20 years in the bariatric industry: Past reflections, present challenges and future perspectives

In this interview, Arno van der Veek, Managing Director of Bariatric Solutions International, looks back on his career, the importance of developing evidence-based data and shares his ideas about the future of bariatric and metabolic surgery.

"After I had finished medical school in Amsterdam in 1988, I realised that my interest lay more in doing business than in curing patients. I signed up for an MBA at the Rotterdam School of Medicine and immensely enjoyed the course. I started my career at the Boston Consulting Group in Düsseldorf, but soon thereafter rolled into the medical device industry.”

After working at several companies, he decided to start his own company in 2003 and teamed up with a business partner to start Bariatric Solutions International in 2005.

“We started the company selling just one product – an adjustable gastric band – at what turned out to be the high point of gastric banding, and the market was only going downhill from that moment. A clear-cut case of bad timing...”

As the number of gastric band procedures declined, they realised that they had to diversify into the more popular gastric sleeve and bypass procedures. They were at an IFSO Congress, and by chance happened to have a stand next to MAL Fobi’s Baria Tec company, and soon afterwards became the European distributor of the Fobi Ring. Nevertheless, there were only few surgeons doing ring-augmented (at the time referred to as ‘banded’ procedures) procedures. In the meantime, they also started selling liver retractors and Goldfingers, however, these products were not unique as there were quite a lot of companies selling more or less the same product.

“In 2010, a couple of things happened. We picked up an instrument in Russia, with which one could actively deflect the tip of a Goldfinger, moving it back and forth. Unfortunately, the Russian design was impossible to clean and sterilise. So we had to redesign it and developed and patented the Pinky Trigger – a fully sterilisable instrument which allows for active deflection, provides tactile feedback and allows for single hand operation. Around the same time, our distribution agreement with Baria Tec expired. We thought the FOBI Ring had promise but could be improved.”

MiniMIZER Ring

Over the next couple of years, they would work on various designs and modifications of a gastric ring, and in 2012 they launched the MiniMIZER Ring. However, there was a big hurdle to take, particularly as at the time many surgeons associated the term ‘banded’ with the adjustable gastric band. Arno realised that, in order to convince surgeons that the addition of the Ring to a bypass or a sleeve was beneficial, they had to produce the data to demonstrate this. Essentially, creating sales by developing and publishing high level, evidence-based data.

“We had to be able to prove that the Ring works for very specific applications. And if we learn that it doesn’t work for any specific application, then that is good too, because we can avoid disappointment with surgeons and patients alike. Hence our moto: ‘Progress through PubMed.’”

Subsequently, they established and initiated, in collaboration with various surgical centres, around 40 scientific studies. The outcomes from about 20 have already been published.

GLP-1s

In several countries, the launch of the newer generation of GLP-1s has had an impact on bariatric procedural numbers, particularly where bariatric surgery is dominated by private providers. However, he does not foresee that this will be a long-term problem.

“There are about 50 GLP-1 products in the pipeline, and inevitably, some will be better than the ones we have seen so far. But I think that there still will be similar or even higher levels of bariatric surgery ten years from now. There is a certain group of people who are not able to deal with GLP-1 side-effects – whether that’s nausea or gastrointestinal effects – there are also patients who are non-responders, there are patients who cannot afford these drugs, and can healthcare systems afford to pay for these drugs for the next 20 or 30 consecutive years?

“Long-term complications will cast a shadow of doubt over the risk-return ratio of GLP-1 products, where surgery has a track record of decades of data, proving its effectiveness and safety. With the current hype around GLP-1 treatments, many patients will start losing weight with the drug, but will struggle and fail to keep it once they stop using it. I foresee that a considerable cohort of these patients, who will have temporarily enjoyed lower BMIs for a while, will start to look for a more permanent treatment and will make the step to surgery for a more durable solution for their weight issues. For these reasons, I believe there will remain a large group of patients for whom surgery remains the best option. Last, but not least, I think that a combination of surgery-GLP-1 therapies will emerge.”

Challenges With nearly 35 years’ experience in the medical device industry, including 20 years running his own company, he believes that the biggest challenge facing companies like his – and the medical and pharma companies more widely – is the ever-increasing regulatory burden that are not just medical device related, but also financial and environmental.

“We’ve just filled out documents for the NHS tender. I really think the NHS is a great institution the UK can be proud of, but the pages and pages of ritual rain-dance documentation is astounding. I understand it’s been done out of the desire to do good, but it doesn’t create any value to anybody the way it currently is set up.

“Also, the way things were regulated under the MDD, we’re not in order. But now, under the new MDR, the pendulum has swung to the completely opposite end of the spectrum, where I really feel that we are often forced to prove that water is wet. At our organisation, at least one third of our time is currently related to quality management and regulatory issues, having a severe impact on the cost structure, which will, eventually, translate itself into higher prices. It is something that runs through our entire society – if you see what banks must do in whitewashing measures, farmers administering their nitrogen exhaust, factories tracking their CO2 impact, etc – we’ve tried as a society to regulate things for good reasons, but right now these regulations oftentimes do more harm than good.”

What does the future have in store?

“A wise man once told me, ‘if you want to make God smile, tell him your plans’, so giving a view on the future is always a delicate exercise. Keeping it close to home, I foresee further growth of our company by developing products on our own, but also through acquisitions.

“We recently acquired the A.M.I. gastric band, because we believe there will be a place for this technique in the future and we want to be there to serve that market. The EHMS stapler, to close the mesenteric defect, was also acquired and added to our portfolio last year, and I am sure more deals like this will follow.

“We have recently launched www.myminimizerring.com to inform patients about the benefits of the MiniMIZER Ring. Increasing the levels of teaching to patient groups – backed up by e-campaigns – can lead to a flow of patients looking for ring-augmented procedures and the website supports surgeons in explaining the merits of this technique to their patients.

“One of the toughest parts of running a business is finding the right people, and we are blessed to have a great team at Bariatric Solutions International. In the years to come we will expand this team to cover all continents.

“Although the GLP-1 revolution poses a serious challenge to bariatric and metabolic surgery, it also offers opportunities. What matters in doing business is not if you will encounter bad luck, but how you deal with it. So, this is the moment in our industry where the men are separated from the boys, we are dedicated to making it our finest hour.”

This article was published in supplement, "Bariatric Solutions International 20th Anniversary". To download the supplement, please click below