On August 9–10, 2017, the American College of Surgeons hosted a symposium on metabolic surgery, with 12 follow-on papers published serially in the Bulletin of the College. The current synopsis outlines the varied contents of these papers, often in the original words of their authors, who are cited within their topic sections. Topics covered include the following: history and definition of metabolic surgery, bariatric surgery, international bariatric surgery, mechanisms of metabolic surgery, diabetes and the metabolic syndrome, frontiers of metabolic surgery, institutional collaborations, accreditations and quality initiatives, professional training, the role of the National Institutes of Health, and advocacy. Based on these insights, an enthusiastic affirmation for the future of metabolic surgery is warranted.
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Academic institutions by virtue of their resources and capabilities have made outstanding breakthroughs in our knowledge of adiposity-based chronic diseases and the physiological bases of our interventions . Yet, bariatric surgery private practices have been the setting for numerous surgical innovations, including the laparoscopic technique . Many of the first pivotal peer-reviewed bariatric surgery papers were authored by private practice surgeons. The first certified bariatric COEs were private practices, and widespread training under the ASMBS was also initiated by private practice surgeons . Over time, industry support of private practice training centers has decreased in favor of funding of surgical fellowship training and research studies in university medical centers. As bariatric surgery moves forward within the emerging context of metabolic surgery, it is important for our professional surgical societies to jointly foster private and academic surgical practices as they expand the purview of high-quality patient care.
NIH-supported research investigations over the last 50+ years have made significant contributions to the understanding of obesity and the effects of bariatric surgery in the areas of adipocyte biology, basic physiology, and in clinical applications (i.e., cancer, inflammation, cardiovascular disease, and T2DM). The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the NIH established a multicenter research consortium, the Longitudinal Assessment of Bariatric Surgery (LABS), which, using four trial groups (LABS-1, LABS-2, LABS-3, and Teen-LABS) and an observational cohort, addressed multiple clinical, epidemiological, and behavioral hypotheses of metabolic bariatric surgery . These and other trials (e.g., the Small Animal Metabolic Surgery [SAMS] Resource Core studies ) funded by the NIH and other resources including industry, foundations, and the involved institutions have consistently shown markedly greater diabetes mellitus remission and improved glycemic control by the surgical arms. Providing research support to strengthen personalized care among populations with obesity, and enhancing prediction of the populations that may experience the greatest degree of metabolic surgery benefit will be the next frontier in NIH research .
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- ACS, ASMBS, IFSO, NIH
- Bariatric surgery
- Metabolic surgery
- Metabolic syndrome