different complications of obesity

Jason-1Last week, I attended three days of scientific sessions at ObesityWeek 2015 and left with a number of enduring takeaways about metabolic disease and its treatments. But unlike other medical conferences I’ve been to, what made this one refreshingly different was not that an overwhelming number of new topics were being introduced, although that’s not to say there weren’t any. But as is the case with medical specialties that are long established and can therefore be advanced across new frontiers with cutting-edge research and medical technology, what is telling about the field of bariatrics is the incremental speed at which advances can happen. This is because obesity as a disease still remains much misunderstood, its etiology elusive, and its treatments constantly up for debate. The same basic questions that have been on obesity’s front page remain there, now as in the past, printed with a font size that’s larger than ever, hoping it can soon be replaced with a new headline.

What I’d like to share in this blog, then, are five things about obesity, bariatric surgery, and emerging endoluminal treatments I knew going into ObesityWeek, but left reconsidering.

What I knew: Sleeve gastrectomy is currently the most commonly performed bariatric surgery in the world due to its moderate risk-benefit profile, relative to the lower risk-benefit gastric band and the higher risk-benefit Roux-en-Y gastric bypass.

What I now know: Yes, the sleeve is popular, but the way surgeons are performing them can create a bunch of problems down the line; surgeons are increasingly taking note of this and thinking about complication prevention as much as weight loss outcomes. Besides common problems such as leaks, there is a rising concern about the development of GERD postsurgery. Also, revision rates are higher than I initially thought, with one attendee I spoke to saying it can reach as high as 40%.

What I knew: Gastric band numbers aren’t looking good. The market is rapidly declining and surgeons have moved on from this option.

What I now know: I did not expect to hear it put so bluntly, but during a session titled “The Current Leading Procedures in Metabolic Surgery”, one panelist boldly—but rhetorically—asked, “Are bands dead?” to which no one in the room could deny. Meanwhile, omega-loop procedures are rising globally, at least driven by some proponents outside the US.

What I knew: Obesity is a multifactorial disease requiring a multidisciplinary approach to treatment.

What I now know: For once, MDs didn’t dominate the convention halls. The attendee mix was diverse, with a sizable proportion of them wearing the letters RN, RD on their badges, along with psychologists and PhDs representing a variety of fields. And while the conference was US-centric, I got to experience its international exposure firsthand while discussing socialized healthcare over lunch one day with surgeons from Sweden, and sharing thoughts about ReCharge trial data with a surgeon from Australia.

What I knew: Endoluminal bariatric therapies have always been, and will continue to be, an area where innovation is headed.

What I now know: As promising as endoluminal treatments seem to be, they don’t necessarily tackle the roots of obesity and diabetes, because very little yet is known about what those roots actually are. For example, EnteroMedics’ vBloc Maestro works by blocking the vagus nerve to induce feelings of satiety. However, one session that was devoted to the vagus nerve’s role in obesity talked about how vagal stimulation and blockade both produce similar effects. What is really going on? Similarly, while gastric bypass surgery is probably the most trusted procedure due to its long history and significant weight loss outcomes, what happens when we attempt to mimic its effects with devices like the EndoBarrier or by ablating the duodenum with Fractyl’s Revita? As innovation continues, we should remind ourselves that EBT can stand for both endoluminal bariatric therapies and evidence-based treatment.

What I knew: Telehealth, e-Health, digital health…whatever you want to call it—it’s the future of medicine across pretty much every specialty.

What I now know: Bariatrics is moving in that same direction, at a faster pace than I could imagine, because now it has become part of the integrated health deliverer’s toolkit. Whether it is a mobile app that tracks eating behavior, a Fitbit-like device that counts the number of bites you take, or a service that helps you buy healthier groceries, health care providers are increasingly using digital tech to make sure that surgery is not seen as a panacea but one step in the weight loss journey, to stay in touch with patients more often and across far distances, and to prevent them from falling off the wagon.

Follow Jason Lau on Twitter at @JLauDRG for additional medtech market insights.

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