Cherie Lisa Vaz, MD is an American Board of Obesity Medicine (ABOM) Diplomate, answers questions regarding the importance of an obesity medicine physician.
What unique skill set can the obesity medicine physician bring to the bariatric surgical setting?
The global rise in morbid obesity and associated comorbid diseases concerns a wide range of specialists. Increasing numbers of physicians from other specialties, including endocrinologists such as myself, dedicate a portion of their practice to obesity medicine. Like other chronic diseases, such as diabetes, hypertension, or hyperlipidemia, the treatment of obesity requires long term care. Studies have shown that decision making by primary care physicians for severely obese patients seems to underprioritize obesity treatment and overestimate bariatric surgery risks (1). The obesity medicine specialist would fill in these existing gaps in education of primary care physicians and improve patient care by serving as the expert in the care of patients requiring bariatric surgery.
The obesity medicine specialist plays a key role in helping patients navigate successfully through their medical as well as surgical weight loss journey. We have significant evidence of health benefits to patients following bariatric surgery. The obesity medicine specialist would decide when the patient should be referred for bariatric surgery. The obesity medicine specialist brings a unique skillset to the bariatric surgical setting by providing comprehensive care for patients with their expertise in nutrition, lifestyle modification, pharmacotherapy, and management of cardiovascular risk factors associated with obesity.
What impact can the obesity medicine physician have on patient outcomes?
The obesity medicine specialist can have a dramatic effect on patient outcomes. By providing continuity of care, expert management for obesity related co-morbidities, such as diabetes and hypertension before and after bariatric surgery, the obesity medicine specialist can significantly improve patient outcomes in relation to bariatric surgery. As we move towards an outcomes-based reimbursement model, insurers will look closer into actual patient outcomes following bariatric surgery, possibly even at patients’ progress at 1 year and 2 years following bariatric surgery. Institutions will need to show strong patient follow up rates with long-term weight loss and weight maintenance to confirm that they provide high quality care and to improve reimbursement rates.
Have you had the experience of working with a bariatric surgeon?
As Faculty in Endocrinology at Temple University and Lewis Katz School of Medicine, I work closely with our bariatric surgeons to optimize patients’ glycemic control and weight before and after surgery. We have a care team comprised of obesity medicine specialists, endocrinologists, cardiologists, pulmonologists, bariatric surgeons, nutritionists and diabetes educators for patients undergoing bariatric surgery. With strategic coordination across multiple specialties, we ensure our patients have a seamless experience as they prepare for their bariatric surgery and follow up thereafter.
Are there any clinical findings or evidence based research supporting the value of obesity medicine physicians and bariatric surgeons working together?
Existing literature shows that obesity medicine specialists tend to have higher rates of referral to bariatric surgery as compared to other specialists. A survey of 478 experienced physicians from 6 specialty areas was conducted to ascertain the attitudes and practices regarding the treatment of morbidly obese patients. They found that primary care physicians and subspecialists see a high proportion of morbidly obese patients; however, many are unfamiliar with morbid obesity management and surgical referral guidelines (2). Even though the perception of surgical effectiveness was quite high, the referrals for surgery were relatively low. Despite the respondents’ perception that most surgery recipients achieve good to excellent long-term results, only 15.4% of patients were referred for consultation with a surgeon – as an example- 8.0% for cardiologists and 26.1% for obesity medicine specialists (2).
Studies comparing patient outcomes when treated by an obesity medicine specialist in conjunction with the bariatric surgeon are needed.
What is the value of working with an ABOM Diplomate specifically?
Just as with other subspecialties, certification by the American Board of Obesity Medicine ensures that the physician has completed a significant amount of obesity specific training and education and has passed the certifying exam written by experts in multiple areas of obesity medicine including bariatric surgeons, endocrinologists, cardiologists, and obesity researchers. An ABOM Diplomate practices evidence based obesity medicine and provides a comprehensive approach to the management of obesity.
- Funk LM, Jolles SA, Greenberg CC, Schwarze ML, Safdar N, McVay MA, Whittle JC, Maciejewski ML, Voils CI. Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study. Surg Obes Relat Dis. 2016 May;12(4):893-901.
- Avidor Y, Still CD, Brunner M, Buchwald JN, Buchwald H. Primary care and subspecialty management of morbid obesity: referral patterns for bariatric surgery. Surg Obes Relat Dis. 2007 May-Jun;3(3):392-407.
Dr. Cherie Lisa Vaz is Faculty at Lewis Katz School of Medicine, Temple University, Philadelphia, where she practices Endocrinology and Obesity Medicine. Dr. Vaz is board certified in Internal Medicine, Endocrinology, and Obesity Medicine. At Lewis Katz School of Medicine, Dr. Vaz teaches and prepares medical students for their first interactions with patients during the Doctoring program. She conducts electives for education in Obesity Medicine, Endocrinology, and Nutrition. Dr. Vaz has been serving on the Endocrine Training Support Committee at the American Association of Clinical Endocrinologists (AACE) since 2012 and is a reviewer for abstracts submitted for the annual AACE meetings. Dr. Vaz is a member of the ABOM Exam Item Writing Committee, which works in conjunction with National Board of Medical Examiners (NBME) to formulate the Obesity Medicine Board Exam. Dr. Vaz conducts clinical and translational research in the fields of obesity, type 2 diabetes, and the metabolic syndrome.