Rapid shifts in the demographics and techniques of weight loss surgery (WLS) have led to new issues, new data, new concerns, and new challenges. In 2004, this journal published comprehensive evidence-based guidelines on WLS. In this issue, we've updated those guidelines to assure patient safety in this fast-changing field. WLS involves a uniquely vulnerable population in need of specialized resources and ongoing multidisciplinary care. Timely best-practice updates are required to identify new risks, develop strategies to address them, and optimize treatment. Findings in these reports are based on a comprehensive review of the most current literature on WLS; they directly link patient safety to methods for setting evidence-based guidelines developed from peer-reviewed scientific publications. Among other outcomes, these reports show that WLS reduces chronic disease risk factors, improves health, and confers a survival benefit on those who undergo it. The literature also shows that laparoscopy has displaced open surgery as the predominant approach; that government agencies and insurers only reimburse procedures performed at accredited WLS centers; that best practice care requires close collaboration between members of a multidisciplinary team; and that new and existing facilities require wide-ranging changes to accommodate growing numbers of severely obese patients. More than 100 specialists from across the state of Massachusetts and across the many disciplines involved in WLS came together to develop these new standards. We expect them to have far-reaching effects of the development of health care policy and the practice of WLS.
In this chapter, executive leadership of Trust for America’s Health (TFAH) and Well Being Trust describe the need to move “upstream” in prevention efforts to address opioid and other drug-related deaths. This means addressing the broad social and economic factors that drive substance misuse and addiction, including racism and other forms of discrimination and poverty. TFAH and Well Being Trust’s National Resilience Strategy highlights the causes of “deaths of despair” and promotes prevention efforts that are aligned along a spectrum from early childhood throughout all stages of adulthood. This chapter highlight five major strategies for public health practitioners; focusing on children and their families, assisting adults who may be at elevated risk, incorporating routine screening in multiple settings, supporting community health and social service resource availability and promoting equity in broad terms.
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