Latest / Becker’s Healthcare - Clinical Leadership Podcast / Omar M. Ghanem, MD, Professor of Surgery at Mayo Clinic College of Medicine, Chair of the Division of Metabolic & Abdominal Wall Reconstructive Surgery, Medical Director of Mayo Clinic International

Transcript

Omar M. Ghanem, MD, Professor of Surgery at Mayo Clinic College of Medicine, Chair of the Division of Metabolic & Abdominal Wall Reconstructive Surgery, Medical Director of Mayo Clinic International · Becker’s Healthcare - Clinical Leadership Podcast

• 0:02
  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where do they go
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  - to pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
• 0:51
  - Hello. Welcome to the Becker's Healthcare podcast. My
• 0:54
  - name is Paige Twenter, and I'm an editor
• 0:56
  - with Becker's Hospital Review.
• 0:58
  - I'm really honored to be welcoming,
• 1:01
  - doctor Omar Ghannam at Mayo Clinic today. I'd
• 1:04
  - love to just go to get started. Doctor
• 1:06
  - Ghannam, can you go ahead and introduce yourself
• 1:08
  - and tell us a bit about your work
• 1:10
  - at Mayo Clinic?
• 1:12
  - Absolutely. Thank you,
• 1:14
  - Paige, for for having me. It's an honor
• 1:16
  - to be here, and,
• 1:19
  - happy to be on this, podcast to share,
• 1:22
  - a bit more about obesity and obesity treatment
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  - and and, what's new in this field. I'm
• 1:29
  - Omar Ganem. I'm a metabolic surgeon, and I'm
• 1:32
  - the... Also the chair of the division of
• 1:35
  - metabolic and abdominal wall reconstructive surgery at Mayo
• 1:38
  - Clinic in Rochester, Minnesota.
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  - My clinical practice,
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  - at Mayo focuses mainly on bariatric and metabolic
• 1:46
  - surgery, mainly in complex patients.
• 1:49
  - So for example, patients who have, large hernias
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  - and they need to lose weight,
• 1:54
  - and they they need to have bariatric surgery
• 1:57
  - before their hernia repair or patients who need
• 1:59
  - to undergo transplant,
• 2:01
  - for example, and they need to lose some
• 2:03
  - weight before their transplant so they get referred
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  - to me. The other aspect of my clinical
• 2:08
  - practice focuses mainly on reoperations
• 2:10
  - and revisions.
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  - So as you know, Mayo is a is
• 2:13
  - a destination medical center for patients with complex
• 2:16
  - pathology, and,
• 2:18
  - many patients from all around The US or
• 2:21
  - from the world come to Mayo Clinic
• 2:23
  - when they got,
• 2:26
  - an answer that nothing can be done. We
• 2:28
  - cannot help you. And and we always manage
• 2:31
  - to find ways to help them here at
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  - Mayo Clinic, sometimes by surgery, sometimes through other
• 2:35
  - tools.
• 2:36
  - But but that's what my...
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  - The focus of my clinical,
• 2:40
  - practice is.
• 2:43
  - At Mayo, we have three shields. We have
• 2:45
  - the clinical part, we have the research part,
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  - and we have the education, and now there
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  - is more also
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  - innovation. So, while I have the privilege to
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  - take care of patients from the clinical aspect
• 2:55
  - and manage their obesity and their metabolic disease,
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  - I also try to help
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  - advance,
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  - the science of obesity treatment through clinical research.
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  - Much of my recent work have been focused
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  - on understanding
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  - the long term health benefits of bariatric surgery
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  - and metabolic surgery, particularly their impact on diabetes,
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  - on cardiovascular
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  - health, and overall longevity.
• 3:19
  - So, this is the introduction. Hopefully,
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  - that that kind of,
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  - answers your question of who I am and
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  - what do I do.
• 3:27
  - No. It it does. Thank you. And on
• 3:29
  - that kind of fourth shield of innovation
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  - that Mayo Clinic is spearheading,
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  - what are the most significant shifts today that
• 3:38
  - you're seeing in bariatric and metabolic surgery?
• 3:43
  - Thank you for this, important question because we
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  - are
• 3:47
  - living
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  - now in in in a transformation
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  - period in the field of obesity care.
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  - And,
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  - this major shift, in fact, is based on
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  - three important
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  - factors
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  - or points. The first point is that now
• 4:04
  - obesity is viewed as a chronic disease. In
• 4:07
  - the past, obesity has been viewed as a
• 4:09
  - lifestyle choice.
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  - And,
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  - physicians
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  - and health care providers and societies have worked
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  - so hard for the past couple of years
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  - to change this narrative.
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  - Obesity is a chronic disease, and it is
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  - associated with so many other chronic conditions.
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  - This change in the view of obesity has
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  - allowed us to change also the way,
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  - we view the treatment of obesity care and
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  - we manage obesity.
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  - So that's point number one.
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  - The other,
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  - reason for this transformation is the
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  - emergence
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  - of the anti obesity meds, the GLP ones,
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  - which are an effective... As an effective therapy
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  - for
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  - for, certain types of obesity.
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  - Of course,
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  - this has,
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  - expanded the awareness.
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  - Because of the publicity they got, it has
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  - expanded the awareness of obesity, again, as a
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  - disease and
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  - attracted more patients towards looking at their own
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  - health and how they can manage obesity and
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  - seeking
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  - the help they need for for their,
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  - obesity care.
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  - Finally,
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  - we are seeing
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  - a growing emphasis on
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  - how we can measure obesity
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  - success... Treatment success.
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  - So in the past,
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  - any weight loss modality
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  - used to be measured as how many pounds
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  - did you lose.
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  - And depending on how many pounds did that
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  - patient lose,
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  - did you succeed or you didn't succeed?
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  - That
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  - change in how we view success
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  - has also
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  - contributed to this transformation we're living.
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  - And now we measure more about what are
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  - the metabolic benefits
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  - of this
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  - obesity treatment.
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  - What is the
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  - diabetes remission
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  - incidence if we use this modality versus that?
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  - The cardiovascular
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  - risk reduction,
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  - the quality of life, the overall health outcomes.
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  - Again, that's a much more meaningful way to
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  - think about
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  - treatment success.
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  - So
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  - to go back,
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  - obesity as a chronic disease,
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  - the emergence of GLP one therapy, and how
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  - we measure
• 6:30
  - success, all of these, again,
• 6:32
  - have shifted how we view obesity and also
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  - how we view the obesity treatment and thus
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  - this transformation.
• 6:40
  - What was once seen as, like, a a
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  - lifestyle
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  - choice or change has finally succeeded,
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  - after years of efforts
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  - to be recognized as complex
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  - disease Disease. Mhmm. That needs
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  - complex
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  - treatments
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  - and
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  - requires complex or even, like, not even complex,
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  - but numerous
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  - test of measurements for treatment success, such as
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  - Absolutely. Metabolic benefits, cardiovascular,
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  - disease risks,
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  - quality of life, etcetera. So Absolutely. Absolutely.
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  - Definitely.
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  - Now,
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  - that,
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  - I would say that those three
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  - points I discussed,
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  - it changed not just how we view obesity,
• 7:27
  - but more importantly,
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  - how we view the obesity treatment.
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  - And that allows us to help more patients
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  - more precisely, more adequately by matching the
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  - the treatment... Corrected treatment
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  - to the patient.
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  - If we can go back... We were just
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  - talking kind of, like, more industry trend Mhmm.
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  - Kind of larger picture. If we can go
• 7:47
  - back to Mayo Clinic. So a growing share
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  - of your practice is provisional and reoperative
• 7:53
  - procedures.
• 7:54
  - Correct.
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  - Can you kinda tell me what's driving that
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  - trend?
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  - Absolutely. So
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  - I'm gonna talk about Mayo Clinic, and I'm
• 8:02
  - gonna talk also nationally what's happening because this
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  - would help you kind of see that this
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  - is not only at Mayo. This trend is
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  - happening,
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  - nationally as well.
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  - But to start with Mayo Clinic,
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  - everything I try to say,
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  - is based on studies that we've done.
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  - We looked at the trends and what is
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  - driving this, growing,
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  - revisional and the operative procedure
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  - practice.
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  - So Mayo, again, is a destination medical center
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  - for complex diseases. So by default, we get
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  - more share of these three operative cases than
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  - most of the programs nationwide. And that's sometimes
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  - double to three times
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  - the number of percentage wise to to other
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  - programs. Just, again, looking at our history and
• 8:49
  - what we've done in the past.
• 8:51
  - But this,
• 8:53
  - trend is also changing nationally. We are seeing
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  - more revisional bariatric surgery,
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  - being done on the national level,
• 9:04
  - And this comes from several factors.
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  - One,
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  - the the fact that
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  - millions of patients have already underwent bariatric surgery.
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  - We've been doing bariatric surgery
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  - since the late nineteen seventies
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  - and and
• 9:20
  - in this current form, at least since the
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  - nineteen nineties.
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  - So millions of patients now live
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  - with bariatric surgeries. And as these patients age,
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  - they might experience
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  - weight recurrence. They might experience anatomic changes. They
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  - might start experiencing reflux,
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  - nutritional issues.
• 9:39
  - So,
• 9:41
  - other complications, all of these patients at some
• 9:43
  - point will require further
• 9:46
  - intervention.
• 9:47
  - So the first point is simply demographics. We
• 9:50
  - have more patients living with bariatric surgery, so
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  - we're gonna get more reoperative
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  - experience and mere more reoperations.
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  - The second one
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  - is our understanding of obesity has evolved, Paige.
• 10:04
  - So
• 10:05
  - looking again at at
• 10:07
  - our... Just the point that we discussed
• 10:10
  - in in the previous question, obesity is now
• 10:13
  - looked at as a chronic disease.
• 10:15
  - So it's relapsing. It comes back.
• 10:18
  - So patients who have undergone biotic surgery or
• 10:20
  - weight loss modalities might, in fact, have weight
• 10:23
  - recurrence
• 10:24
  - or sometimes not the weight itself. They may
• 10:26
  - have obesity medical condition recurrence. For example, they
• 10:30
  - might not have recurrence of their obesity, but
• 10:32
  - might have recurrence of their diabetes.
• 10:35
  - So intervening on those patients sometimes
• 10:39
  - through,
• 10:42
  - behavioral therapies, sometimes through medications or pharmacotherapy,
• 10:46
  - sometimes endoscopically, but sometimes surgically
• 10:50
  - will show that there is an increased trend
• 10:53
  - of free operations or revisional procedures.
• 10:56
  - The last aspect is how much we've gotten
• 10:59
  - better as surgeons and health care systems.
• 11:02
  - Most of our revisions now are being done
• 11:04
  - in a minimally invasive fashion. So this advancement
• 11:07
  - in technology,
• 11:09
  - laparoscopy,
• 11:10
  - and robotics
• 11:12
  - allow us to do more complex procedures through
• 11:14
  - small incisions, through
• 11:19
  - minimally invasive fashion. And, again,
• 11:22
  - this allows us...
• 11:23
  - When we assess the risk portfolio of a
• 11:25
  - patient
• 11:27
  - and see that the risk of surgery is
• 11:28
  - not that high, allows us to offer that
• 11:31
  - treatment modality to the patient who needs it.
• 11:34
  - It also allows the patient and the referring
• 11:36
  - provider
• 11:37
  - to accept
• 11:39
  - the fact that this patient now needs an
• 11:41
  - reoperation
• 11:42
  - or a newer intervention
• 11:43
  - knowing
• 11:44
  - the safety profile
• 11:46
  - we have now as surgeons.
• 11:48
  - All of these,
• 11:49
  - should not,
• 11:51
  - be taken, like, as a as a given.
• 11:54
  - I do believe that these three operations
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  - need special expertise and needs to be done
• 11:58
  - at specialized centers.
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  - I'm I'm lucky as a surgeon to practice
• 12:04
  - within Mayo where we have a lot of
• 12:05
  - tools around us, a lot of help, a
• 12:07
  - lot of expertise
• 12:09
  - because these reoperation sometimes are associated with some
• 12:12
  - risk. And if that complication were to happen
• 12:15
  - around the time of surgery, you need the
• 12:17
  - correct team around you to help you,
• 12:20
  - help the patient, essentially.
• 12:22
  - I have more questions, but, unfortunately, we only
• 12:25
  - have a few more minutes. So I'm gonna
• 12:27
  - skip ahead if that's okay to the... Your
• 12:29
  - research.
• 12:31
  - So various clinic research showed that surgery
• 12:34
  - outperforms medications
• 12:36
  - alone, like GLP-one medications alone, just on long
• 12:39
  - term cardiovascular
• 12:41
  - risk.
• 12:43
  - I've seen a few other studies also kind
• 12:45
  - of corroborate that finding. How
• 12:48
  - should, you know, that outcome alone shape the
• 12:51
  - broader treatment landscape going forward, do you think?
• 12:55
  - Great question. Our recent study published in the
• 12:57
  - Nasosurgery, one of the most prestigious,
• 13:00
  - surgical donors, I would say,
• 13:03
  - looked at both metabolic surgery and GLP one
• 13:06
  - medications and how they improve cardiovascular
• 13:09
  - risk.
• 13:11
  - So the risk reduction with surgery long term
• 13:13
  - was about eight point seven, and it was
• 13:15
  - about one point seven with GLPs.
• 13:17
  - What that study also showed is that this
• 13:20
  - trend,
• 13:21
  - kind of followed or matched the
• 13:24
  - weight loss trends as well, because we saw
• 13:26
  - about twenty eight percent,
• 13:29
  - weight loss reduction with surgery versus eleven percent
• 13:32
  - with medications.
• 13:34
  - But but this is not to compare these.
• 13:37
  - This this study
• 13:38
  - was not to show that surgery is better.
• 13:41
  - Surgery will always be better. It was more
• 13:43
  - to match
• 13:45
  - what
• 13:47
  - what the treatment should be offered to which
• 13:49
  - patient. So
• 13:51
  - the first takeaway is that the the... And
• 13:53
  - this is the most important, is that we
• 13:55
  - didn't measure just weight loss. We measured the
• 13:58
  - metabolic benefit. Again, we shouldn't be measuring success
• 14:02
  - just by the pounds you lose. We should
• 14:04
  - be measuring success on how much health benefit
• 14:06
  - this has given a certain patient or a
• 14:08
  - certain population.
• 14:10
  - The second one, page
• 14:12
  - is that surgery should not be viewed as
• 14:15
  - a last resort.
• 14:17
  - Surgery can be the stand alone and the
• 14:20
  - best
• 14:21
  - one procedure or intervention the patient can have.
• 14:24
  - Sometimes it's medication alone,
• 14:27
  - but we shouldn't look at surgery as the
• 14:29
  - last option when everything has failed. Okay. Let's
• 14:31
  - offer this patient surgery. Because looking at the
• 14:34
  - study, some patients have the
• 14:36
  - biggest risk reduction
• 14:38
  - just with surgery.
• 14:39
  - And if they present with a... And their
• 14:42
  - main worry is really their cardiovascular
• 14:44
  - health, then surgery should be on the table
• 14:46
  - from the get go.
• 14:49
  - The last thing,
• 14:50
  - we didn't again do this
• 14:52
  - to compare
• 14:53
  - one versus the other.
• 14:55
  - I I don't want to to,
• 14:58
  - show,
• 14:58
  - our study to show just that surgery is
• 15:00
  - better. It wants to understand
• 15:03
  - what can we match, which treatment to which
• 15:05
  - patient according to their needs and risk portfolio.
• 15:08
  - Over the next five
• 15:10
  - years, where do you see the field heading
• 15:13
  - when it comes to combining medical and surgical
• 15:15
  - therapies?
• 15:18
  - Thank you again, Paige, for for, this question.
• 15:21
  - As a physician scientist, very hard for me
• 15:23
  - to predict the
• 15:25
  - the future without data and without,
• 15:28
  - facts. But I'll I'll answer your question based
• 15:31
  - on the efforts that we are doing now
• 15:33
  - as an institution as well as the national
• 15:36
  - societies and how can this translate into
• 15:40
  - outcomes on... In obesity care,
• 15:42
  - therapies in the in the future.
• 15:45
  - So the first thing we we wanna talk
• 15:47
  - about is
• 15:48
  - the more of the integration
• 15:50
  - of
• 15:51
  - medical
• 15:52
  - and surgical treatments,
• 15:54
  - like like cancer.
• 15:56
  - This is... In the past, every cancer needs
• 15:58
  - a surgical operation. Now we look at cancer
• 16:01
  - differently. Some of them need only chemo. Some
• 16:03
  - of them need
• 16:05
  - chemotherapy and radiation.
• 16:06
  - Some of them need surgery and radiation. Some
• 16:09
  - of them need radiation before surgery, then chemo
• 16:11
  - afterwards.
• 16:12
  - So obesity is being looked at in a
• 16:15
  - similar way. A lot of the efforts being
• 16:18
  - done now, we're gonna see a lot of
• 16:19
  - studies come out. And based on these study
• 16:23
  - outcomes, we're gonna be able to choose
• 16:25
  - what do we do if a patient presents
• 16:27
  - with a BMI of sixty or seventy? Should
• 16:29
  - we start medications first, then do surgery? Or
• 16:32
  - should we just do surgery
• 16:34
  - and maybe do medication afterwards? Should we do
• 16:37
  - them all together at the same time?
• 16:39
  - This shift in understanding will become
• 16:43
  - more prominent when we see the outcomes of
• 16:45
  - all what's being done
• 16:47
  - now.
• 16:48
  - Also,
• 16:50
  - one of our leaders here at Mayo in
• 16:52
  - in obesity care, doctor Andres Acosta, is... He's
• 16:55
  - a leader in precision medicine. So what does
• 16:58
  - that mean?
• 16:59
  - It means
• 17:00
  - looking at each disease pathology
• 17:02
  - from a,
• 17:04
  - metabolic profiling, genetic profiling, phenotypes,
• 17:08
  - and then match the treatment modality according to
• 17:12
  - that. That individualized
• 17:13
  - care that the patient will get
• 17:16
  - is gonna be something that is gonna be
• 17:18
  - very prominent in the future as the field
• 17:21
  - of
• 17:22
  - of, precision medicine as well,
• 17:24
  - evolves.
• 17:25
  - And lastly,
• 17:27
  - I hope with time, we're gonna move away
• 17:30
  - from,
• 17:31
  - providing
• 17:32
  - those modalities as alternatives.
• 17:35
  - Again, this or that.
• 17:38
  - You're gonna get GLP one therapy
• 17:40
  - or surgery.
• 17:41
  - That shift,
• 17:43
  - in the future,
• 17:44
  - I believe, is gonna be,
• 17:46
  - very important in shaping the obesity care treatment
• 17:49
  - options,
• 17:50
  - and a lot of patients will benefit from
• 17:53
  - all these modalities combined.
• 17:55
  - To to summarize, there was a
• 17:58
  - study that just came out this week,
• 18:00
  - page on on... In obesity journal.
• 18:03
  - One of the most rising populations in The
• 18:05
  - US are patients with the BMI above sixty.
• 18:08
  - That means patients with very, very severe obesity.
• 18:11
  - But when we look at the trends in...
• 18:13
  - And and those patients, sorry,
• 18:15
  - surgery
• 18:16
  - needs to be part of their algorithm. Medications
• 18:18
  - alone are not gonna treat patients with such
• 18:21
  - severe disease, at least with the current medications
• 18:23
  - we have now.
• 18:25
  - So looking at this trend of increasing patients
• 18:28
  - that have
• 18:29
  - BMI sixty and looking at the surgical trends
• 18:31
  - where that number of surgery being offered to
• 18:34
  - this patient population has been stable,
• 18:37
  - show the mismatch we have in the growing
• 18:40
  - population of obesity
• 18:42
  - versus the patients that are getting the proper
• 18:45
  - treatment. I do believe we need to bring
• 18:48
  - more patients,
• 18:49
  - more medical providers to the table
• 18:52
  - to show how safe bariatric surgery is, how
• 18:55
  - important it is for these patients to have
• 18:57
  - access
• 18:59
  - to this treat... Treatment modalities. Only one patients...
• 19:03
  - One percent of patients with obesity
• 19:06
  - get
• 19:07
  - to bariatric surgery. One percent.
• 19:10
  - So
• 19:11
  - will this,
• 19:12
  - shift in how we view obesity
• 19:15
  - change this percentage?
• 19:16
  - That's my hope because our hope is to
• 19:18
  - help the patients who need it.
• 19:20
  - Well, thank you so much, doctor Gannon, for
• 19:23
  - joining us today for this podcast. I really,
• 19:26
  - really appreciate, you know, you sharing your time
• 19:28
  - and expertise with us.
• 19:30
  - Oh, thank you. Again,
• 19:31
  - I'm I'm happy I was able to be
• 19:34
  - here and, again, honored to participate. Thank you
• 19:37
  - so much.