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Olympus speaks with Associate Professor Dr. Talbot about bariatric surgery and obesity

Thursday, September 28, 2017
Section: General

 

Olympus speaks with Associate Professor Dr. Talbot about bariatric surgery and obesity

 

Associate Professor Michael Talbot is a Specialist in Upper Gastrointestinal Surgery, Bariatric Surgery, therapeutic Endoscopy/ERCP, Oesophageal Physiology and Reflux. Dr Talbot has been a pioneer of complex Bariatric Surgery in NSW and has been in the forefront of adopting new surgical, endoscopic and more recently robotic technologies in patient treatments.

Dr. Talbot will be presenting a talk titled, ‘Emerging Technologies in Bariatric Surgery’ at the Obesity Surgery Society of Australia and New Zealand (OSSANZ) Conference on Wednesday, October 4th 2017, in Adelaide.

He kindly participated in a Q&A session with Olympus and revealed some interesting knowledge and insights in relation to bariatric surgery and obesity.

 

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What role can technology have in helping patients achieve their weight and health goals, and importantly maintain them?

One of the issues of obesity management is that it tends to be and still is predominantly clinician focused, rather than patient focused. It is still very much in siloes and that’s because data about what works hasn’t been translated to changes in practice by government, hospitals and clinicians. While Obesity surgery receives support through Medicare, public hospitals exclude patients from treatment, effective medicines are not PBS subsidized and GP’s are not incentivized to help patients with obesity management plans.

Technologies such as personal monitors are starting to become more prevalent and data about dietary habits that make people more prone to weight gain is growing. Although, while we have good data, this is not being communicated effectively to people and the bulk of information that people receive is based on personal opinion and anecdotes. Every six months another dietary fad is announced and promoted, but messages about effective health habits are routinely drowned out by conflicting opinions.  It’s one of those areas where we have good data but it is not being translated into good practice. The prevalence of obesity is increasing by half a percent every year in Australia since the 80’s and it shows no sign of slowing down so we still have a long way to go.

Bariatrics is an evolving field. Technology creates a whole host of new possibilities in patient monitoring, real-time support, individualized therapies and improvements in the safety and effectiveness of our obesity interventions, and all of those possibilities are really just evolving. Certainly, within our industry, technology has evolved to make the therapies we deliver to patients almost unbelievably safe, the struggle we find now is increasing the number of people that we treat. The safety profile of surgery has exceeded what people could have predicted a decade ago predict but we are still only able to treat a very small percentage of people.

 

What's been the biggest change in Bariatric surgery in the last ten years?

We have found that as a result of patient demand, the Sleeve Gastrectomy has become the most dominant procedure for weight loss surgery. This has become a worldwide trend in bariatrics. 

 

What's been the biggest impact of "Dr. Google" in your practice?

We’ve seen that compared to 10 years ago, our patients’ level of base knowledge has increased but the problem remains that a lot of what’s on the internet may not reflect the realities of obesity, bariatric surgery and how patients can achieve and maintain weight loss.

A lot of my patients are internet savvy and have become experienced at putting filters on things and they find the most useful sites nowadays are blogs written by people who have been through treatment themselves because they can create a narrative that patients can understand and relate to.

There’s a lot of information on the web that is more based around advertising or promoting a particular perspective rather than providing useful information. Thankfully people are getting better at thinking, ‘why is this on the web? Are people trying to sell me something or are they relaying their own personal experiences’. Today’s generation of internet users are becoming better able to editorialise the content rather than taking everything at face value.

 

What needs fixing in the world in bariatrics?

The patient follow up process needs to be improved. Getting patients to commence treatment with surgery is quite straight-forward once they have been assessed as suitable candidates. Unfortunately a large percentage of patients that have initially successful surgery will have long-term suboptimal outcomes because they’ve escaped mechanisms that we have in place to ensure the long term safety and effectiveness of the surgery.

Our biggest problem isn’t the effectiveness and safety of our treatment. They are now very safe and very effective; the biggest problem is maintaining their effectiveness in a society that promotes mindless 24/7 eating.

We find that once patients have achieved a healthy weight, a fair percentage of them will drift back to the unhealthy behaviours that contributed to their weight gain in the first place. They can lose the weight through surgery, independent of lifestyle changes and then they start the cycle of weight gain all over again. That’s our biggest problem and what we need to fix. Improved monitoring technologies, smart-phone delivered appropriate support, and better communication between people treating overweight patients and their GP’s will all hopefully tip the balance in favor of people recognizing that surgery isn’t a “quick-fix” for obesity but part of a lifelong package that needs to be lifelong in order to maintain its safety and effectiveness.

 

A lot of innovations are touted as "the next big thing" - what's looking like living up to this promise in the field of bariatrics?

Certainly a lot of it depends on what perspective you want to take because obesity management is a multi-layered challenge – all of these layers need to work synergistically for bariatric surgery to be effective.

I think the next big thing is likely to be big data, data mining and trying to find out the characteristics of people who respond better to one treatment or another. Data can help identify the sorts of behaviours we need to encourage in patients in order to achieve and maintain weight loss.

From a technical point of view, augmented reality will deliver significant advantages when training practitioners and performing procedures. Incorporating these technologies into hospitals is difficult because medicine is highly complex and the risks are great. For example with big data, the risks relate to personal freedom so you can’t actually get good data about people without creating the possibility for data breaches.

 

What would bring innovation to the world of bariatrics?

Collaboration is key to innovation. Anything that brings different groups together, focused on the interest of the patient creates the possibility for improvement so it really is collaboration that will drive innovation. It is getting people together and making our treatment of patients more individualized and less provider specific.

There are a lot of problems in medicine about care being based on what the provider offers rather than what the patient requires so the more input you have on patient’s interest, the better the patient’s outcome. That’s the area where innovation will occur - individualised medicine.

Individualised care is already happening in cancer therapies and it is also the next big thing in a lot of other diseases. Making therapy not provider-specific but patient-specific requires good data about outcomes – but you also need collaboration, people working together.

 

To register for Dr. Talbot’s OSSANZ October 4th talk, click the banner below.

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