Needs Assessment
Currently, behavior modification and nutritional and pharmacologic methods alone have not shown efficacy in achieving medically significant long-term weight loss in severely obese adults, nor has medical management shown efficacy in resolution of comorbidities. In contrast, surgical intervention has been shown to achieve long-term weight control for severely obese individuals. However, to ensure success, surgical intervention must begin with realistic goals and proceed with diligent, long-term follow-up.

Important to the short- and long-term success of managing this complex disease is the need to more fully explore the underlying behavioral and physiologic issues associated with severe obesity and the impact of various behavioral, pharmacologic, and surgical treatment modalities on patient outcomes. Long-term strategies that focus on evidence-based behavioral, nutritional, pharmacologic, and surgical interventions are pivotal to ensuring maximum therapeutic benefit and reducing the morbidity and mortality associated with this debilitating disease. Endocrinologists, bariatric physicians, bariatric surgeons, and bariatric coordinators play an integral role in the identification, referral, and short- and long-term follow-up of these patients to optimize therapeutic outcomes.

Learning Objectives
Upon completion of this activity, participants will be able to:

1. Describe evidence-based studies that explore the efficacy, safety, and therapeutic benefits of both medical and surgical intervention strategies in the management of the severely obese patient
2. Understand the medical and surgical interventions that help resolve the comorbid conditions accompanying obesity
3. Define populations with comorbidities that may decrease/resolve with surgical interventions, eg, adolescents, patients with lower body mass index
4. Identify the integral role of clinicians in the early identification of comorbidities associated with the condition of the severely obese patient as well as their important role in appropriate referral and the long-term follow-up of these patients to optimize therapeutic outcomes
5. Explain the collaborative relationship necessary between the various specialties involved in the management of this patient population, which is pivotal to ensuring successful and sustained weight and health outcomes

Target Audience
This activity has been developed for endocrinologists, bariatric surgeons, bariatric specialists, bariatric coordinators, and other healthcare professionals interested in the treatment of patients with obesity.

Learner Bill Of Rights

The American Association of Clinical Endocrinologists (AACE) recognizes that you are a life-long learner who has chosen to engage in continuing medical education to identify or fill a gap in knowledge, skill, or performance. As part of AACE's duty to you as a learner, you have the right to expect that your continuing medical education experience with AACE includes:

 CONTENT that:

• Promotes improvements or quality in healthcare;
• Is valid, reliable and accurate;
• Offers balanced presentations that are free of commercial bias for or against a product/service;
• Is vetted through a process that resolves any conflicts of interests of planners, teachers or authors;
• Is driven and based on learning needs, not commercial interests;
• Addresses the stated objectives or purpose; and
• Is evaluated for its effectiveness in meeting the identified educational need.

A LEARNING ENVIRONMENT that:

• Supports learners’ ability to meet their individual needs;
• Respects and attends to any special needs of the learners;
• Respects the diversity of groups of learners; and
• Is free of promotional, commercial, and/or sales activities.

DISCLOSURE of:

• Relevant financial relationships planners, teachers, and authors have with commercial interests related to the content of the activity; and
• Commercial support (funding or in-kind resources) of the activity.

Accreditation Statement
The American Association of Clinical Endocrinologists is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Association of Clinical Endocrinologists designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Method of Participation

• Read the entire CME information.
• View the educational webcast.
• Complete the post test questions and get a passing mark of 70%.
• Complete the CME activity evaluation.
• Fax/Mail completed post test and evaluation form to (908) 832-0729 (SynerMed Communications) for processing.
• Only those who get a score of 70% or higher will receive credit.
• Upon the successful completion of the CME activity evaluation a CME certificate will be mailed to you. Please Allow 6-8 weeks for processing of CME Certificates.
• Be sure to submit the forms prior to July 31, 2008. After this date, this activity will no longer be designated for credit.

Faculty
Program Chair/Moderator
Ken Fujioka, MD
Director, Nutrition and Metabolic Research
Del Mar Center for Weight Management
Scripps Clinic
San Diego, California

Program Faculty
Jeffrey W. Allen, MD
Associate Professor of Surgery
Department of Surgery
University of Louisville School of Medicine
Louisville, Kentucky

John M. Miles, MD
Professor of Medicine
Mayo Clinic College of Medicine
Rochester, Minnesota

Disclosure Information
Declaration of Disclosure and Conflicts of Interest

It is the policy of AACE to ensure balance, independence, objectivity, and scientific rigor in all of its CME activities. Presentation content may include discussion of an unlabeled use of a commercial product or an investigational use of a product not yet approved for any purpose. AACE requires that participating faculty disclose to the audience any product(s) and its use(s) discussed in the educational activity that are unapproved/unlabeled for the use by the FDA or still considered investigational in nature.

Everyone who is in a position to control the content of an educational activity must disclose all relevant financial relationships. “Relevant financial relationships” are financial relationships in any amount occurring within the past 12 months that create a conflict of interest. AACE requires speakers, faculty, CME Committee and other individuals who are in a position to control the content of this educational activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly evaluated by AACE for fair balance, scientific objectivity of studies mentioned in the presentation and educational materials used as basis for content, and appropriateness of patient care recommendations.

The intent of this disclosure is not to prevent a speaker with commercial affiliations from presenting, but rather to provide learners with information from which they may make their own judgments. Informed learners are the final safeguards in assuring that a CME activity is independent from commercial influence.

Speaker Disclosures:
Ken Fujioka, MD reports that he has received research grants from Abbott Laboratories, Amgen Inc, Amylin Pharmaceuticals, Inc, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Johnson & Johnson, Merck & Co, Inc, Novartis Pharmaceuticals, Orexigen Therapeutics, Inc, Ortho-McNeil, Inc, sanofi-aventis, Schering-Plough Corporation. He has also received honoraria in his role as a consultant for Abbott Laboratories, Amgen Inc, Eli Lilly & Company, Johnson & Johnson, Merck & Co, Inc, Ortho-McNeil, Inc, and sanofi-aventis. He has also received honoraria for his role in the speaker’s bureau for Abbott Laboratories, AstraZeneca, GlaxoSmithKline, and sanofi-aventis. He also reports that his presentation will include discussion of investigational or unlabeled use of metabolic agents or devices which he has consulted on or researched. Dr. Fujioka has no identified conflicts of interest.

Jeffrey W. Allen, MD reports that he has received honoraria in a proctoring role on the Lap-Band procedure from Allergan Medical (formerly INAMED) and Ethicon Endo-Surgery, Inc. He also reports that his presentation will not include discussion of any investigational or unlabeled use of a product. Dr. Allen has no identified conflicts of interest.

John M. Miles, MD reports that he has received honoraria in a consultant role from GlaxoSmithKline. He has also received advisory board honoraria from sanofi-aventis. He has also received a grant in a principal investigator role from Takeda Pharmaceuticals North America, Inc. He also reports that his presentation will not include discussion of any investigational or unlabeled use of a product. Dr. Miles has no identified conflicts of interest.