At this week’s ISORAM Boot Camp hosted jointly by the Canadian Obesity Network, University of Alberta, and University of Leipzig (Germany), one of the main topics of discussion was bariatric surgery.  While I was only able to attend a fraction of the week long meeting due to my clinic schedule, I had the great pleasure of hearing several great sessions, including the final lecture provided by Dr Arya Sharma.

Dr Sharma, as always, gave a very thought provoking talk, highlighting several points, ranging from the ‘4 M’s’ of obesity assessment and management for clinicians to consider, to the ‘5 A’s’ of obesity counseling.  When we overeat, he urged us to consider: are we eating in response to hunger (called ‘homeostatic hyperphagia’ in medicalese), or for the purpose of reward (aka ‘hedonic hyperphagia’)?

Another of the many topics Dr Sharma explored was the discussion of what type of patient benefits most from bariatric surgery.  He reviewed the 2012 update from the landmark Swedish Obese Subjects (SOS) study for us, which examined the long term effect of obesity surgery on heart attacks and strokes, compared to control patients who did not have obesity surgery.  While the study did show a lower rate of cardiovascular events and cardiovascular deaths in the group that had obesity surgery, it took nearly two decades of study for this difference to emerge.  As the SOS study participants were obese but otherwise quite healthy, this suggests that body mass index (BMI) alone may not be an appropriate criterion to decide who is the most appropriate candidate for obesity surgery.  As has been suggested by many studies since the SOS study began, it may be more prudent to select patients based on whether they have complications of their excess body weight (eg diabetes, severe hypertension, etc), as there may be greater health benefits to be had for these individuals.

Interestingly, the SOS study also found that it didn’t matter how high the patient’s starting weight was, nor did it matter how much weight the patient lost by having obesity surgery – the reduction in risk was the same.  Again, this suggests that body weight or BMI alone is probably not the best way to decide who stands to benefit most from bariatric surgery – an assessment based on the presence or absence of complications of excess body weight (ie the EOSS staging system) may be far more appropriate.

Congratulations to the CON on another hugely successful meeting!

Dr Sue Pedersen © 2012

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