Bariatric News was delighted to catch up with Mr Vinod Menon, an upper gastrointestinal and obesity surgeon, and cancer specialist, from the University Hospitals Coventry and Warwickshire NHS Trust, and the new president of the British Obesity & Metabolic Surgery Society (BOMSS). In our interview, he discusses the impact of COVID, the new relationship BOMSS will have with the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS), the importance of fostering greater relationships with other specialties, GPs and patients groups, and his aims as President over the next two years.
In July this year, BOMSS was one of the first – if not the first – surgical society to hold face to face annual meeting, what were the difficulties involved organising a meeting in such circumstances?
We were the first surgical specialty to have a face-to-face meeting after the UK’s ‘Freedom Day’ on July 19th. Historically, we hold our annual meeting in January and our last meeting was in Aberdeen in January 2020. As we all know, the COVID pandemic in March 2020 resulted in huge disruption and changes to all our personal and professional lives. One of the positive aspects that has emerged from the pandemic has been the overall acceptance of the association between the outcomes from COVID and having severe obesity. In March 2020, all elective surgery ground to a halt and BOMSS did a lot of work behind the scenes to try and get elective surgery restored, and it was resumed four months later in July 2020.
As COVID cases increased in the winter of 2020, it would have been unrealistic to host a meeting in January 2021, and so we waited to see how things would evolve. As situation began to improve, we hoped to have a meeting at the beginning of June. Of course, hosting a meeting in such circumstances comes with a host of challenges – such as the location, how many people could attend, what restriction would be in place, would we have to test attendees prior to the meeting or on site, given the pressure on the NHS would attendees get study leave, what about travelling and accommodation etc? So, there were a host of considerations.
In the end, I believe we took the brave and correct decision to hold the meeting in July working in conjunction with our Secretariat, Executive Business Support (EBS), who were very pro-active in helping us overcome and find solutions to these challenges. We did have several discussions about whether we should hold a face-to-face meeting or a hybrid meeting, but in the end we decided that it was important for the discussions around the scientific content and for networking that a face-to-face meeting was the way forward.
Due to the three-week delay in ‘Freedom Day’ we held the meeting at the Examinations Halls, University of Oxford, Oxford from July 26-28th 2021. The meeting included a training day, with over 90 attendees, followed by a two-day annual scientific meeting with more than 300 delegates. We usually have approximately 300-350 delegates attending our annual meeting, so we were delighted to welcome similar numbers to our first post-COVID meeting.
In the last year, BOMSS has moved away from its association with AUGIS, why did this occur and what benefits will this bring to BOMSS and its members?
We have had a long-standing relationship with AUGIS and it was primarily one under which they provided a secretarial function. BOMSS has always been an independent society separate from AUGIS with our own membership, subscription, Annual Scientific Meeting, training days etc. When BOMSS first started, we did not have the financial capability to have an independent secretariat so we agreed to pay AUGIS an annual fee to help us manage our administrative and secretarial functions.
Over the last few years’ with the emergence of bariatric and especially metabolic surgery as a specialty, most if not all national bariatric and metabolic societies have become independent. Therefore, the move away from AUGIS is a reflection of a growing international trend. In addition, BOMSS also has a large number of integrated healthcare professionals (nurses, dieticians, psychologists etc) who have joined BOMSS as members, so we felt that there was a need for us to establish our own infrastructure, financial independence and secretariat, while still maintaining an excellent working relationship with the AUGIS. For example, a very large number of surgeons are members of both societies, including myself as an upper GI cancer specialist. With this new relationship, I believe both societies will be stronger and will be able to focus on their work, as well as maintain our close collaborative arrangements.
We will also be working closely with other societies such as the Association of Laparoscopic Surgeons of Great Britain and Ireland, and for the first time ever we have a bariatric surgeon, Mr Ahmed Ahmed, on the Council of the Royal College of Surgeons of England. Ahmed will be working to get bariatric surgery included on the curriculum of higher surgical training, which currently falls under the umbrella of upper GI surgery. BOMSS is the main organisation who can provide support to the College of Surgeons and endorse post-CCT Senior Clinical Fellowships in bariatric surgery, so you can see how a new, independent BOMSS can further the interests of our members, specialty and the patients we serve.
BOMSS has also formed a separate charity to oversee membership, why have you decided to make this change?
Yes, we have formed a Charitable Incorporated Organisation (CIO), the essential objective of the charity is for the advancement of the public benefit of the science and practice of not just surgery but also the multidisciplinary and multi-professional treatment of people with severe and complex obesity. In our previous arrangements with AUGIS, there could be lags in some of the activities or ambitions we were trying to implement as a society. For example, the meeting in Oxford was organised via our charity and this status will also allow BOMSS to hasten the process of establishing research initiatives, publishing policy and guidance documents, increase our ability to accept charitable donations etc. Even in this short period of time the new charitable structure has given us some immense advantages.
This year has also seen BOMSS establish the monthly educational bariatric journal club webinars, why is this important for BOMSS and its members?
Continuing Professional Education is the backbone of good clinical care because we do not just train healthcare professionals, but we must also continue their education. With the advent of COVID and the cancellation of face-to-face meetings, there was a necessity for us to bring together our shared experiences and knowledge. For the first few months of COVID the treatment changed from anti virals to steroids and then we had all the discussions around vaccines. At the same time, quite a number of senior BOMSS Council members were involved in a number of webinars focussing on the implications of stopping elective surgery and how elective surgery could be safely re-started.
Our Professional Educational Lead, Mr Sherif Awad, proposed the idea of a twice monthly educational activity for our membership. The BOMSS journal club is held on the second Wednesday and the webinar on the fourth Wednesday of each month at 8 PM. The Journal Club is held on the second Wednesday where two papers are presented, one by a surgeon / physician and the second by an Integrated Health Professional (IHP), with each session chaired by a trainee, surgeon and an integrated healthcare professional.
The journal club on the second Wednesday brought together the 40+ bariatric units within the UK on a rotational system and on the fourth Wednesday we have had a host of national and international speakers including the incoming IFSO president, Dr Scott Shikora, as well as Dr Ali Aminian and Dr Matthew Kroh. The response has been excellent with about with around 900 professionals from around the world on our mailing distribution list.
What are you hoping to achieve in your two-year term as President?
I am coming into the post at a really interesting time as the link between COVID and severe obesity is more evident than ever. In the UK alone, there are 14 million people with clinical obesity of whom two million would qualify for bariatric and metabolic surgery – and at the moment there are about 5,000 procedures been performed on the NHS each year. That means only 0.25% of those who qualify for surgery receive this every year. So, a priority for BOMSS is to continue to have meaningful discussions with NHS England and to increase the number of patients who receive surgery from 0.25% to 1%, so we want to see an incremental change from 5,000 to 20,000 operations per year. As a society, if we can see such a change over the next two to three years that would be a great success.
I believe we have a great society full of dedicated professionals, but I would like to see it become more vibrant, inclusive and multidisciplinary with more endocrinologists, gastroenterologists, endoscopists, anaesthetists etc involved in our society.
In addition, hands on training has really taken a backseat during the last 18 months, so we are taking a leadership role in ensuring our trainees are well trained. We currently have about 45 centres with 175 surgeons with 400 members, so if we are to quadruple the number of procedures performed each year, we really need to look across the spectrum and ensure the funding and infrastructure is in place and everyone is appropriately and adequately trained.
One of my passions is how we record, analyse and report clinical outcomes, and how we can translate that into the social and economic outcomes/benefits. The National Bariatric Surgical Registry (NBSR) is the ‘jewel on the crown’ of our society. As a society we are determined to carry on the excellent work carried out by Mr Richard Welbourn, Mr Peter Small, Dr Peter Walton and Dr Robin Kinsman, as well as all the team at Dendrite Clinical Systems. We are committed to making the NBSR even stronger. One of the great advances over the last year, is that the NBSR now has a real-time procedure log that informs BOMSS of how many procedures have been performed over the last 24hrs. Moreover, surgeons, with the press of a single button, can publish their outcomes data for patients, commissioning groups, accreditation purposes etc.
We also need to be a more listening and engaging society, we need to work with patient groups and we now have a patient representative on the NBSR committee, and we would welcome having a patients voice on several of the BOMSS committees. We currently have Dr Helen Paretti, who is a GP representative on the BOMSS Council and I would also like to see more inclusion from our colleagues in general practice because they play such an important place in the referral and follow-up of our patients.
We have an fantastic working relationship with corporate partners including Medtronic, Novo-Nordisk, Johnson & Johnson, WL Gore etc who have been instrumental in BOMSS setting up the new CIO and in supporting our educational and research activities. This relationship with continue to flourish and broaden over the next few years. We are partnering with Obesity Surgery Society of India (OSSI) across a number of domains including providing faculty and speakers at each other’s ASM’s, as well as short fellowships for senior trainees involving visits to designated centres.
Are there any other activities and/or BOMSS developments, you would like to outline?
We are also working with Professor Jonathan Valabhji, who is the National Clinical Director for Obesity and Diabetes at NHS England, and we are providing his team with all the evidence and documentation they need to support a multi-year financial settlement of the funding of bariatric services. Hopefully, as the number of procedures increase this will require not only more funding to train more surgeons but also our multidisciplinary colleagues such as nurses, dieticians, psychologists etc.
I am also the Director of the West Midlands Surgical Training Centre and we are working to set up a twice-yearly Master class to allow trainee surgeons to go through bariatric procedures on cadaveric models to make up for the lost opportunities from the last 18 months.
BOMSS is also offering free membership to both undergraduates and post graduate trainees, this is important for a number of reasons, particularly as membership of BOMSS is absolutely essential to become a member of IFSO who offer a number of Fellowships to trainees. We are also developing a new website that will incorporate all the latest guidelines and a ‘members only area’, as well as ramping up our presence on social media.
Can you tell us when the next BOMSS annual meeting will be?
As there has been an 18-month gap between meetings, our view is that January 2022 will be too soon. So, we are planning to host the 13th BOMSS Annual Scientific Meeting in late spring 2022 from 16th to 18th May 2022 at Brighton. I am delighted to say that Mr Chetan Parmar, who did such a fantastic job of organising the scientific programme in Oxford, will again be leading organisation of the scientific programme in 2022.
I would also like to particularly thank my immediate predecessor, Professor David Kerrigan, who has put BOMSS on such a firm footing and he is a tough act to follow, but if I leave BOMSS in a better place from when I was elected President, I’ll be happy.
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