Center for Advanced Laparoscopic General and Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States.
Professor Emeritus, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
World J Gastroenterol. 2017 Sep 21;23(35):6371-6378. doi: 10.3748/wjg.v23.i35.6371.
A world-wide rise in the prevalence of obesity continues. This rise increases the occurrence of, risks of, and costs of treating obesity-related medical conditions. Diet and activity programs are largely inadequate for the long-term treatment of medically-complicated obesity. Physicians who deliver gastrointestinal care after completing traditional training programs, including gastroenterologists and general surgeons, are not uniformly trained in or familiar with available bariatric care. It is certain that gastrointestinal physicians will incorporate new endoscopic methods into their practice for the treatment of individuals with medically-complicated obesity, although the long-term impact of these endoscopic techniques remains under investigation. It is presently unclear whether gastrointestinal physicians will be able to provide or coordinate important allied services in bariatric surgery, endocrinology, nutrition, psychological evaluation and support, and social work. Obtaining longitudinal results examining the effectiveness of this ad hoc approach will likely be difficult, based on prior experience with other endoscopic measures, such as the adenoma detection rates from screening colonoscopy. As a long-term approach, development of a specific curriculum incorporating one year of subspecialty training in bariatrics to the present training of gastrointestinal fellows needs to be reconsidered. This approach should be facilitated by gastrointestinal trainees' prior residency training in subspecialties that provide care for individuals with medical complications of obesity, including endocrinology, cardiology, nephrology, and neurology. Such training could incorporate additional rotations with collaborating providers in bariatric surgery, nutrition, and psychiatry. Since such training would be provided in accredited programs, longitudinal studies could be developed to examine the potential impact on accepted measures of care, such as complication rates, outcomes, and costs, in individuals with medically-complicated obesity.
全球肥胖患病率持续上升。这种上升增加了肥胖相关医疗状况的发生、风险和治疗成本。饮食和活动计划在长期治疗医学上复杂的肥胖方面往往是不够的。完成传统培训计划后提供胃肠道护理的医生，包括胃肠病学家和普通外科医生，并没有在可用的减肥护理方面接受统一的培训或熟悉。可以肯定的是，胃肠病医生将把新的内镜方法纳入他们治疗医学上复杂肥胖患者的实践中，尽管这些内镜技术的长期影响仍在研究中。目前还不清楚胃肠病医生是否能够提供或协调减肥手术、内分泌学、营养、心理评估和支持以及社会工作等重要的联合服务。根据其他内镜措施（如筛查结肠镜检查的腺瘤检出率）的经验，获得检查这种临时方法有效性的长期结果可能很困难。作为一种长期方法，需要重新考虑将一年的减肥专业培训纳入现有的胃肠病学研究员培训中，以制定具体的课程。这种方法应该通过胃肠病学受训者在为肥胖并发症患者提供护理的专科（包括内分泌学、心脏病学、肾脏病学和神经病学）的先前居住培训来促进。这种培训可以包括与减肥手术、营养和精神病学的合作提供者进行额外的轮转。由于这种培训将在认可的项目中提供，因此可以制定纵向研究来检查对接受的护理措施（如并发症发生率、结果和成本）的潜在影响，这些措施适用于医学上复杂的肥胖个体。
