Report from groundbreaking 'EndoVators Summit' offers guidance for obesity treatment

The Summit convened nearly 100 obesity management experts, innovators and key decision-makers from industry, insurers, technology companies and regulatory agencies. Their charge was to review the current state of the obesity epidemic in America and the role that endoscopic bariatric and metabolic therapies (EBMTs) can play in managing this disease. In addition, ASGE invited leaders of key health and medical organizations with an interest in EBMTs to participate in an exchange of ideas related to training, education and research in this field, with the goal of identifying areas for cooperation and coordination.

"One of the most important messages from the Summit is that we need to reframe the debate," said Kenneth R. McQuaid, MD, FASGE, immediate past president of ASGE. "Instead of seeing obesity as a consequence of bad lifestyle choices, we must recognize it as a chronic disease and remove the stigma around it."

During a panel discussion on policy issues, including federal programs to address hunger, Dr. McQuaid noted, "This is a public health problem, and we have to take public health measures to address it."

Several presenters stressed that health effects associated with obesity -- including diabetes, cardiovascular problems and more -- represent an enormous cost to the healthcare system. According to Dr. McQuaid, "Reimbursement is a huge challenge that we'll need to address. This is in the best interest of all of us in healthcare as well as our patients."

Obesity among adults in the U.S. remains high at 35 percent of the population. Obesity is associated with numerous health problems, including diabetes and heart disease. It has many other ramifications as well, such as preventing patients from having lifesaving organ transplants.

Treatment options for patients with obesity include lifestyle intervention, dietary counseling, pharmacotherapy and bariatric surgery. Recently, endoscopic bariatric therapies (EBTs) have become available. These may be a recommended option for patients within certain body mass index (BMI) ranges for whom diet and behavior changes are not working sufficiently, who are not good candidates for surgery, or who are not willing to undergo surgery. Endoscopic bariatric therapies are performed without surgery, so they are considered less invasive. Of all patients with obesity who are candidates for bariatric surgery, only about 2 percent choose that route.

Christopher C. Thompson, MD, FASGE, Chair of the Association for Bariatric Endoscopy, presented information about various endoscopic treatments, reporting on patients whose health improved as a result.

Drs. McQuaid and Thompson noted the contribution of Marvin Ryou, MD, who captured the essential content and conclusions of the meeting to develop the white paper.

Topics discussed during the Summit included:

• the extent of the public health crisis around obesity, with rates increasing among women and some groups of children;
• a wide range of contributing factors ranging from food insecurity to hormonal/metabolic conditions to the structure of farm subsidies;
• health literacy and public education;
• considerations and challenges with federal and private reimbursement for medical treatment;
• the latest treatment approaches and options, including endoscopic bariatric therapies that provide a less invasive approach compared with surgery;
• the various specialties, support systems and tools that contribute to a collaborative approach to helping patients through a variety of treatment approaches; and
• the fundamentals of setting up a bariatric program.

In concluding the meeting, Dr. McQuaid thanked the participants for accomplishing the goals of the Summit, and emphasized the importance of the key players continuing to collaborate, including various medical specialties. He said, "We are much more effective working together."

ASGE and ABE have led a continued dialogue with leaders of the organizations represented at the Summit, related to registry development, advocacy, public education and research. The organizations will continue to coordinate efforts on behalf of their constituents, with the overall goal of ultimately benefiting patients.