Reuters Health recently published an article about the long-term benefits of gastric bypass surgery. Palo Alto Medical Foundation (PAMF) bariatric experts report that positive outcomes with their patients met or exceeded those reported in the recent report. PAMF is part of the Sutter Health network that serves the San Francisco Peninsula and South Bay areas.
Research released by the University of Utah School of Medicine in Salt Lake City showed that improvements in diabetes and blood pressure may hold up for years after the procedures. The study’s six-year patient follow-ups found that three quarters of people who’d undergone gastric bypass surgery had lost at least 20 percent of their pre-surgery weight and kept it off.
PAMF’s 2011 weight management and bariatric surgery outcomes report shows that PAMF’s positive patient outcomes equaled or exceeded the findings of the University of Utah School of Medicine. The PAMF outcomes study illustrates that patients averaged a 12-point reduction in their BMI after surgical intervention. The average weight loss experienced ranged from 106 to 196 pounds.
Bariatric surgery is typically recommended for people with a body mass index (BMI) – a measure of weight in relation to height – of at least 40, or at least 35 if they also have co-occurring health problems such as diabetes or severe sleep apnea.
Albert Wetter, M.D., the medical director of the Metabolic and Bariatric Surgery program at PAMF’s Burlingame Center, cited an outcomes report he recently co-produced with colleagues that measured his department’s outcomes and successes.
“If BMIs were lowered, the number of Americans who could be spared from developing major obesity-related diseases would be dramatic,” Dr. Wetter said.
To quantify the obesity crisis in California, Dr. Wetter contrasts incidence of high-risk medical conditions in California with those in Alaska:
- Type 2 diabetes: 14,389 in Alaska to 796,430 in California
- Coronary heart disease and stroke: 11,889 in Alaska to 656,970 in California
- Hypertension: 10,826 in Alaska to 698,431 in California
- Arthritis: 6,858 in Wyoming to 387,850 in California
- Obesity-related cancer: 809 in Alaska to 52,769 in California
“If obesity rates continue on their current trajectories, by 2030 the obesity rate in California could exceed 46 percent. If BMIs were reduced by five percent, the number of California residents who could be spared from developing new cases of major obesity-related diseases is compelling,” Dr. Wetter said, citing these projections:
- 796,430 people could be spared from type 2 diabetes
- 656,970 from coronary heart disease and stroke
- 698,431 from hypertension
- 387,850 from arthritis
- 52,769 from obesity-related cancer
While weight loss surgery isn’t the answer for every person who is more than 80 pounds overweight, it is the most reliable way to sustain significant weight loss for years.
“While most people can lose some weight and keep it off in the short term, weight loss surgery is proven to help people keep most of their excess weight off for the long-term. This study confirms that the weight loss, as well as the benefits of it, persists years after the operation,” said Pamela Foster, M.D., another bariatric surgery expert at PAMF’s Burlingame Center.
In the last five years, Drs. Wetter and Foster, along their PAMF colleagues John Feng, M.D., Beeman Khalil, M.D., and Prithvi Legha, M.D., have performed more than 2,200 weight loss surgeries.
“It is very rewarding to see patients at a healthy weight and a more satisfying quality of life,” said Dr. Feng.
According to the American Society for Metabolic and Bariatric Surgery, about 200,000 people have weight loss surgery every year.
PAMF launched regional, coordinated weight management programs that tackle the foundations and consequences of obesity. The teams include physicians, weight loss surgeons, dieticians, exercise physiologists, health care educators, behavioral health experts and nurses, all of whom work together in an integrated weight management program designed to meet the variable needs of their patients.
The Palo Alto Medical Foundation (PAMF) was one of six physician organizations connected to the Sutter Health network that was recognized as statewide leaders in clinical quality by the Integrated Healthcare Association (IHA), a renowned industry leadership group in California. PAMF was ranked as “Top Performer.”
“This award is a testament to the excellent care that PAMF physicians and staff provide to our patients,” said Laurel Trujillo, M.D., PAMF medical director of quality who accepted the award on behalf of the medical group.
Out of nearly 200 physician organizations, the 47 top performers achieved the highest overall quality in 2011 based on the IHA statewide Pay for Performance (P4P) program measures. In addition to celebrating the top performers, IHA honored the physician organizations that demonstrated the most quality improvement from 2010 to 2011.
Learn more about IHA’s program in the Sutter Health newsroom.
Researchers at the Palo Alto Medical Foundation Research Institute (PAMFRI) have received a one-year grant from the Verizon Foundation to implement an innovative and unique virtual Shared Medical Appointment (SMA) for weight management. SMAs are group appointments for patients with similar medical concerns and include components of a regular office visit. As a result, patients get more time with physicians and have an opportunity to learn from other patients. The new virtual SMA for weight management will utilize telepresence technology, allowing patients and physicians to connect through high-definition video conferencing.
SMAs have been in use at Palo Alto Medical Foundation (PAMF) since 1996 for a range of health care issues. A previous research study conducted Latha Palaniappan, M.D., MS, and her research team showed that the specialized SMA for weight management designed by Amy Muzaffar, M.D., was successful in helping individuals lose weight and improve their diet and physical activity in order to manage chronic disease and improve health outcomes.
JAMA Publishes Editorial by PAMF Physician
While some health professionals have called for changes to the food environment, less attention is paid to the quality of food medical professionals themselves are eating at medical meetings, conferences and seminars, as well as at hospitals and clinics.
The problem of physician eating habits and potential solutions are described in the September 12, 2012, edition of the Journal of the American Medical Association, (JAMA) an international peer-reviewed medical journal.
“Most people in the U.S. eat too much food, and physicians are not immune to the obesity epidemic,” says Lenard Lesser, M.D., MSHS, a Family Medicine physician with the Palo Alto Medical Foundation (PAMF) and research physician at the PAMF Research Institute. “If a doctor is overweight, it may affect their approach to patient care, as overweight physicians are less likely to counsel patients about obesity.”
Dr. Lesser co-authored the Viewpoint piece with Deborah Cohen, M.D., MPH, and Robert Brook, M.D., ScD, researchers from the RAND Corporation. He worked with them while he was in the Robert Wood Johnson Foundation Clinical Scholars Program at the University of California, Los Angeles (UCLA).
In the Viewpoint piece, Dr. Lesser observes that medical organizations could take several initial steps toward better meals and healthy eating for health professionals.
Similar to the healthy movement of smoke-free campuses becoming a standard, “certified healthy” meals could be an industry model, Dr. Lesser posits. He points out that the movement for smoke-free workplaces started in hospitals. A similar movement could start with healthy meals in medical practices, and spread to surrounding communities.
“The medical profession has the capacity to encourage food-system change within its own institutions,” concludes Dr. Lesser. “This could reduce caloric consumption by health professionals, support the health of physicians, and potentially cause a positive ripple effect in local food economies.
“Caterers could even alter their nutritional sales pitch to indicate that, ‘These are like the lunches your doctor eats’,” Dr. Lesser says.
Dr. Lesser makes several other recommendations to improve the food served to health professionals in the article, including providing calorie labeling and eliminating sugar-sweetened beverages.
Contact: Dr. Lenny Lesser, 650-330-4576; firstname.lastname@example.org. @LennyLesser
PAMF’s Dr. Paul Tang Member of the Institute of Medicine’s Learning Health Care System Committee
The increasing complexity and escalating costs of health care in the United States threaten the nation’s economic stability and undermine progress in improving Americans’ health. Medical care lags behind many other industries in its ability to meet needs, offer choice, and become safer and more affordable to those it serves.
On September, 6, 2012, the Institute of Medicine (IOM) released its latest report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, which details ways to bring about better quality care at lower cost by harnessing existing knowledge and technologies. The report calls for a transformation of the health care system into one that continuously improves, and it describes the specific steps that should be taken by all participants — including care providers, hospital and clinic managers, health insurers, policymakers, clinical researchers, and patients and their families — to achieve this improved system.
“This report provides a framework for creating a health care delivery system in America that continuously learns and continuously improves. It leverages something America already does very well – innovation – and applies that to health care,” according to Paul Tang, M.D., M.S., internist and vice president, chief innovation and technology officer at the Palo Alto Medical Foundation (PAMF) and the PAMF Innovation Center.
Dr. Tang is an elected member of the IOM and has participated on a number of IOM studies, including a patient-safety study he chaired, which published two reports: Patient Safety: A New Standard for Care, and Key Capabilities of an Electronic Health Record System.