Surgeons often become frustrated with the fact hat, for various reasons, it can take a long time for research to translate into practice. Consequently, we rarely celebrate our accomplishments
and often forget the tremendous progress we have
made in our understanding of surgical diseases and
how they are best treated. Our heightened awareness of the causes and effects of morbid obesity is an
example of an area that has experienced significant
improvements in recent decades.
A learning experience
Two pioneers in metabolic and bariatric surgery—
Henry Buchwald, MD, PhD, FACS, FRCS(Hon), and
Walter J. Pories, MD, FACS—convened a Metabolic
Surgery Symposium, August 9−10 in Chicago, IL. The
American College of Surgeons (ACS) sponsored the conference, and I participated in both days of the program.
The experience was eye-opening and invigorating.
Dr. Buchwald, professor of surgery and biomedical
engineering, University of Minnesota, Minneapolis, is
renowned for his research into type 2 diabetes and its
reduction through bariatric surgery, as well as for the
introduction of new approaches to bariatric surgery.
Dr. Pories is professor of surgery, biochemistry, and
kinesiology at East Carolina University, Greenville,
NC. In addition to his seminal work in wound healing,
Dr. Pories was the first to describe the full and durable
remission of type 2 diabetes following gastric bypass
surgery. He is a principal investigator for the National
Institutes of Health (NIH) study Longitudinal Assessment of Bariatric Surgery and other research into the
mechanisms of diabetes remission supported by the
NIH and industry.
The symposium comprised a group of other outstanding leaders in the field of metabolic and bariatric care
(see sidebar, page 11, for list of speakers). They addressed
a range of issues, including mechanisms of metabolic
bariatric surgery, metabolic surgery to control diabetes,
psychiatric treatment for eating disorders, neurologic
conditions and metabolic surgery, international metabolic
surgery, ACS quality and safety programs in metabolic
surgery, and the effects of politics on metabolic surgery.
An evolving specialty
These speakers showed how our understanding of
morbid obesity and its treatment have evolved. Initially, we thought morbidly obese patients could be
treated through weight-loss procedures, followed
by diet, exercise, and the adoption of healthy life-styles. But diet and exercise have only a temporary
effect. A study of winners of the weight-loss competition television show The Biggest Loser indicated
that the contestants usually regain the weight they
lost within six years. This return to their previous
weight is attributed to two factors. First, their resting metabolisms continued to slow even after they
lost the weight and assumed healthy eating habits.
Second, their bodies produced lower levels of leptin,
which led to increased hunger, cravings, and eating
binges. In other words, their bodies actually resisted
Furthermore, many morbidly obese people who
have tried to lose weight through diet and exercise often cannot afford or other wise don’t have access to the
full range of caregivers who can help them maintain
a stable weight, including psychologists, sleep specialists, trainers, and so on.
Bariatric surgery has proven to be the most effective
means of addressing morbid obesity and its comorbidities, including type 2 diabetes mellitus, hypertension,
dyslipidemia, cardiovascular disease, stroke, sleep apnea, gallbladder disease, hyperuricemia and gout, and
osteoarthritis. Although many drugs are in development to regulate metabolism, their long-term effect is
minimal in comparison with the long-lasting impact of
metabolic surgery. These procedures also help people
improve their self-image and self-confidence, thereby
reducing the risk of depression and anxiety.
Perhaps most importantly, bariatric surgery is safe,
has durable outcomes, and is acceptable to patients who
are presented with the option. Numerous studies have
shown that bariatric operations can be performed as
safely and with outcomes that are equal to operations
performed to treat gastroesophageal reflux disease.
There was palpable excitement as the speakers at
the Metabolic Surgery Symposium shared this infor-
by David B. Hoyt, MD, FACS