Obesity Week: Getting to the Heart of the Matter

Miriam E. Tucker

November 08, 2018

NASHVILLE, Tenn — This year's joint meeting of The Obesity Society (TOS) and American Society for Metabolic and Bariatric Surgery (ASMBS) will focus on the important links between obesity and cardiovascular health.  

The Obesity Week 2018 conference will take place in Nashville on November 11-15. This is the first year it will have an overall theme, dubbed "The Heart of the Matter." Sessions from the two organizations will explore topics such as cardiovascular effects of weight loss medications and cardiovascular outcomes following metabolic/bariatric surgery. 

An important facet of this is a recent paradigm shift in stepping away from the notion that weight loss automatically correlates with cardiometabolic health, noted TOS Program Chair Lori M. Zeltser, PhD, associate professor of pathology & cell biology at Columbia University, New York City, in an interview with Medscape Medical News.  

"I think what's really important about some of the studies that will be presented with regard to cardiometabolic risk and obesity is to divorce the idea that the two always go together...improving cardiometabolic fitness and decreasing long-term risk is not always read out on the scale," Zeltser said.

Several of the speakers, she said, will touch on the idea of "recalibrating" the main goal of weight loss. "It's to improve health and reduce long-term disease risk and improve quality of life. We should be looking at cardiometabolic endpoints instead of just body weight as a metric of success," she said.

Nissen Is Keynote Speaker; Registration Up by 30%

The official meeting sessions will kickoff Tuesday morning with a joint society keynote talk by Steven Nissen, MD, chair of cardiovascular medicine, Cleveland Clinic, who will speak on "The Intersection Between Obesity and Heart Disease."

Current ASMBS president Samer Mattar, MD, Medical Director of Swedish Weight Loss Services, Seattle, Washington, told Medscape Medical News, "We're very lucky to have Steve Nissen as our keynote speaker. He's a giant in the field and he's contributed so much to research and clinical care of patients who have heart disease but also who are obese. This is obviously one of the highlights."

Of course, Obesity Week 2018 sessions will address many other areas encompassing basic research and the medical, surgical, lifestyle, epidemiology, and policy aspects of obesity management. The interdisciplinary nature of the conference is one of its most compelling features, the two obesity experts said.

"We've tried to include as many interdisciplinary opportunities as possible, with the same issue covered from multiple perspectives," Zeltser said. "One of the unique features of Obesity Week is you have the opportunity to get that input and broaden your horizons."

Mattar noted, "Obesity Week is a partnership between ASMBS and TOS. We’re basically a bunch of surgeons joining forces with obesity medicine and basic scientists." He also pointed out that advance registrations for this year’s meeting, around 5000, represents about a 30% increase from last year.

"It's a nice upward trend. We're not sure of the reasons, but we certainly welcome it."

Sessions Focussed on the Heart

From ASMBS, the Tuesday morning "Top Paper Session 1" is dedicated to heart-related topics, including the role of bariatric surgery in reducing the incidences of atrial fibrillation and mortality in patients with congestive heart failure.

Mattar pointed to a recent 5-year observational study that showed bariatric surgery reduces cardiovascular death in patients with diabetes, noting, "certainly there's rising evidence showing numerous benefits of bariatric surgery in patients with cardiac disease."

On the TOS side of the conference, an oral abstract session on Thursday afternoon entitled, "A Change of Heart — New Findings on Obesity and Cardiometabolic Health," will address topics such as prevalence of the "skinny fat" phenotype among young adults, the exceedingly low proportion of American adults who are metabolically healthy, and the association between obesity and heart failure exacerbation in patients with ischemic heart disease.

Diet Approaches and Weight Maintenance Among TOS Topics

Beyond the heart, one TOS session likely to draw a crowd is the Tuesday morning symposium "Diets in the News: When, What, or How Much?" Speakers will address time-restricted feeding and intermittent fasting, the ketogenic diet, and very low-calorie diets and meal replacements.

"This one is going to be great," Zeltser predicted, adding, "these diets get a lot of hype. Trying to parse what's really happening is important."

A related session on Thursday morning will feature a debate between two experts pitting meat-based versus plant-based diets.

"I think that will also be very interesting. People claim to lose weight both ways," Zeltser noted.

Of course, weight-loss drugs will also be a major topic at the meeting.

During a Tuesday evening keynote lecture, obesity expert Donna Ryan, MD, professor emerita at Pennington Biomedical, New Orleans, and President-Elect of the World Obesity Federation, will speak on "Weight Loss Medications — Winning Combinations and New Directions."

Zeltser said a new focus will be the role of those medications in weight maintenance. That subject will be specifically covered during a keynote on Thursday by another noted obesity expert, Louis Aronne, MD, director of the Weill Cornell Comprehensive Weight Control Center, New York City. His talk is entitled, "Weight Loss Maintenance — Winning the War, Not the Battle."

Zeltser commented, "The issue is maybe we need to change our thinking. Certain drugs may be good at causing weight loss, but those aren't as good at keeping it off, and vice versa. I think this will be a very important talk. Usually you hear about which drugs promote weight loss. This talk will be very informative in discussing which [approaches] help keep it off."

Mining Bariatric Surgery Data for Outcomes

In terms of news on weight loss surgery, there will be more data than ever coming from the registry of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), a combined effort of the ASMBS and American College of Surgeons.   

Abstracts of studies that used MBSAQIP data will be presented Tuesday afternoon in a session about complications, with topics including risk prediction for complications and readmissions, robotic-assisted outcomes, the role of staple line reinforcement, and intraoperative leak testing. Another abstract presentation on Wednesday afternoon will also examine prediction of postoperative adverse outcomes using MBASQIP data.

"We're now reaping the benefits of MBASQIP and the accreditation program," Mattar said. "It's now available in aggregate form, and anybody who wants access can get it by applying…It has become so rich."

Of course, as with most large, cutting-edge research meetings, Obesity Week attendees will have to choose among several informative sessions from both organizations during most time slots.

"The program is really great," Zeltser remarked. "I'm a basic scientist and I can't decide which sessions I want to go to."

Mattar has reported receiving honoraria from Gore. Zeltser has reported no relevant financial relationships

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