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COMMITTEE REPORTSAccess to CareWayne English, MDThe Access to Care committee has the principal mission to assist patients affected bymetabolic disease and obesity in obtaining appropriate, safe and effective medical care.Committee activities include: developing the strategic vision and strategies to makeimprovement in access to care; advocating for legislative changes on the state and locallevel that will affect health care coverage; address the politics, policies and ethics ofaccess issues on the local, state and national levels; and bringing together initiatives andpartners to effectively address access issues.Committee MembersChairASMBS Staff LiaisonWayne English, MDLeslie VinsonCo-ChairsMembersBrandon Williams, MDJohn Scott, MDEC LiaisonJohn Morton, MDOAC LiaisonsChris GallagherJoe NadglowskiAllen Browne, MDChristopher Eagon, MDGustavo Bello, MDMary Lou WalenRachel Moore, MDRoc Bauman, MDWalter Lindstrom, EsqAnna R. Ibele, MDArthur M. Carlin, MDRobert O. Carpenter, MDRobert B. Lim, MDCorrigan L. McBride, MDRichard M. Peterson, MDKinga Powers, MD, PhDJerome F. Schrapps, MDMatthew M. Hutter, MDJeffrey Ganaw, MDCarl Pesta, MDRachel Blind, NP-BC, CBNSuper STARs & STARs (State Access Represenatives):Super STARsDominick Gadaleta, MD(Northwest)John D. Scott, MD (Mid Atlantic)Brandon Williams, MD (SoutheastCentral)Teresa LaMasters, MD (UpperMidwest)Lloyd Stegemann, MD (LowerMidwest)Valerie Halpin, MD (Northwest)Ajay Upadhyay, MD (Southwest)STARs(NY) Ashutosh Kaul, MD(NH) John P. Gens, MD andMaureen Quigley, APRN(ME) Jamie Loggins, MD(MA) Sheila Partridge, MD(VT) Patrick Forgione, MD(CT) Darren Tishler, MD(RI) Siva Vithiananthan, MD(NC/SC) Ranjan Sudan, MD(MD) David Von Rueden, MD(NJ) Alex Onopchenko, MD(PA) Ann M. Rogers, MD(DE) Rahul Singh, MD(VA/WV) Troy Glembot, MD(AL) Todd Foreman, RN(FL) Joseph Chebli, MD(GA) Titus Duncan, MD(OH) Joe Northup, MD(TN) Pamela Davis, MD(KY) Joshua Steiner, MD(IN) Brenda Cacucci, MD(MI) Matthew Weiner, MD(WI) Shanu Kothari, MD(MN) Daniel A.P. Smith, MD(IL) Jayaraj Salimath, Do, BSN(MO) James Pitt, DO(IA) Matthew Christopherson, MD(NE) Gary Anthone, MD(KS) James Hamilton, MD(Canada) Michel Gagner, MD(LA) David Treen, MD(MS) Paul Bird, MD(AR) Josh Roller, MD andJohn Baker, MD(OK) Sarah Kitchen, RN, BSN, CBN(TX) Michael Seger, MD(NM) Charles F. Bellows, MD(CO) Matthew Metz, MD(MT) John Pender, MD(ND) Luis Garcia, MD(OR) Valerie Halpin, MD(SD) Kristin Turek, MD(WY) Richard Fermelia, MD(ID) Allan Garay, MD(WA) Brian Sung, MD(AK) Michael Todd, MD(AZ) Robert Berger, MD(HI) Brian Wong, MD(CA) Ajay Upadhyay, MD(NV) Shawn Tsuda, MD(UT) Walter Medlin, MD andEric Vlockman, MDIndustry Ad HocEthiconNatalie HeidrichGary RichardsonCovidienGina BaldoVincent ZeringueMichael MorseonApollo EndosurgeryJanet S. Fike, MHA, FACHE,CPC-H, CPMATed StephensMichael ObergPotomac CurrentsChris GallagherObesity Action CoalitionJoe NadglowskiThe Obesity SocietyTed KyleASMBS 2014–2015 // ANNUAL REPORT7

COMMITTEE REPORTSCommittee Goalsöö Affordable Care Act/Health Insurance Exchanges: Convert 28 “No”states to “Yes” states with the "Leave No States Behind" campaignòò Utilized Essential Health Benefit Toolkit documentsòò Letters sent to State Insurance commissioners requesting ameeting to address the lack of bariatric surgery coverage underthe ACAÎÎ Meetings occurred in TX, CT, GA, WA, FL, OR, TN, MO, LA, MN,VA and CO – Focuses on 12 states initially for political reasonsand population densityöö Second letter was submitted with emphasis on clarification ofhospitalization section of the EHBöö Third letter was submitted with emphasis on gender discriminationand obesity as a disability; violation of the Civil Rights Act of 1964òò Obesity as a Protected Class under Title VII of the Civil Rights Actof 1964ÎÎ Title VII prohibits discrimination by covered employers on thebasis of race, color, religion, sex or national originÎÎ Disparate impact resulting from the Affordable Care Act: afacially neutral policy that disproportionately impacts membersof a protected classòò The Equal Employment Opportunity Commission (EEOC) nowtakes the position that morbid obesity should be recognized as adisability under the ADAAA of 2008ÎÎ 2008 Amendment of ADA of 1990 broadens the definitiona covered disability as a physical or mental impairment thatsubstantially limits one or more major life activities, a history ofhaving such an impairment, or being regarded as having suchan impairment.ÎÎ ADAAA of 2008: The amendment broadened the definitionof "disability," thereby extending the ADA's protections to agreater number of people. The ADAAA also added to the ADAexamples of "major life activities" including, but not limitedto, "caring for oneself, performing manual tasks, seeing,hearing, eating, sleeping, walking, standing, lifting, bending,speaking, breathing, learning, reading, concentrating, thinking,communicating, and working" as well as the operation ofseveral specified major bodily functions.òò A paragraph addressing the lack of state employee coverage wasadded to ID, MT, PA, WI and SCöö Thanks to the many STARs and Super STARs for their participation inthis campaignöö Social media campaignòò Twitter: 1,594 impressions, 113 clicks, 12 retweets, 15 favoritesòò Facebook: 498 people reached, 16 likes, 11 sharesòò Emails: 1,842 received, 450 opened (24.5% open rate), 114 clicksöö Deadline for selecting benchmark plans for the State Exchange wasJune 1, 2015TRICARE Sleeve Gastrectomy Task Forceöö DHA Office of Medical Reimbursement recently completed a reviewof the sleeve gastrectomy literature – being submitted to the DODòò Summary being reviewed by the Deputy Director of the DODòò Being coordinated within the branches of the serviceòò Submitted to the Director of the DODöö John Scott to visit to the Hill - Communication with Senator Graham’sstaff – chair of senate subcommittee for military personnel, workingon getting an initiative through committeesöö Continue working behind the scenes to prepare for possiblecongressional inquiriesöö Sign on letter from Armed Services committee's subcommittees formilitary personnelVA Bariatric Surgery Task Forceöö Developing a network of VA surgeons within each of the 23 VISNs toexpand bariatric surgery access to all veterans - have 4-5 so faröö Members: George Eid, Dan Eisenberg, Cori McBride, RobertO’Rourke, Carl Pesta, Chris Gallagher, Brandon Williams, WayneEnglishöö Two meetings held so far; first meeting May 18, 2015öö Recent studyòò On average, only 250 bariatric surgery procedures are beingperformed throughout all 23 VISNs within the VA system. Only 3-4programs perform more than 30 cases annuallyòò 58% reduction in 10 year mortality for obese veterans undergoingbariatric surgery compared to those that do not have surgeryöö Develop toolkitöö Patient education, legislative action website and social mediacampaignöö Chief of Surgery and Regional Director lists generatedöö Washington DC campaignòò Director of VAòò Veterans Affairs committeeöö Call to Action blast email to be submitted after approval by EC,requesting Surgeon champions to represent each VISNòò Each VISN surgeon champion will be asked to request a meetingwith regional directorsòò Identify gaps (void VISN)öö VA Task Force Town Hall Meeting at ObesityWeek (hopefully will haverepresentatives from all 23 VISNs attending)òò PPT presentationòò Questions from audienceMedicaid Coverage in all 50 States: Only MONTANA remainsState employee Coverage in all 50 States: PA, SC, MT, ID, WIöö PILOT programs initiated in: GA, OK, AR, LAöö State Employee and Medicaid Coverage in Washington: benefit nowextended to individuals 18 years of age with:öö Washington Stateòò BMI 40òò BMI 35 - 40 with one comorbidityòò BMI 30 - 35 with Type 2 DiabetesObesityWeek Access to Care Symposiumöö The Affordable Care Act and ASMBS No State Left Behind Campaign:John Scott, MDöö Lessons Learned in Successful Policy Negotiation with a PrivateInsurer: Ranjan Sudan, MDöö Social Media Campaign and National Advocacy Update: ChrisGallagher and Joe Nadglowskiöö Metabolic Evolution of Bariatric Surgery as a Means to ImproveAccess to Care: Henry Buchwald, MDöö Building the Case: Excluding Obesity Treatment is Illegal andDiscriminatory: Jennifer Shinall, PhD and JDöö Question & Answers: Panel MembersContinue on following page ASMBS 2014–2015 // ANNUAL REPORT8

COMMITTEE REPORTSCommittee Objectivesöö Increase awareness of access issues and progress among the publicand membersöö Identify reasonable targets for progress in short med and long termSpecific Projects that Achieved Goals/Objectivesöö Medicare Sleeve gastrectomy coverage now 100% covered with noage restrictionsöö LCD Reconsideration Request to revise comorbidity definitions felt tobe too restrictiveòò Revise language in LCD regarding comorbidity definitions forhypertension, cardiomyopathy, sleep apnea and hepatic steatosis.öö Contact via letters and meetings with State Insurance commissionersrequesting to address the lack of bariatric surgery coverage under theACAöö Planning of ObesityWeek Access to Care Symposiumöö Development of VA Bariatric Surgery Task Forceöö Efforts on multiple fronts to secure sleeve coverage in Tricare plansFuture Plansöö Employee Awareness Task Forceöö Focus on largest employers in each state (data from industry)Adolescent Surgery Task Force: Allen Brown, MDòò Day in Bariatric Surgery - IL, SC, TN, OH, FL, TX, PA, MN and CTTelehealth Task Force – to improve patient access to care (Willperform feasibility analysis)ASMBS 2014–2015 // ANNUAL REPORT9

COMMITTEE REPORTSBariatric Surgery TrainingAlfons Pomp, MD, FASMBSThe Bariatric Surgery Training committee is responsible for designing guidelines andresources for metabolic and bariatric surgery training and fellowship programs. It alsocertifies that trainees have received adequate training through validation of their experienceand the development and continuous updating of examinations.Committee MembersChairMembersAlfons Pomp, MD, FASMBSMelissa Bagloo, MDMorgan Bresnick, MDJudy Chen, MDRonald Clements, MDGregor Dakin, MDEric DeMaria, MDKaren Flanders, MSN, ARNPMatthew Fourman, MDWilliam Gourash, ARNPBrandon Grover, MDJames Lau, MDMatthew Martin, MDCo-ChairCorrigan McBride, MDEC LiaisonAlfons Pomp, MD, FASMBSImmediate Past ChairScott Shikora, MDASMBS Staff LiaisonMartha LindseyCommittee GoalsShort Termöö ASMBS Certificate of Satisfactory Training in Bariatric SurgeryFellowship (award annually)Mid Termöö Work towards a designated Board added qualification through theABS Task Force.Long Termöö Create a web-based resource for residents and fellows that hasthe fundamentals of bariatric surgery, based in curriculum fromFundamentals of Bariatric Surgery course.ASMBS Mission Met by the CommitteeTo raise and maintain the quality and safety standards of metabolicand bariatric surgery through provision of standard curricula, supportiveresources, and evaluation of the training of bariatric surgeons, fellowsand residents.Samer Mattar, MDRachel Moore, MDNissin Nahmias, MDCarl Pesta, MDDana Portenier, MDJohn Price, MDPrashanth Ramachandra, MDRaul Rosenthal, MDMichael Russo, MDPhilip Schauer, MDBruce Schirmer, MDScott Shikora, MDCommittee 2015 Objectivesöö Certification for PAs and Possibly NPsöö Residents Curriculum: Essentials in Bariatric Surgery Curriculum Appöö Medical Student Curriculum2015 Activities Accomplished to Meet the Objectivesöö Finalized evaluation and revisions to ASMBS Fellowship Certificatecurriculum requirements.öö Reviewed and approved 72 ASMBS Certificates of Acknowledgementof Satisfactory Training: Metabolic and Bariatric Surgery for Fellows2015 Activities Still in Progressöö Working with task force towards a curriculum for American BoardCertification through a revision of the current fellowship curriculum tomeet the model required by the ABS. Propose curriculum to the ABSin 2016ASMBS 2014–2015 // ANNUAL REPORT10

COMMITTEE REPORTSClinical IssuesShanu N. Kothari, MDThe mission of the Clinical Issues committee is to create evidence-based guidelines andposition statements regarding clinical issues to enhance quality in metabolic and bariatricsurgery patient care and to support ASMBS member practices. The Clinical Issues committeealso performs systematic review of existing statements and guidelines, researches the currentdata and makes appropriate updates and revisions as evidence becomes available. Thecommittee is also charged with developing time-sensitive statements or recommendationsrelated to new developments in the field of bariatric surgery.Committee MembersChairMembersShanu N. Kothari, MDMohamed Ali, MDToms Augustin, MDDan Azagury, MDNaveen Ballem, MDGuilherme Campos, MDRobert Carpenter, MD, MPHJonathan Carter, MDEric DeMaria, MDDan Eisenberg, MDMaher El Chaar, MDBarry Fisher, MDCo-ChairJulie J. Kim, MDEC LiaisonStacy Brethauer, MDASMBS Staff LiaisonTeresa WhiteASMBS Missions Met by the Committeeöö To improve the care and treatment of people with obesity and relateddiseases by providing timely, evidence-based guidelines to societymembers caring for patients with obesity.öö To be the recognized authority and resource on metabolic andbariatric surgery by working in a collaborative fashion with fellowsocieties to develop position statements that mutually benefit themembers and patients of each respective society on issues directlyrelated to obesity.öö To advance the science and understanding of metabolic and bariatricsurgery by (1) identifying issues and needs that our membersface in their practice and by publishing new position statementsaddressing these needs, trends and state-of-the-art practices of thefield of metabolic and bariatric surgery; (2) continuing to update thesystematic review of existing statements and revise them as neededbased on current literature.Committee GoalsShort-Termöö Proposed Joint Statements with Obesity Summit task force: Infertilityand Bariatric Surgery with ACOG and ASRMöö Revision of two existing statements: (1) Preoperative SupervisedWeight Loss Requirements from 2011 and (2) Bariatric Surgery inClass I Obesity from 2012öö Publication of collaborative statements with the National LipidSociety (NLA) and the American Association of Hip and KneeSurgeons (AAHKS)Daniel Gagné, MDSaber Ghiassi, MD, MPHBrandon Grover, DOIsam Hamdallah, MDMarcelo Hinojosa, MDJason Michael Johnson, DO, FACSMark Kligman, MDFady Moustarah, MDSabrena Noria, MD, PhDRobert O’Rourke, MDPavlos Papasavas, MDManish Parikh, MDAnthony Petrick, MDAnn Rogers, MDKeith Scharf, DOBruce Schirmer MDDavid Schumacher, MDBrian Smith, MDHarvey Sugerman, MDDana Telem, MDIH CIG Committee LiaisonsTerry McKenzie, RN, CBNStephanie Sogg, PhDLong-Termöö Joint guidelines with American Heart Association and AmericanDiabetes Associationöö Provide ongoing clarity on issues related to bariatric and metabolicsurgeryCommittee 2015 Objectivesöö Identify existing and emerging gaps in guidelines/positionstatementsöö Increase understanding of clinical issuesöö Establish and disseminate standards and protocolsöö Establish timeline based on relative clinical importance of issues2015 Activities Accomplished to Meet the Objectivesöö Standardized Reporting Outcomes for Bariatric Surgery, published inSOARD, May 2015öö ASGE/SAGES/ASMBS: Role of Endoscopy in the Bariatric SurgeryPatient, published in SOARD, May 2015öö Revision of the 2009 statement, Prevention and Detection ofGastrointestinal Leak after Gastric Bypass including the Role ofImaging and Surgical Exploration, published in SOARD, May 2015öö ASMBS participation with the ABIM Foundation in their initiative,Choosing Wisely: Five Things Physicians and Patients ShouldQuestion. Clinical Issues committee submitted the top five thingspatients should question when considering bariatric surgery.Published June 2015Mid-Termöö Ongoing identification of issues to develop statements and providetopics for EC Reviewöö Ongoing review/revision of all existing and new statementsContinue on following page ASMBS 2014–2015 // ANNUAL REPORT11

COMMITTEE REPORTSöö 5. ASMBS Position Statement on Alcohol Use Before and AfterBariatric Surgery, submitted to SOARD September 2015.öö 6. Three statements completed and currently with membership forreview and comment:òò ASMBS Position Statement on Intra-Gastric Balloon Therapyòò ASMBS Position Statement on Vagal Blocking Therapy for Obesityòò ASMBS Position Statement on Long-Term Survival Benefit afterBariatric Surgery2015 Activities Still in Progressöö ASMBS Position Statement on Accreditation of Bariatric SurgeryCentersöö Joint Statements in Process:òò National Lipid Association (NLA) and ASMBS position statementon The Role of Metabolic and Bariatric Surgery in the Managementof Lipid Disorders – will likely be ready for EC review at OWmeetingòò American Association of Hip and Knee Surgeons (AAHKS) andASMBS position statement on the timing of bariatric surgery inrelation to hip and knee proceduresöö Revision of the 2012 statement, Bariatric Surgery in Class I Obesityöö Revision of the 2011 statement, Preoperative Supervised WeightLoss RequirementsASMBS 2014–2015 // ANNUAL REPORT12

COMMITTEE REPORTSCommunicationsDaniel Herron, MDThe aim of the Communications committee is to facilitate communication betweenthe ASMBS and its members, potential members and the public. This includes makingrecommendations on new opportunities and technologies to enhance communications;working with the ASMBS staff to develop methods for timely identification of pertinentjournal articles, special reports, media events, and Society activities appropriate forpromotion; and maintaining active communication channels with the ASMBS President andthe Executive Council.Committee MembersChairASMBS Staff LiaisonDaniel Herron, MDClaire Wilsen, MACo-ChairASMBS IT Staff LiaisonsRichard Peterson, MD, MPHImmediate Past-ChairKyle TuckerJames OsterhoutBrian R. Smith, MDMembersIH Communications LiaisonJoshua B. Alley, MDGregory Byer, MDJonathan Finks, MDCarlos Galvani, MDNathaniel J. Sann, MSN, CRNP,FNP-BCASMBS Mission Met by the Committeeöö To foster communication between health professionals on obesityand related conditionsCommittee GoalsShort-TermMatthew J. Weiner, MDMark Fusco, MDD. Wayne Overby, MDEmma Patterson, MDCarlos Galvani, MDValerie Halpin, MDMarcelo Hinojosa, MDMarina Kurian, MDAllan Okrainec, MDD. Wayne Overby, MDAileen A. Murphy, DOKevin Reavis, MDMichael A. Russo, MDShawn Tsuda, MDDuc C. Vuong, MDöö Developed a list of ten videos to be part of the video course forpeople considering weig

Christine Bauer, MSN, RN, CBN IH President-Elect Karen Flanders, MSN, ARNP. ASMBS 2014-2015 // ANNUAL REPORT5 Our ASMBS Staff Georgeann Mallory Executive Director . BSN (MO) James Pitt, DO (IA) Matthew Christopherson, MD (NE) Gary Anthone, MD (KS) James Hamilton, MD (Canada) Michel Gagner, MD (LA) David Treen, MD (MS) Paul Bird, MD (AR .