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The urgent need to understand obesity is a disease state and break the stigma around accessing care

Updated: Oct 31, 2023

Bariatric and metabolic surgery (BMS) is the most durable and effective treatment for weight loss, yet only one percent of currently eligible patients receive surgical treatment for obesity. For years, bariatric specialists have debated how to increase access for patients, but the number of procedures have remained stubbornly low. At the recent International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) World Congress in Naples, Italy, Bariatric News talked to Sandeep Makkar, Global President of Energy and Endomechanical at Ethicon, who said that to increase access there needs to be a complete change in mindset, in addition to a greater emphasis on education and new technologies.

Sandeep Makkar

“Whether it is a developed country or an emerging country, access to bariatric surgery is shockingly low. For example, India has a population of 1.4 billion people and one of the highest burdens of diabetes across the world, with an increasingly obese population due to lifestyle changes. Despite these increases, only 20,000 patients each year benefit from bariatric surgery,” he said. “And the numbers in China tell a similar story.”

So, why are the numbers so low? According to Makkar, obesity as a disease is not at the forefront of decision making because it still carries significant stigma for patients and HCPs.

Challenging the status quo

If you look at the diagnosis and treatment of obesity compared to other conditions, such as cardiovascular disease or cancer, the way patients are prioritized is incomparable, even though some of those conditions may be tied to their obesity.

There is an urgent need for a more cohesive partnership between societies, educators, and the community at large. According to Makkar, taking a multidisciplinary approach to treating obesity by working across surgical, endocrine, allied health societies and the broader medical community, can break this cycle.

In addition, the current medical curriculum regarding obesity is woefully outdated – a real need exists to shape a curriculum that incorporates all of the new evidence and learnings on obesity as a disease. “The world around us is shifting and metabolic disorders and conditions are rising disproportionately and yet, our payers, educators and the general public’s perceptions are stuck in time – decades behind.”

Advocacy is another important component to raise awareness of the positive impacts of BMS on patients. We need to continue sharing patients’ experiences living with obesity, hypertension, diabetes, sleep deprivation or mental illness to give those patients a voice, allowing them to tell their stories and reveal how BMS helped transform their lives.

“There is no magic formula to increase patient access to surgery because if there was, we would have found it already. But I think as a bariatric community, if we go at it consistently and cohesively with a multi-dimensional approach, we are going to make a lot of progress.”

A new world of learning

According to Makkar, the body of medical evidence is growing rapidly, and Ethicon is innovating on the education front to ensure surgeons have the latest data, tools and techniques available to access in both traditional and emerging formats.

“We are pushing the boundaries of how people learn, the quality of content, and how the content is delivered. The future is here – offering personalized, hybrid online telemedicine courses is critical to meeting the surgeons where they are. The acceptance of digital educational technologies by the surgeons means 60 – 70 percent of our learning is now hybrid and digital in nature, and that has been the major shift for us.”

Now, there are virtual assessment tools showing the critical steps in a procedure that surgeons can watch at their convenience, allowing them to constantly monitor, upgrade and sharpen their skills through objective assessment.

“And this is where I think artificial intelligence (AI) is going to be so powerful in terms of learning, because AI technologies are going to help us curate videos, learn from them, and provide surgeons with intraoperative insights. Regardless of the approach the surgeon chooses, robotic or laparoscopic, they should feel comfortable doing surgery with Ethicon’s solution. We are giving them all of the tools that are grounded in science and are consistent in addressing the tissue variability and the surgeon variability.”

Gathering the evidence

“For Ethicon, generating the scientific clinical body of evidence around metabolic diseases and the impact of surgery in resolving comorbidities, as well as the diverse types of surgeries for different patient types are some of our key priorities. We have a grants process so that we can empower surgeons to generate the body of evidence. For many years, we have supported clinical societies and researchers around the world in generating that body of evidence, and we will continue to do so.”

A key part of gathering evidence is listening to the concerns and needs of the surgical community and developing solutions. For example, in a recent survey conducted by SERMO, on behalf of Ethicon, surgeons worldwide revealed deep concern that tissue variability and bleeding complications pose the most serious implications for patients.

“As a company, we have always listened to and worked with our surgical partners when we are designing and developing products to help manage challenging conditions to reduce leaks and bleeds. We continue to invest in furthering our understanding of the science of surgical stapling not only in preclinical testing, but in comprehensive post-market follow-ups of our products as well.

“So, how can we reduce that variability in innovation? Right now, we have intelligent algorithms built into our devices that sense tissue conditions, and the device responds. By reducing variability, surgeons can produce more consistent results on the staple line formation or an anastomosis or in management of bleeding or leak situations. By incorporating intelligent algorithms into our technologies, we have changed the dynamic from what were traditionally mechanical solutions.”

Makkar believes that broadening the medical community’s understanding and acceptance that obesity is a complex disease state is the starting point to help to break the stigma that has existed for far too long. Awareness and education coupled with continuous innovation to improve patient outcomes are critical to broadening access to Bariatric and Metabolic surgery as an effective treatment option.


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