a focus in the majority of bariatric surgery centers.

After a year of planning, we’re now six months into this project and have another year to collect data. In July 2018, we will finish the data collection phase, and I expect to report on our findings at the Society’s meeting in November 2018. We call this initiative by the acronym ENERGY, which stands for Employing New Enhanced Recovery Goals in Bariatric SurgerY.

Q: What have been some of your other areas of focus?

A: I’ve been working on efforts to ramp up the involvement of our state and regional chapters. All 50 states are represented in one of the Society’s 37 chapters. The chapters have varying degrees of activity and maturity, and each one holds an annual meeting.

One goal is to activate the chapters to become more engaged with patient advocacy and access issues. Another goal is to ensure that the chapters are making good use of all the educational resources that the Society has to offer. We are also working to fully use the state chapters as a conduit for communication with individual members. I want those members to know that they have a direct line to leadership, not just to the state chapter’s president but also to the national leadership of the Society.

Q: How are you using your role as a platform to broaden the ASMBS’s reach?

A: We’re launching a social media campaign that will speak to both patients and physicians, emphasizing that bariatric surgery is safe and effective. I am doing this through a series of whiteboard video talks. They’re two- to four-minute presentations designed to catch peoples’ attention online. The content of the talks is based on a national survey that we did last year, which looked at perceptions of obesity and obesity treatments in the U.S.

From that survey, we learned that people generally do recognize obesity as a serious medical problem. In fact, obesity ranked as high as cancer as a medical issue, but the majority of the people surveyed felt that obesity was an issue that individuals could manage on their own. Furthermore, most people didn’t feel like their doctor would have the knowledge or the time to help them with obesity.

Also, while people recognize obesity as a national problem, they often don’t recognize that they themselves are obese when they are. They also overestimate the effectiveness of diet and exercise and underestimate the effectiveness of proven therapies like surgery.

Our social media campaign will includes both patient-facing videos and another physician-facing video. The one for clinicians will address myths that many providers have about the safety, durability and effectiveness of bariatric surgery. A lot of providers have outdated perceptions and are very skeptical about bariatric surgery, and it’s a constant battle to dispel myths and show that what we do is safe and effective.