Bariatric Surgery and the Role of the Clinical Endocrinologist

2011 Update

Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU

Disclosures

Endocr Pract. 2011;17(5):788-797. 

In This Article

Abstract and Introduction

Abstract

Objective: To discuss the emerging roles of bariatric surgery and clinical endocrinology within the context of obesity and diabetes mellitus comprehensive care plans and cost-effective strategies.
Methods: Relevant literature is reviewed and clinical cases are presented.
Results: The global obesity epidemic poses many challenges to clinical endocrinologists and has fomented a coordinated effort among specialists to revolutionize management paradigms. Technologic innovation drives the need for accelerated learning and research efforts in bariatric surgery. The national shortage of physicians with expertise in nutritional medicine compounds the management problems for this expanding patient population. Certain issues merit continued attention and research, such as gastric banding for mild obesity, surgery for treatment of diabetes, sleeve gastrectomy, and nutritional and metabolic consequences.
Conclusion: Clinical endocrinologists should have a central role in the perioperative decision-making for patients undergoing bariatric surgery.

Introduction

The global obesity epidemic has incited innovation and technology to advance at such a great pace that many subspecialties have had to reengineer and reprioritize their efforts in metabolic medicine. Perhaps the best example is that of bariatric surgery and the role of the clinical endocrinologist in perioperative care. In 2008, the American Association of Clinical Endocrinologists (AACE), The Obesity Society, and the American Society for Metabolic and Bariatric Surgery published evidence-based clinical practice guidelines (CPG) on the perioperative nutritional, metabolic, and nonsurgical support of patients undergoing bariatric surgery.[1] Within these CPG, also endorsed by the American Society of Parenteral and Enteral Nutrition, are 164 specific recommendations providing a comprehensive and collaborative effort to support clinical decision-making. Even though this resource was a welcomed addition to the armamentarium for bariatric surgery perioperative care, it also identified a potential weakness: that many patients undergoing bariatric surgery were not receiving expert medical nutrition care and that the number of available physicians with expertise in nutritional medicine was probably insufficient to care for the expected number of patients. Because clinical endocrinologists receive formal training in metabolic disorders and some training in clinical nutrition, AACE has incorporated plenary sessions, workshops, and "Meet The Experts" sessions on bariatric surgery since 2007 at their annual meetings. This article will review contemporary trends in bariatric surgery and then present 4 controversial aspects that have emerged since the 2008-published CPG. The discussions will focus on recent publications, most in the past 1 to 2 years, and have particular applicability to the role of the clinical endocrinologist in perioperative decision-making.

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