“AGA recognizes that gastroenterologists are often in the front line of specialists who treat obesity-related disorders. Our goal in creating this comprehensive, multi-specialty program was to empower GI physicians to treat obesity by providing the tools and strategies needed to join or create a multi-disciplinary team to combat obesity and improve the lives of their patients,” said Madelin Siedler, director of clinical practice at the AGA.

Gastroenterologist and ABOM Diplomate Dr. Andres Acosta, MD, PhD, at the Mayo Clinic, was one of the lead authors of the guide. He helped coordinate a group of contributors to the resource that also included The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), The Obesity Society (TOS), the Academy of Nutrition and Dietetics (AND), and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).

Dr. Acosta spoke with ABOM about the development of the guide:

Q. Why was it important to develop an obesity resource for gastroenterologists?

Gastroenterologists already have our clinics full of patients with complications related to obesity, such as gastroesophageal reflux disease and non-alcoholic fatty liver disease, as well as colonic polyps and colon cancer.  For that reason, we think that it is essential that gastroenterologists embrace obesity and feel comfortable managing it. Additionally, in our tool box we can feel very comfortable using medications, as well as endoscopic devices, to help patients with obesity. Furthermore, we are already collaborating with all the key members necessary for an obesity practice, which include our colleagues in nutrition medicine, registered dieticians, psychologists and psychiatrists, as well as bariatric surgeons.

Q. Describe the episode of care framework and how it adds an element that may be missing from other obesity resources.

While obesity is at an epidemic level, understanding the business operations and billing process can be quite challenging.  For that reason, AGA established the Obesity Episode of Care and Bundle Initiative Work Group to develop an episode framework to support value-based management of patients with obesity, focusing on the provision of non-surgical and endoscopic services. The recommendations of the workgroup were recently presented in a white paper. The episode of care will help us facilitate what resources are available for care providers who want to adopt obesity management in their practice, as well as serve as a guide to understand the “business process” of obesity care.  Additionally, this guide will not only help physicians, but also support the other members of the multidisciplinary team to be compliant with the current standards and regulations in the management of obesity.

Q. How can physicians with other specialties incorporate the information in the guide into their own practices?

Other physicians can adopt this guide based on some novel concepts:

• This practice guide focused on the importance of obesity management as a “continuum of care”.  We think this is a new concept that needs to be emphasized.  That’s why we have divided this practice guide into four main areas — assessment and evaluation of patients with obesity; weight loss phase; weight maintenance phase; and weight regain prevention phase.  This is essential, because we know that obesity is not a simple intervention that once you have lost some weight, you are going to maintain it. As we know, unfortunately, weight regain is extremely common with all interventions, including bariatric surgery.

• Other physicians might benefit from understanding what other specialists can contribute in the obesity practice, especially how to work with dieticians, psychologists, endocrinologists, and gastroenterologists, as well as endoscopists and bariatric surgeons. Clearly, these multidisciplinary guidelines will help us advance obesity in a multidisciplinary, multi-society fashion.

Q. What was the benefit of working with organizations such as The Obesity Society (TOS), The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and others on a resource like this?

The benefit of working in a multi-society guide like POWER was that we were able to get state-of the-art and the best evidence, as well as practical recommendations, from all different specialties.  Instead of us having to go and review the literature and try to come to a conclusion of what we think would be the best care, we asked the experts in the field to contribute to the POWER white paper.  By doing this, we didn’t only get the best evidence, but also the best expert opinion from multiple members of each of these societies, and the outcome is that each of the respected societies endorsed this new guide to be used by all health care providers who want to embrace and manage obesity.  Furthermore, we have laid the foundation and formed strong bridges with all of these different societies to continue to collaborate to fight this epidemic.  We are all facing the same issues with this obesity epidemic that floods our clinics; we should all work together to embrace this disease and hopefully revert the progression of this epidemic.

Clearly one of the most important aspects of the POWER program is the endorsement from the multiple societies.  This tells us that we have put together one of the strongest practice guides for obesity and one that we tried to make very simple for the busy clinician.  Our hope is that not only gastroenterologists, but every physician and practitioner who is trying to manage obesity can read this guide and add these very simple, but evidence-based recommendations to their practice.

Physicians interested in learning more can join a free webinar on Tuesday, March 28, from noon to 1 p.m. ET. The webinar will review the AGA Obesity Practice Guide and discuss how physicians can begin to implement the POWER program into their practices.