: For Bariatric Surgeon, Patient Access to Procedures Remains Chief Concern

The evolving procedures were once largely considered “cosmetic,” but today, cardiologists, endocrinologists and primary care physicians are referring patients for treatment of morbid obesity and its related health concerns.

Author: Lucy Schultze

It started as an operation, then it became a disease. Now it’s an entire field of medicine.

That’s how J. Stephen Scott, MD, sums up the dramatic evolution of bariatric surgery since he first added it to his general surgery practice 20 years ago. Over time, bariatric surgery has become the focus of his practice and has matured in its technique, safety and acceptance by the medical community.

“When we first began, bariatric surgery was viewed almost as a cosmetic procedure,” said Scott, medical director for metabolic disease at the Des Peres Hospital Bariatric and Surgical Institute.

“The biggest change is that, today, we understand the consequences of obesity,” he said. “Back then, we knew that if you were really overweight, that’s an unhealthy thing. But we didn’t really understand the implications.

“Now we understand the cost of obesity, both from a medical point of view and an economic point of view. People understand bariatric surgery as a medically necessary intervention.”

The other most significant change: The way complication rates have come down tenfold over the past two decades.

“It’s just amazing,” Scott said. “Weight-loss surgery today is a very safe procedure, and the introduction of robotic surgery is improving it even more. I’m excited to see how the technology evolves in the years to come.”

Scott’s entry into the field of bariatric surgery came through a relationship with a San Diego physician group, which came to him for early training in laparoscopic surgery. That group had begun performing bariatric surgery, and Scott and his partner learned from them in return.

Scott’s practice began offering weight-loss surgery in the St. Louis area, and in 1997 it became the fifth group in the country to offer the procedures laparoscopically.

“That part of our practice grew, and as weight-loss surgery has developed significantly since then, we’ve continued to stay on the leading edge,” Scott said.

The group started out offering the traditional gastric bypass procedure, then took part in the FDA trial for the adjustable gastric band. Next, the group was among early adopters for sleeve gastroectomy. Now Scott has begun to offer the single anastomosis duodenal switch procedure as the latest technique.

Scott and his colleagues have also been part of the evolution toward endoscopic procedures, performing the first intragastric ballon procedure in the St. Louis area. That non-surgical option places a saline-filled balloon temporarily inside the patient’s stomach to curb appetite and accelerate weight loss.

As the procedures have evolved, so, too, has the team which supports patients before and after surgery.

“When I first started, I had my receptionist and my administrative assistant and the surgeons,” he said. “Now we have a complete team, with two full-time dieticians, a psychologist and exercise staff. We have a multidisciplinary approach, which improves everything for the patient and also allows me to focus on the surgical aspects.”

The latter has been a positive side benefit for Scott.

“What happens in the operating room is still the most enjoyable part of what I do,” he said.

Still, he said, his focus on bariatric surgery has meant the opportunity to develop relationships with his patients.

“For most general surgeons, you see a patient once before surgery and maybe once or twice after,” he said. “Once you fix somebody’s hernia or take their gallbladder out, that’s it. But with bariatric surgery, we tell people: ‘You’re our patient for the rest of your life.’ We have annual visits and follow them up closely. It really is a long-term relationship you develop with patients, and you get to see the effects of your work over a long period of time.”

Among those effects: The fact that when a familiar patient comes back to the office for an annual visit, he or she may look like a complete stranger.

“I saw a patient today I didn’t recognize at all,” Scott said. “He’d lost 176 pounds and weighs 180 now. He’s just a completely different guy.

“He’s gotten off a lot of his medications and is exercising for an hour and a half three times a week — something he could never have done before. For my staff and me, having the opportunity to change somebody’s life like that is very rewarding.”

Improving access to such a life-changing procedure is among Scott’s efforts as the current president of the Missouri chapter of the American Society of Metabolic and Bariatric Surgery.

“Our goal is to be advocates for the patients,” he said. “We still have patients who don’t have access to this treatment, which is very difficult. You have patients come to you, and you know you have something to offer that would really help them — make their diabetes and sleep apnea and high blood pressure go away. And yet the insurance company says it’s not medically necessary.

“That’s why the biggest focus of our group is to educate other doctors, insurance companies, businesses and the public in general about the disease of morbid obesity. This disease costs everybody a lot of money, and treating it is a very smart thing to do from an economic and medical point of view.”

Raised in a small town between Kansas City and Springfield, Scott attended the University of Missouri for his undergraduate degree and for medical school. He went on to complete an internship and residency in general surgery at Mount Sinai Medical Center in Miami and began private practice in 1991. He joined Des Peres Hospital in 2012.

Outside of work, Scott and his wife, Donna, a nurse, enjoy traveling to follow their children’s endeavors. Son Michael is currently pursuing a master’s degree in Australia, while daughter Mandy and son Nathan are undergraduates at the University of Iowa and Ball State University, respectively.



Des Peres Hospital: Bariatric Medical and Surgical Institute

American Society for Metabolic and Bariatric Surgery: Missouri

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