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Emerging Technologies in Bariatric Surgery
Abstracts / Can J Diabetes 39 (2015) S1eS7
PL18 Emerging Technologies in Bariatric Surgery LAURENT BIERTHO* Department of Surgery, Université Laval, Québec, QC, Canada; Québec Heart and Lung Institute, Université Laval, Québec, QC, Canada Obesity has grown to epidemic proportions over the last decade. Even though bariatric procedures represent the only effective longterm weight-loss solution for morbidly obese patients, only 1% of potential candidates actually undergo such surgery. The fear of complications, side effects and permanent changes to the gastro-intestinal tract has limited the acceptance of bariatric surgery. New endoluminal therapies have recently emerged that could potentially change the current surgical field. Endoscopic procedures aim to mimic the principles of bariatric surgery, by diminishing gastric volume, decreasing the absorption of food or by a combination of both. We will review the most recent development in endoluminal restrictive procedures (swallowable intragastric balloon, endoscopic gastroplasty and implant of restrictive systems); malabsorptive procedures (duodeno-jejunal sleeve) and mixed procedures (endoscopic gastro-duodeno-jejunal bypass). The procedures presented are new with limited knowledge on safety and long-term efficacy. Their place for the management of obesity and morbid obesity will be discussed.
Friday, May 1: Plenaries p.m. PL19 The Obesity Action Coalition: Giving Voice to People Living with Obesity THEODORE K. KYLE* ConscienHealth, Pittsburgh, PA, USA Obesity is well-documented to be a highly stigmatized disease complicated by a high prevalence of both explicit and implicit weight bias. This bias leads to discrimination in education, healthcare, employment, and social interactions – often with little recourse or protection for the people affected. Public policies to address obesity have historically placed an implicitly low value on the unmet needs of people with obesity. Resources were instead disproportionately directed into prevention efforts. Until recently, options and resources for clinical care of people with obesity have been limited. Regulatory authorities set unreasonably high bars for innovative treatments that stifled innovation for almost a decade. Blunt assessments from policymakers presented to leaders in obesity medicine and bariatric surgery made it plain that without a strong voice for people living with obesity, these conditions would not change. In response to this situation, the Obesity Action Coalition (OAC) was incorporated in 2005 as a 501(c)(3) nonprofit organization to elevate and empower people affected by obesity though education, advocacy, and support. The OAC has grown to nearly 50 000 members, distributed more than 1.5 million pieces of educational materials, confronted weight bias, forged advocacy partnerships, and successfully advocated for more innovation in obesity treatment options. Through its annual meeting, OAC brings together more than 500 people to learn, provide mutual support, and develop advocates. The presentation will review key milestones and factors for a successful advocacy, education, and support organization serving people living with obesity.
PL20 Tailored Approach in Adult Bariatric Medicine DAVID MACKLIN* Medcan 365 Weight Management Program, Toronto, ON, Canada; Mount Sinai Pregnancy Clinic, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada Overeating drives the modern obesity epidemic spurred on by what may be best explained as a collision between an ancient
S5
reward brain and our modern pleasurable food-filled environment. The development of effective behavioural weight loss interventions requires a detailed understanding of the neurobiological forces that drive overeating, and the ones that inhibit overeating. This plenary will suggest a tailored approach to therapy based on these 2 competing forces. Force #1: The drive to overeat. To date, the majority of eating behavioral research has focused on the homeostatic system; yet, it has become increasingly clear, that obtaining the pleasurable effects of hyper-palatable foods is a powerful motivating force that can override homeostatic satiety signals resulting in overeating and obesity. This plenary will discuss the evolving understanding of the responsibility of the hedonic system in creating the motivational drive to overeat. Force #2: The capacity to inhibit the impulse to overeating. Scientific understanding of the mechanism involved in the inhibition of the reward driven overeating is only beginning to emerge. The human prefrontal cortex has emerged as the primary neurological center for restraint. The capacity to restrain the impulse to overeat is primary cognitive. This presentation will demonstrate a tailored approach that places impulse and impulse control as a central focus of treatment. PL21 Resilience as a Pathway to Healthy Living for Indigenous Youth Living with or at Risk for Obesity JONATHAN M. MCGAVOCK* The Manitoba Institute of Child Health, Winnipeg, MB, Canada Indigenous youth are significantly more likely to be obese and suffer from obesity-related chronic diseases. The disparities in obesity rates are likely attributed to an array of adverse experiences that Indigenous children face, including stress, poverty, food insecurity and transgenerational stress secondary to legacies of colonization, acculturation and residential school trauma. Previous work by our group and others suggest that peer-led mentoring programs, centered on strength-based approaches can be effective for attenuating weight gain in high risk children, including Indigenous youth living in remote settings. A growing body of evidence suggests that interventions that support resiliency (i.e. a psychological construct that describes a child’s ability to thrive despite adversity) improve health outcomes in children. The current talk will focus on an Indigenous theoretical frame work, called the Circle of Courage, discuss the physiological benefits that accompany interventions focused on its primary tenets and how these may be effective for preventing or treating youth living with obesity. PL22 Tailored Surgical Approaches OLIVER COURT* McGill University, Montreal, QC, Canada Abstract not available at time of print. PL23 Back to the Future: The Case for Using Home Visits to Manage Severe Pediatric Obesity GEOFF BALL* Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Severe pediatric obesity (body mass index [BMI] 99th percentile) is linked with a number of adverse cardiometabolic and psychosocial outcomes. Clinical practice guidelines for obesity management recommend that health care interventions include multidisciplinary, family-centered approaches that
PL18 Emerging Technologies in Bariatric Surgery LAURENT BIERTHO* Department of Surgery, Université Laval, Québec, QC, Canada; Québec Heart and Lung Institute, Université Laval, Québec, QC, Canada Obesity has grown to epidemic proportions over the last decade. Even though bariatric procedures represent the only effective longterm weight-loss solution for morbidly obese patients, only 1% of potential candidates actually undergo such surgery. The fear of complications, side effects and permanent changes to the gastro-intestinal tract has limited the acceptance of bariatric surgery. New endoluminal therapies have recently emerged that could potentially change the current surgical field. Endoscopic procedures aim to mimic the principles of bariatric surgery, by diminishing gastric volume, decreasing the absorption of food or by a combination of both. We will review the most recent development in endoluminal restrictive procedures (swallowable intragastric balloon, endoscopic gastroplasty and implant of restrictive systems); malabsorptive procedures (duodeno-jejunal sleeve) and mixed procedures (endoscopic gastro-duodeno-jejunal bypass). The procedures presented are new with limited knowledge on safety and long-term efficacy. Their place for the management of obesity and morbid obesity will be discussed.
Friday, May 1: Plenaries p.m. PL19 The Obesity Action Coalition: Giving Voice to People Living with Obesity THEODORE K. KYLE* ConscienHealth, Pittsburgh, PA, USA Obesity is well-documented to be a highly stigmatized disease complicated by a high prevalence of both explicit and implicit weight bias. This bias leads to discrimination in education, healthcare, employment, and social interactions – often with little recourse or protection for the people affected. Public policies to address obesity have historically placed an implicitly low value on the unmet needs of people with obesity. Resources were instead disproportionately directed into prevention efforts. Until recently, options and resources for clinical care of people with obesity have been limited. Regulatory authorities set unreasonably high bars for innovative treatments that stifled innovation for almost a decade. Blunt assessments from policymakers presented to leaders in obesity medicine and bariatric surgery made it plain that without a strong voice for people living with obesity, these conditions would not change. In response to this situation, the Obesity Action Coalition (OAC) was incorporated in 2005 as a 501(c)(3) nonprofit organization to elevate and empower people affected by obesity though education, advocacy, and support. The OAC has grown to nearly 50 000 members, distributed more than 1.5 million pieces of educational materials, confronted weight bias, forged advocacy partnerships, and successfully advocated for more innovation in obesity treatment options. Through its annual meeting, OAC brings together more than 500 people to learn, provide mutual support, and develop advocates. The presentation will review key milestones and factors for a successful advocacy, education, and support organization serving people living with obesity.
PL20 Tailored Approach in Adult Bariatric Medicine DAVID MACKLIN* Medcan 365 Weight Management Program, Toronto, ON, Canada; Mount Sinai Pregnancy Clinic, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada Overeating drives the modern obesity epidemic spurred on by what may be best explained as a collision between an ancient
S5
reward brain and our modern pleasurable food-filled environment. The development of effective behavioural weight loss interventions requires a detailed understanding of the neurobiological forces that drive overeating, and the ones that inhibit overeating. This plenary will suggest a tailored approach to therapy based on these 2 competing forces. Force #1: The drive to overeat. To date, the majority of eating behavioral research has focused on the homeostatic system; yet, it has become increasingly clear, that obtaining the pleasurable effects of hyper-palatable foods is a powerful motivating force that can override homeostatic satiety signals resulting in overeating and obesity. This plenary will discuss the evolving understanding of the responsibility of the hedonic system in creating the motivational drive to overeat. Force #2: The capacity to inhibit the impulse to overeating. Scientific understanding of the mechanism involved in the inhibition of the reward driven overeating is only beginning to emerge. The human prefrontal cortex has emerged as the primary neurological center for restraint. The capacity to restrain the impulse to overeat is primary cognitive. This presentation will demonstrate a tailored approach that places impulse and impulse control as a central focus of treatment. PL21 Resilience as a Pathway to Healthy Living for Indigenous Youth Living with or at Risk for Obesity JONATHAN M. MCGAVOCK* The Manitoba Institute of Child Health, Winnipeg, MB, Canada Indigenous youth are significantly more likely to be obese and suffer from obesity-related chronic diseases. The disparities in obesity rates are likely attributed to an array of adverse experiences that Indigenous children face, including stress, poverty, food insecurity and transgenerational stress secondary to legacies of colonization, acculturation and residential school trauma. Previous work by our group and others suggest that peer-led mentoring programs, centered on strength-based approaches can be effective for attenuating weight gain in high risk children, including Indigenous youth living in remote settings. A growing body of evidence suggests that interventions that support resiliency (i.e. a psychological construct that describes a child’s ability to thrive despite adversity) improve health outcomes in children. The current talk will focus on an Indigenous theoretical frame work, called the Circle of Courage, discuss the physiological benefits that accompany interventions focused on its primary tenets and how these may be effective for preventing or treating youth living with obesity. PL22 Tailored Surgical Approaches OLIVER COURT* McGill University, Montreal, QC, Canada Abstract not available at time of print. PL23 Back to the Future: The Case for Using Home Visits to Manage Severe Pediatric Obesity GEOFF BALL* Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Severe pediatric obesity (body mass index [BMI] 99th percentile) is linked with a number of adverse cardiometabolic and psychosocial outcomes. Clinical practice guidelines for obesity management recommend that health care interventions include multidisciplinary, family-centered approaches that