The past several years have witnessed tremendous growth in bariatric surgery. There are more surgical procedures performed and every day there are new surgeons entering the field. There have also been "growing pains" including a higher number of complications and the increased cost of more operations borne by the insurance carriers.

The number of surgeons in many regions...has more than quadrupled during the past five years. Patients are now able to choose a surgeon within a reasonable distance from their home. So what criteria should patients use to choose their surgeon?

Experience

Experience can be divided into several components including:

• The number of years in the field;
• The number of operations performed;
• The variety of operations performed;
• The participation and leadership in professional organizations representing the field.

The available data suggest that the complication rate (including mortality) is directly related to the number of bariatric operations performed by individual surgeons and the number performed at a given hospital or medical center.

Board Certification

Certification by the American Board of Surgery demonstrates that a surgeon has:

• Completed training in a program accredited by the American Board of Surgery;
• Passed both parts (written and oral) of examinations given by the Board to young surgeons after completion of their training;
• Recertification via another written examination is required every ten years for established surgeons in order to maintain an active certification status.

ASBS Membership

The American Society for Bariatric Surgery (ASBS) is the only professional society in the United States that is entirely focused on bariatric surgery. In this regard, the ASBS has proposed guidelines for credentialing both bariatric surgeons and hospitals regarding the special needs of severely obese patients. The ASBS also offers educational seminars and courses for both members and other interested parties at the annual meeting and throughout the year. I strongly believe that competent bariatric surgeons should regularly attend meetings of the ASBS in order to remain current within the field.

To attain regular membership in the ASBS (preferred), a surgeon must be Board certified and in good standing in the local community.

Note that Affiliate members are either inexperienced (less than 25 bariatric operations), not Board certified, or both.

Strong Commitment to Follow Up

The outcome of every bariatric surgical patient discharged following their operation is a question mark. This is because weight loss typically occurs for more than a year prior to stabilization. Any surgeon who doesn't follow his/her patients for a least that long will have no idea regarding the effectiveness of the operation performed. Moreover, longer follow up is necessary to know if patients are keeping their weight off. I feel that regular long-term follow up is essential for obtaining the best weight loss results. Nutritional counseling should be available at each office visit.

Hospital and Office Facilities

It is extremely important that hospitals boarding bariatric surgical patients are supportive toward all components of the program. Be sure to ask the following questions:

• Are the anesthesiologists comfortable in managing morbidly obese patients?
• Is the nursing staff comfortable and well educated with regard to the special needs of bariatric patients?
• Does the hospital have special facilities for large patients (i.e., wheelchairs, beds, gowns, lavatories, etc.?)
• Does the hospital openly endorse/promote their bariatric surgery program?
• Are intensive/critical care physicians and facilities adequate?

Likewise, in the surgeon's office be sure to ask:

• Is the office staff courteous and knowledgeable with regard to the needs of bariatric patients?
• Does the staff understand the insurance problems and nuances associated with third party payers?
• Does the office have special facilities for bariatric patients (i.e., exam tables, chairs, scale, etc.?)

This article is reprinted with permission from Beyond Change, a periodical with information regarding obesity and obesity surgery, available at www.beyondchange-obesity.com.