Under the direction of Colleen Tewksbury, PhD, RD, the Penn Metabolic and Bariatric Surgery Program has instituted an In-Office Bariatrics Update series to bring critical information about obesity treatment and the post-bariatric experience to community physicians. Dr. Tewksbury is the Program’s senior research investigator and bariatric program manager.
Bariatric surgery is the most effective therapy for severe obesity. However, the medical needs of bariatric patients in both the short- and long-term can be particularly challenging for community physicians, who may lack sufficient guidance and resources to best monitor patients’ nutrition, exercise, and comorbidities. Such counsel is both critical and necessary in the immediate aftermath of surgery because the medical needs of post-bariatric patients during this time can have a significant impact on the long-term outcomes for these patients.
In addition, bariatric patients require lifelong dietary counseling and nutritional monitoring, and these needs may shift with time. Although bariatric surgery is becoming more common, few physicians seeing bariatric patients years after surgery feel as though they are sufficiently prepared to interpret metabolic warning signs and other critical information.
The rising obesity rate in the United States and a consequent wave of bariatric surgeries is bringing these issues to the forefront for the physician community. In the five years between 2013 and 2018, more than one million bariatric surgeries were performed in the United States. By 2030, it’s estimated that one in four Americans will be a candidate for bariatric surgery. It’s likely that less than 1% of these individuals will have surgery, the estimated addition to the post-bariatric population will approach 1 million within that timeframe. One of the top cited barriers to patients receiving this care is provider perceptions of the surgical treatment process.
Dr. Tewksbury created the In-Office Bariatric Update Program to address all of these concerns. The Program brings information about the many resources available from Penn Metabolic and Bariatric Surgery directly to physicians in the community. The Program is flexible to accommodate the needs of particular offices. Depending upon the needs of a particular office, Dr. Tewksbury and her staff will do a formalized presentation, or a brief sit down to address any questions physicians may have.
“What most providers are concerned about—and primary care particularly—are links to additional subspecialties to care for these patients,” Dr. Tewksbury explains. “So, we let them know about the dietitians, psychologists and surgeons available to them at Penn Medicine, as well as other resources they may not be aware of—the seven support groups that meet each month for patients, for example, as well as our online systems, which are designed to encourage patient participation.”
Built into EPIC, Smart Sets are chief among the assets available to community physicians from the Metabolic and Bariatric Surgery Program at Penn Medicine. These simple but sophisticated tools offer physicians immediate access to the recommended orders, tests, diagnostics and surveillance for long-term management of bariatric patients.
New at the Program, the enhanced recovery after surgery protocol, or ERAS is a common element in other areas of surgery, but hasn’t been widely applied to bariatrics.
“In the last few years, we’ve implemented an ERAS protocol that’s shortened length of stay for most bariatrics patients to one overnight in the hospital, and minimized opioid use overall,” says Dr. Tewksbury. “In fact, we’re now looking at the total elimination of opioids for the majority of patients.”
Because physiology is only the beginning of the issues facing the community physician who manages post-bariatric patients, the In-Office Bariatric Update Program incorporates the psychological and emotional needs of those struggling with obesity and post-bariatric patients. Multidisciplinary counseling is an important part of the postoperative adaptation phase for patients adapting to profound changes in eating behavior and body image.
However, the Program focuses on provider behavior, as well.
“Patients who experience weight bias in conversation or other subtle ways may be less likely to take the step toward bariatric surgery, or return for preventative services or acute care,” Dr. Tewksbury says. “So here at Penn Medicine, we work with researchers in the Center for Weight and Eating Disorders at the Perelman School of Medicine whose area of expertise is weight bias among clinical providers.”
The research focuses upon the mental and physical health consequences of weight stigma and explores strategies to reduce weight-biased attitudes.
“The Center for Weight and Eating Disorders’ goal, and ours, is to ensure that patients are comfortable with their treatment options, and comfortable with the health system establishment.”
In-Office Bariatric Update Program Registration
Practices and individuals interested in scheduling the In-Office Bariatric Update Program may contact Lori Pray at Lori.Pray@pennmedicine.upenn.edu. or your Penn Medicine Physician Liaison.
Additional Bariatric Surgery Resources from Penn Medicine