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i n f r a s t r u c t u r e a n d r e s o u r c e s t o es t a bl i sh comprehen sive ba r i at r ic ca re for t he a dolescent popu lation, which requires a dif ferent approach t o pat ient ca re a nd educat ion t ha n the adult population. Dr. Sekha r is in a unique position to of fer adolescent bariatric surgery due to his background in pediatric surger y. W hen treating a dolescent pat ient s, ba r iat r ic ca re providers must address emotiona l and lifestyle factors within the family envi- ronment that may a ffect the patient 's ability to meet long-term goa ls and a lso consider the ex pectations, a n xieties and preferences of the patient 's parents or lega l g ua rdia ns. " Ma na g i ng a n adolescent patient mea ns ma na g i ng t he enti re fa m i ly, a nd we do our best to accommodate this in our ca re pla n," Dr. Sekha r says. " Fa m i ly members a re incor porated into the patient 's nutrition education a nd psycholog ica l suppor t prog ra ms to ensure that not only the patient, but a lso the pa rents, a re committed to the patient 's success." PROVEN EFFICACY Medica l literature suppor ts surg ica l treatment of obesit y in adolescents. In a 2012 rev iew of published dat a , the A merica n Societ y for Metabolic a nd B a r i at r ic Su r ger y det er m i ned t hat patient sa fet y a nd weig ht-loss outcomes for ex tremely obese adoles- cents following ba riatric surger y a re compa rable to or bet ter t ha n t hose seen in adults. Dr. Sekha r ag rees a nd ack nowledges t hat a misconception exists a mong ma ny pediatricia ns a nd family practitioners that conser vative measures, such as lifest yle modif ica- tion a nd behaviora l therapy, should be deployed a s a stopgap mea sure unti l the patient reaches adulthood, when surgica l a lternatives may be discussed. W h i le c on s er v a t ive t her a pie s a r e a lways the frontline option, a mounting body of evidence shows that ba riatric su rger y ca n be more ef fective t ha n long-term conser vative treatments for ex tremely obese adolescents. " T he con sen sus i n t he l it erat u re is that the ea rliest possible surg ica l intervention is best for morbid obesity," Dr. Sek ha r says. " You n ger pat ient s actua lly experience a g reater benef it from weight-loss surger y because they haven't yet developed chronic comor- bidities, such as joint issues, that would hinder t heir recover y a nd abi lit y to exercise a f ter surger y, both of which a f fect the long-term ef fectiveness of surger y. Adolescents a lso have a higher metabolic rate a nd a re genera lly more physica l ly active, enabli ng t hem to lose weight much faster af ter surger y." A TOOL FOR SUCCESS W hether treating adolescent or adult pat ient s, Dr. A n gs t a dt say s ca re at t he Wei g ht L os s Su rger y Cent er i s a lways d r iven by best practices for long-term success. " Weight loss surger y is a tool f irst a nd a t r e a t ment s e c ond ," he s ay s . " Ba riatrics is unique in that the sur- geon a nd the entire medica l tea m have to play a n integra l, ongoing role in the patient 's life in order for surger y to be successful." F o r m o r e i n f o r m a t i o n a b o u t t h e We i g h t L o s s S u r g e r y C e n t e r a t S t . C h a r l e s H o s p i t a l , v i s i t stch arl esh os p ital .ch sli .o rg/we ight- loss-surgery-center. ■ Understanding Changes in Bariatric Accreditation RECENT CH A NGE S TO the accreditation process for bariatric centers can lead to confusion for the general practitioner. For many years, the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) operated independent accreditation programs for bariatric surgery centers. This prevented the ability of patients and referring physicians to perform an apples- to-apples comparison of bariatric providers, as the accreditation process for each organization varied not only in criteria, but also in format and verbiage. To address this knowledge gap, the ACS and ASMBS consolidated their respective programs in April 2012 to form a unified accreditation platform called the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). As a result, bariatric centers that were formerly accredited through one or the other organization were required to reapply for MBSAQIP accreditation. As an MBSAQIP-accredited center, the Weight Loss Surgery Center at St. Charles Hospital has achieved outstanding quality and safety outcomes as benchmarked against a national pool of top-rated bariatric centers in the MBSAQIP database. Today, the MBSAQIP seal represents the highest recognized standard in bariatric accreditation in the United States. EARLY INTERVENTION FOR YOUNG PATIENTS The skilled surgeons at the Weight Loss Surger y Center at St. Cha rles Hospita l of fer the benef its of ba riatric surger y to patients as young as 15 yea rs old — a ser v ice t hat disti ng uishes t he faci l- it y a mong ot her simi la r prog ra ms in the a rea . " I recently consu lted on a n adoles- cent patient who lives i n Brook ly n," Dr. Sek ha r says. "She a nd her fa mi ly were w i l ling to travel to Long Isla nd because of the lack of access to these procedures for patients in her age group." M a n y h o s p i t a l - b a s e d b a r i a t r i c p r o g r a m s s i m p l y d o n o t h a v e t h e Lynda Hoffman, MPH, RD, CDE, CDN, dietitian at St. Charles Hospital, counsels a patient postoperatively about portion sizes. Nutrition counseling is critical to success following bariatric surgery. 1 0 C O V E R S T O R Y 1 0