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EDITORIAL
Year : 2015  |  Volume : 2  |  Issue : 1  |  Page : 1-2

Bariatric surgery: What is holding back?


Bariatric Surgeon, Center for Metabolic Surgery Mumbai, Maharashtra, India

Date of Web Publication6-Jan-2015

Correspondence Address:
Ramen Goel
Bariatric Surgeon, Center for Metabolic Surgery Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9906.148589

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How to cite this article:
Goel R. Bariatric surgery: What is holding back?. J Obes Metab Res 2015;2:1-2

How to cite this URL:
Goel R. Bariatric surgery: What is holding back?. J Obes Metab Res [serial online] 2015 [cited 2019 Jun 18];2:1-2. Available from: http://www.jomrjournal.org/text.asp?2015/2/1/1/148589

Being the Guest Editor of this issue of JOMR coinciding with "OSSICON2015" annual national conference of Obesity Surgery Society of India, is a rare honor for which I am indebted to the editorial board.

I have always wondered about the dichotomy in approach to obese patients. While evidence abound that 5-10% weight loss, achieved with medical or lifestyle intervention, results in significant metabolic improvement in patients, on the other hand minimum 25-30% weight loss is a norm after bariatric surgery. Still only 1 in 400 suitable patient undergoes bariatric surgery in USA.

In an editorial in International Journal of Obesity challengingly titled "When common sense does not make sense" Dr. Nikhil Dhurandhar has summarized evidence on misplaced emphasis on "lifestyle modifications" for weight loss, which have failed to tame the growing obesity epidemic.

Bariatric surgery cannot be the only option for treatment of obesity, but it remains the single most effective weight loss treatment modality for a section of society. Unfortunately, a large number continue to suffer or die untreated not because of lack of information or financial constraints, but primarily due to the aura of distrust and un-informed opinions. The cost of reduced productivity and inferior quality of life must be considered before delaying an indicated surgery.

Bariatric surgery is an established treatment modality worldwide and we are pleased to feature "father of obesity surgery" on the cover page of this issue. I shared lunch table with him, almost a decade back at an ASMBS meeting at San Diego, thinking that 1-day I will share memory of this moment with my grandchildren. We are honored to carry an article which he wrote for JOMR making it a collector's item for surgeons in India. It is relevant that at a time when young surgeons are looking for more powerful, strong procedures, Dr. Mason who invented roux-n-y gastric bypass is seeking moderation even in sleeve gastrectomy. "If simple restrictive procedures did not produce sufficient weight loss, it was always my inclination to work with the patient to solve other problems afflicting weight loss rather than going to a more radical procedure" says Dr. Edward Mason.

It is known that surgeons constantly modify a technique since neither the patients nor anatomy is consistently similar. But is it necessary to re-invent the wheel when opportunities abound to learn from experiences of others who modified and modified… but failed to achieve safe weight loss? Modification of a surgical step is not the same as using a failed procedure in an attempt to justify a logical yearning. Fortunately, science is not necessary merely logic but more statistics. Father of bariatric surgery in India, Dr. Shrihari Dhorepatil has extensively covered the evolution of bariatric surgery in India in historical vignette section. It is an interesting read to learn from sincere, but occasionally unsuccessful attempts of the past so as not to expose our trusting patients to procedures, which have failed to deliver.

Original Articles on sleeve gastrectomy and quality of life differentials between RyGBP and MGB reflect the growing body of quality data collection and analysis by bariatric centers in India. Though attempts to start multi-centric trials were made in the past, I believe the time has come for organized research efforts in this field. A research symposium to create awareness amongst participants on possible opportunities and resources is the first in OSSICON.

Review article on obesity and cancer is an eye opener and I can't appreciate Dr. J S Rajkumar more for the effort put in to draw out mechanistic role of obesity and bariatric surgery in cancer incidence and treatment. A complex disease has been attempted to be explained in simple terms by this man of words.

Imperial College, London physicians are involved in follow-up of bariatric surgery patients for years and Dr. Alex Miras et al. have reviewed literature to explain changing goal posts to define success/failure of metabolic surgery. Though modified remission definition shows poorer surgical outcome, it is necessary to compare results with the glycemic control achieved through pharmacotherapy versus surgery.

A unique review of Indian surgeon's bariatric publications by Dr. Anish Desai et al. helps understand the nature of surgeries, complication rates and follow-up details. It will be a reference point for further research in India.

Emphasis on revisional surgery should be tempered as every failed weight loss surgery is not due to procedure failure or even noncompliance. There are reasons which could be part of the psyche, up bringing or environmental influences. It is essential that surgeons refrain from routinely revising failed bariatric surgeries as in the absence of mechanical reasons, the secondary procedure is likely to fail too.

Submission of over 100 abstracts and their publication is a milestone for bariatric community in India. Evidence based medical care has to get precedence and JOMR is pleased to provide a platform to young and academically inclined obesity practitioners.

Bariatric surgeons worldwide are aware of the significance of allied health professionals. I hope the interaction between AIAARO and OSSI members will go a long way in integrated obesity care in India.




 

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