American Society For Bariatric Surgery Research Articles

Adolescent Bariatric Surgery Programs: Progress in Pennsylvania

Objective: In 2019 the American Academy of Pediatrics (AAP) called for increased access to Metabolic and Bariatric Surgery (MBS). To understand adolescent weight loss programs offering MBS in Pennsylvania, a survey was completed. Methods: Adolescent weight loss centers in Pennsylvania offering MBS were identified using the American Society for Metabolic and Bariatric Surgery (ASMBS) on-line directory and Google search. Phone interviews were conducted with the director of each program. Results: Eight programs were identified. Operations were performed in seven adult hospitals. Six had Comprehensive Adolescent Accreditation through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). A total of 92 adolescents were operated on in the year from June 2021 to July 2022 which is an 84% increase from the preceding year. Ninety patients received a sleeve gastrectomy. Adult bariatric surgeons were involved in all operations. Six of the programs were led by diplomates of the American Board of Obesity Medicine. Each clinic had a psychologist. No program had all eight of the health care professionals recommended by the authors, but two programs had seven of the eight. In addition, three included a social worker, two an exercise physiologist and two had pediatric subspecialists incorporated into the clinic. Two programs had the operating surgeon caring for patients in the multidisciplinary clinic. Conclusion: This survey of programs across Pennsylvania shows an increase in the number of bariatric operations. More progress is necessary to improve access to this service and improve the quality of programs in Pennsylvania.

Long-Term Safety and Efficacy of Bariatric Surgery in Septuagenarians.

Metabolic and bariatric surgery (MBS) has been shown to be safe and effective in the elderly population. Unfortunately, utilization of MBS in patients aged 70 years or older remains low, as MBS was just recently endorsed by the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity (IFSO) for septuagenarians. We performed a single-center retrospective cohort study of 103 patients aged ≥ 70 years who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from January 2008 until March 2023. The data analyzed included patient demographics, post-operative complications, resolution of obesity-related comorbidities, and weight loss. A total of 103 patients (71% female; age 72.1 ± 2.5 years; BMI 43.7 ± 6.8 kg/m2) were included. Sixty-two patients (60.2%) underwent RYGB while the remaining 41 underwent SG (39.8%), with a mean follow-up of 4.7 ± 3.7 years. There was no MBS-related mortality. All-cause mortality rates were 7.3% for the SG group after a mean period of 4.5 ± 3.9 years compared to 8.1% for the RYGB cohort after 7.7 ± 3.5 years (p = 0.601). RYGB was reported to have a higher rate of early and late complications when compared to LSG (p = 0.083 and p = 0.274). T2DM (p = 0.011) and OSA (p = 0.019) resolved significantly after RYGB. Our study demonstrates that bariatric surgery is safe and effective in patients aged 70 years and older. Bariatric surgery should not be denied to this group of patients based on chronological age alone. Further studies are required to support these findings.

Lessons learned from the metabolic and bariatric surgery accreditation and quality improvement program site surveys: common deficiencies and corrective actions

BackgroundThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is a joint program between the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS). On-site surveys of the applicant programs to determine adherence to the MBSAQIP standards are a hallmark of the accreditation process. ObjectivesA retrospective review of 619 site surveys completed over 2 years was performed to include analysis of reviewer decisions, tabulation and cross-reference of identified deficiencies to the MBSAQIP standards and determine final disposition of corrective actions and overall accreditation rates. SettingAccredited Hospitals (Community and Academic) within MBSAQIP. MethodsThis is a retrospective review of site surveys by expert panel. Results≥1 MBSAQIP Standards deficiencies were present at 149 of the 619 program site surveys (24.07%). The 3 leading Standards in Deficiency were in order: Commitment to Quality Care, Continuous Quality Improvement Process, and Data Collection. Within a year following initial site survey of the149 programs with Standards deficiencies, 59 programs demonstrated compliance, 83 programs were placed on probation (with a specific time-frame to demonstrate compliance) and 7 programs were denied accreditation. Ultimately, 98.9% of programs were able to gain or maintain MBSAQIP accreditation. ConclusionsThe MBSAQIP accreditation through on-site surveys can identify and improve program adherence to MBSAQIP standards.

Interpretation for indications of metabolic and bariatric surgery released by ASMBS and IFSO in 2022

With the increasing number of obese patients worldwide, metabolic and bariatric surgery (MBS) has quickly become an effective way to treat obesity and related metabolic diseases such as type 2 diabetes, hypertension, lipid abnormalities, etc. Although MBS has become an important part of general surgery, there is still controversy regarding the indications for MBS. In 1991, the National Institutes of Health (NIH) issued a statement on the surgical treatment of severe obesity and other related issues, which continues to be the standard for insurance companies, health care systems, and hospital selection of patients. The standard no longer reflects the best practice data and lacks relevance to today's modern surgeries and patient populations. After 31 years, in October 2022, the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), the world's leading authorities on weight loss and metabolic surgery, jointly released new guidelines for MBS indications, based on increasing awareness of obesity and its comorbidities and the accumulation of evidence of obesity metabolic diseases. In a series of recommendations, the eligibility of patients for bariatric surgery has been expanded. Specific key updates include the following: (1) MBS is recommended for individuals with BMI≥35 kg/m2, regardless of the presence, absence, or severity of co-morbidities; (2) MBS should be considered for individuals with metabolic diseases and BMI 30.0-34.9 kg/m2; (3) the BMI threshold should be adjusted for the Asian population:: BMI≥25 kg/m2 suggest clinical obesity, and BMI ≥ 27.5 kg/m2 population should consider MBS; (4) Appropriately selected children and adolescents should be considered for MBS.

Improving Access to Child and Adolescent Weight Loss Surgery: A Review of Updated National and International Practice Guidelines.

The rise of childhood obesity is a growing concern due to its negative impact on health.Metabolic bariatric surgery (MBS) has gained popularity as an effective and adequate intervention for children and adolescent patients living with severe obesity. Nonetheless, access to MBS for this population is still limited. The objective of this paper is to conduct a comprehensive review of the latest national and international practice guidelines and improve access to MBS for children and adolescents. The paper focuses on the recommendations from the 2023 American Academy of Pediatrics (AAP) and 2022 guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Recently updated guidelines from the ASMBS and IFSO aim to improve access to MBS for children and adolescents and recommend patient selection, preoperative evaluation, and postoperative care. While lifestyle changes, medication, and behavioral therapy are commonly prescribed, they often fail to achieve permanent weight loss and its maintenance. Weight-loss surgeries like sleeve gastrectomy (SG) and gastric bypass (RYGB) show promising results in managing severe obesity in adolescents. SG has become the preferred method for treating severe obesity in adolescents, surpassing RYGB. Weight stigma is also explored in this review, revealing its negative effects on individuals who are overweight and underweight. Furthermore, telehealth is identified as an increasingly valuable tool for managing pediatric obesity, as it can improve access to care, particularly for those in remote areas where physicians trained to treat childhood obesity and the shortage of bariatric surgeons experienced in treating younger adolescents and pediatricians with advanced training are major obstacles.

Ursodeoxycholic acid for prevention of gallstone disease after laparoscopic sleeve gastrectomy: an Atlantic Canada perspective.

Prophylactic ursodeoxycholic acid (UDCA) may be beneficial in reducing gallstone disease after bariatric surgery. The American Society for Metabolic and Bariatric Surgery (ASMBS) 2019 guidelines recommend a 6-month course of UDCA for patients undergoing laparoscopic sleeve gastrectomy (LSG). This has not been adopted broadly. This study intends to assess the effect of routine UDCA administration following LSG on symptomatic gallstone disease. We performed a retrospective chart review of patients who underwent LSG, between 2009 and 2019, at two tertiary care centers in Atlantic Canada. At one center, UDCA 250mg oral twice daily was routinely prescribed following LSG for 6months to patients with an intact gallbladder. At the other center, UDCA was not prescribed. Primary and secondary outcomes were cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) rates. Compliance with and side effects of UDCA therapy were analyzed. A total of 751 patients were included in the study. Patients who had prior cholecystectomy or were lost to follow up were excluded. After exclusion criteria were applied, 461 patients were included for analysis: 303 in the UDCA group and 158 in the group who did not receive UDCA. Cholecystectomy rate was not significantly associated with UDCA administration, however there was a trend towards less cholecystectomy in patients who received UDCA (8.3% vs. 13.9%, p = 0.056). ERCP rate was significantly lower in patients who received UDCA (0.3% vs 2.5%, p = 0.031). Rate of gallstone disease requiring intervention, either cholecystectomy or ERCP, was significantly decreased in patients who received UDCA (8.9% vs 15.8%, p = 0.022). The most common barriers to compliance with UDCA were cost (45.4%) and nausea (18.1%). This is the first study to demonstrate lower rates of ERCP in patients receiving routine UDCA following LSG. Our findings support the ASMBS 2019 guidelines for administering UDCA after LSG for preventing gallstone disease.

Evaluating the Spanish readability of American Society for Metabolic and Bariatric Surgery (ASMBS) Centers of Excellence (COE) websites.

Healthcare disparities continue to be an ongoing struggle in Bariatrics. Limited availability of Spanish online material may be a correctible barrier for accessibility to Hispanic patients. We sought to evaluate accredited Bariatric Centers of Excellence (COE) for Spanish readability via their websites to determine accessibility for Spanish speakers. This was an internet research study. 103 COE accredited by American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS) were evaluated and assigned one of five Spanish Visibility Categories. The United States was divided into 4 regions. Regional Spanish visibility was calculated by dividing each category count by the number of institutions in each region. County Spanish-speaking populations were obtained from the US Census Bureau's 2009-2013 American Community Survey. Differences in their distributions across the Spanish Visibility Categories were investigated using the Mann-Whitney U test. 25% of websites were translatable to Spanish, and a regional discrepancy was found with 61% translatable in the West, 19% in Northeast, 19% in Midwest, and 15% in South. Median Spanish-speaking population was higher in counties where websites were translatable to Spanish than where websites were not translatable. Healthcare disparities in Bariatrics continue to be an ongoing struggle. We suggest that Spanish readability for ASMBS ACS COE websites should be improved regardless of geographic differences in Spanish-speaking populations. We believe it would be valuable for these websites to have standards for readability of Spanish and other languages.

2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery.

Major updates to 1991 National Institutes of Health guidelines for bariatric surgery.

Frequency of Short- vs Long-Term Reporting of Bariatric Surgery Outcomes

Background and AimsBariatric surgery is an effective treatment for obesity. Though both short- and long-term outcomes have been reported, most of the published literature reports on short-term outcomes. Identification of post-operative weight regain and re-emergence of comorbidities requires medium- and long-term follow-up. We aimed to identify the distribution of follow-up times within the literature.MethodsWe screened through 1807 articles from 9 PubMed Indexed bariatric surgery journals published between January to June of 2015 and 2021 and selected articles reporting weight loss as a main outcome. Follow-up intervals were defined as per American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines.ResultsFifty-three and sixty-three articles were identified in 2015 and 2021 respectively. Reported follow-up lengths in 2015 were 60% short-, 26% medium-, and 14% long-term; while in 2021, there were 65% short-, 10% medium-, and 25% long-term articles. Of the articles reporting long-term outcomes in 2015 and 2021, 48%, and 70% of the included patients respectively had > 5 years follow-up.ConclusionThough reporting of long-term outcomes increased, most published outcomes remain short-term. The UK National Bariatric Surgery Registry is helping to mitigate this. An increased effort and emphasis on reporting long-term outcomes is needed.Graphical

Reporting of weight loss outcomes in bariatric surgery following introduction of 2015 ASMBS guidelines.

Heterogeneity in reporting weight loss (WL) outcomes within the bariatric surgery literature limits synthesis and meta-analysis. In 2015, the American Society for Metabolic and Bariatric Surgery (ASMBS) published reporting guidelines to achieve consistency in the literature. We aimed to assess the effect of the ASMBS guidelines in the bariatric surgery literature. Nine PubMed-indexed bariatric surgery journals were screened for articles published in the first 6 months of 2015 and 2021. Of 1807 articles, 105 and 158 articles in 2015 and 2021, respectively, reported primarily on WL outcomes following surgery. Overall ASMBS compliance increased from 5% to 20%, P < .05. Initial weight and body mass index (BMI) was reported in all studies, but specification of this as the immediate preoperative weight reduced from 15% to 6%, P < .05. The percent total WL (%TWL) increased from 17% to 61%, P < .05. Change in the BMI (DBMI) remained 41%. The percent excess BMI or WL (%EBMIL or %EWL) did not significantly change from 76% to 69%, P = .203. In 2021, 2 of the 9 journals gave guidance on reporting WL in their instructions to authors. Thirty percent (42/142) of articles did not comply with the journals' WL reporting guidance. The number of unique WL outcomes used increased from 45 to 54. Significant heterogeneity in reporting WL outcomes remains, hindering robust meta-analysis of articles. Use of referral weight instead of preoperative weight can inflate WL in those with mandated preoperative WL, clarifying initial weight is needed. Use of nonstandard measures of WL remains high.

My heart is full: presidential address of the ASMBS 2022 annual meeting

Welcome back! It is great to see everyone in person at our annual ASMBS (American Society for Metabolic and Bariatric Surgery) meeting. It is truly an honor to stand here before you today as president. This is the highest achievement of my professional career. Looking at photos of this conference over the years, I certainly never dreamed I would be president of the ASMBS. After all, I do not have the grit of a Robin Blackstone, I do not have the energy of a Raul Rosenthal, and I certainly don’t have the hair of a Matt Hutter. Matt, it is truly presidential. But, early in my career, I used to stare in awe and admiration at photos of leaders of this group gathered at this conference, and I now know the sacrifice and dedication it took for them to achieve such a title.

American Society of Metabolic and Bariatric Surgery consensus statement on laparoscopic adjustable gastric band management.

Laparoscopic adjustable gastric band (LAGB) management continues to be an important part of many metabolic and bariatric surgery practices. To replace the existing American Society for Metabolic and Bariatric Surgery (ASMBS) LAGB adjustment credentialing guidelines for physician extenders with consensus statements that reflect the current state of LAGB management. ASMBS Integrated Health Clinical Issues Committee. A modified Delphi process using a 2-stage consensus approach was conducted on LAGB management. Thirty-four consensus statements were developed following a literature search on a wide range of LAGB topics. A 5-point Likert scale was implemented to measure consensus agreement with a Delphi panel of 39 expert participants who were invited and agreed to participate in 2 rounds of Delphi questionnaires. Consensus was set a priori at 75% agreement, defined as the proportion of participants responding with agreement (i.e., 4 or 5) or disagreement (i.e., 1 or 2) on the Likert scale. Consensus was reached on 74% (25 of 34) of the LAGB management statements. In Delphi round 1, 95% (37 of 39) of the participants responded to 34 consensus statements; 21 of the statements (62%) met the 75% criteria for consensus. Thirty-one participants (80%) responded in round 2, shifting the agreement on 4 more statements to the 75% threshold. The ASMBS consensus statement on LAGB management is intended to guide practice with current evidence-based knowledge and professional experience. The ASMBS is not a credentialing body and does not seek to guide credentialing with this document.

Literature review on antiobesity medication use for metabolic and bariatric surgery patients from the American Society for Metabolic and Bariatric Surgery Clinical Issues Committee.

The following literature search is in response to inquiries made to the American Society for Metabolic and Bariatric Surgery (ASMBS) regarding antiobesity medication (AOM) use in patients who are having or have already had metabolic and bariatric surgery (MBS). These recommendations are based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. This paper is not intended to establish a local, regional, or national standard of care. The paper will be revised in the future as additional evidence becomes available.

594 Reporting of Weight Loss Outcomes Following Bariatric Surgery in Comparison to ASMBS Guidelines

Abstract A large volume of literature supports bariatric surgery as an effective therapy. The heterogeneity of weight loss (WL) outcomes significantly limits synthesis and meta-analysis. In 2015, the American Society for Metabolic and Bariatric Surgery (ASMBS) published reporting standards to achieve consistency in the literature. We aim to assess the effect of the ASMBS guidance in the bariatric surgery literature. Nine PubMed journals focusing on bariatric surgery were screened for articles published in the first six months of 2015 and 2021. Of 1807 articles, 105 and 158 articles in 2015 and 2021 respectively, reported on WL outcomes following bariatric surgery. Overall ASMBS compliance increased from 5% to 20%, p<0.05. Initial weight and BMI were reported in all studies but clarification of this as the immediate preoperative weight reduced from 15% to 6%, p<0.05. Percent Total WL (%TWL) increased from 17% to 61%, p<0.05. Change in BMI (ΔBMI) stayed 41%. Percent BMI or Excess WL (%EBMIL or %EWL) did not significantly change from 76% to 69%, p=0.203. In 2021, two of the nine included journals gave guidance on reporting WL in their instructions to authors. 30% (n=42/142) of articles did not comply with the journal's WL reporting guidance. Other unique reported WL outcomes increased from 44 to 55. Significant heterogeneity in reporting WL outcomes remains hindering robust meta-analysis of published articles. Use of referral weight instead of preoperative weight can inflate WL in those with mandated preoperative WL, clarifying initial weight is needed. Other non-standard measures of WL have increased.

698 Frequency of Short vs Long-Term Reporting of Bariatric Surgery Outcomes

Abstract Bariatric surgery is an effective treatment for obesity. Though both short- and long-term outcomes have been reported, most of the published literature to date has focused on short-term outcomes. Identification of post-operative weight regain, and re-emergence of comorbidities require long-term follow-up. We aimed to identify the distribution and changes in follow-up times within the bariatric surgery literature. We screened through 1807 articles from 9 bariatric surgery journals from January to June of 2015 and 2021 via PubMed and identified articles reporting weight loss as a main outcome. Follow-up intervals were divided into short- (<3 years), medium- (3–5 years), and long-term (≥5 years) as per the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines. 53 and 63 articles were identified in 2015 and 2021 respectively. Reported follow-up lengths in 2015 were 32 (60%) short-term, 14 (26%) medium-term, and 7 (14%) long-term; while in 2021 there were 41 (65%) short-term, 6 (10%) medium-term and 16 (25%) long-term articles in 2021. Of the articles reporting long-term outcomes in 2015 and 2021, only 48% and 70% of the included patients respectively had >5 years follow up data available. Though reporting of long-term outcomes increased (14% to 25%), the majority of published outcomes remains short-term. Bariatric surgery registries such as the United Kingdom National Bariatric Surgery Registry (NBSR) are helping to mitigate this, but an increased focus on investigating and reporting long-term outcomes would be beneficial to clinicians and patients making decisions regarding surgery.

American Society for Metabolic and Bariatric Surgery review on fasting for religious purposes after surgery.

This review article is issued by the American Society for Metabolic and Bariatric Surgery (ASMBS) in response to numerous inquiries made to ASMBS by patients, physicians, ASMBS members, hospitals, health insurance payors, the media, and others regarding the safety and recommendations for fasting for religious purposes after undergoing metabolic and bariatric surgery. In this article, a summary of published, peer-reviewed scientific evidence spanning the years from 2000 to 2020 and a recently published 2021 Delphi Consensus and expert opinion is presented.

Complications Rate Variability after Bariatric Surgery and the Importance of Standardization of a Reporting System

BackgroundThe rate of early (< 30 days) complications after bariatric surgery has been reported to be 0.4–27.4%. Although the incidence of serious adverse events has decreased with time and experience, controversy regarding how they are reported persists, and the current literature is heterogeneous. MethodsData from patients, who underwent primary bariatric surgery (gastric bypass and sleeve gastrectomy) at a single institution between 2012 and 2018, were retrospectively reviewed. Any deviation from a “normal” postoperative course (< 30 days) was identified, and a comparative analysis of early complications according to five models was performed: modified Clavien-Dindo; Longitudinal Assessment of Bariatric Surgery (LABS); Bariatric Surgery Centers of Excellence (BSCOE); American Society for Metabolic and Bariatric Surgery (ASMBS); and Li (major/minor). ResultsA total of 788 patients (83.7% gastric bypass), of whom 8.8% deviated from a “normal” postoperative course, were included. After applying the five classifications, the results were as follows: Clavien-Dindo, 8.8%; LABS, 2.3%; BSCOE, 0.4%; ASMBS, 9.9%; and Li, 11.2%. The incidence of major/severe/adverse outcomes were as follows: Clavien-Dindo, 2.4%; LABS, 2.3%; BSCOE, 0.4%; ASMBS, 6.9%; and Li 9.2%. Minor complications were as follows: Clavien-Dindo, 6.5%; ASMBS, 3%; and Li, 2%. There was no mortality. ConclusionGermane heterogeneity was found in reporting of early complications after bariatric surgery. Incidence varied according to classification system applied, and Clavien-Dindo demonstrated accuracy as a reporting model. To avoid bias, standardized reporting should be mandatory, and a more stringent and homogeneous reporting system should be established.

The American Society for Metabolic and Bariatric Surgery (ASMBS) updated position statement on perioperative venous thromboembolism prophylaxis in bariatric surgery

The following position statement is the second update by the American Society for Metabolic and Bariatric Surgery (ASMBS) on prophylactic measures for reducing the risk of venous thromboembolism (VTE) in bariatric surgery patients, after the previous update in 2013 [ [1] Clinical Issues Committee of the American Society for Metabolic and Bariatric SurgeryASMBS updated position statement on prophylactic measures to reduce the risk of venous thromboembolism in bariatric surgery patients. Surg Obes Relat Dis. 2013; 9: 493-497 Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar ]. The purpose of this statement is to enhance the quality of care in bariatric surgery by reviewing the available evidence on VTE prophylaxis. Since there is limited high-quality data, these practice guidelines suggest some recommendations that are based on available knowledge, peer-reviewed scientific literature, and expert opinion regarding reasonable use of prophylactic measures for VTE in bariatric surgery patients. The intent of issuing such a statement is to provide objective information regarding the use of VTE prophylaxis and its possible role in the prevention of such complications. The statement will be revised in the future when additional evidence becomes available. VTE prevention in bariatric surgery: from where have we come, and how did we get here?Surgery for Obesity and Related DiseasesVol. 18Issue 2PreviewThe American Society for Metabolic & Bariatric Surgery (ASMBS) Clinical Issues Committee (CIC) has published 3 position statements on the issue of venous thromboembolism (VTE) prevention in bariatric surgery, including the most recent in this issue of the journal [1]. The authors of this accompanying editorial are the 3 previous chairs of the ASMBS CIC who served during the timeframe in which the previous statements were issued. The purpose of this editorial is to add some perspective to publication of the current position statement that updates the ASMBS position. Full-Text PDF

Biliopancreatic access following anatomy-altering bariatric surgery: aliterature review.

The American Society for Metabolic and Bariatric Surgery (ASMBS) issues the following literature review for the purpose of enhancing quality of care in bariatric surgery. This publication examines the currently available literature regarding how to access the biliopancreatic system following bariatric surgery procedures. The intent of issuing such a review is to provide an objective summary of current literature that examines the advantages and disadvantages of the various existing techniques to access the excluded gastrointestinal (GI) tract. The review may be revised in the future should additional evidence become available. This review is not intended to serve as training, a standard of care, or scientific consensus. It is the responsibility of professionals to determine the appropriate patient plan of care.

Current trends in surgical society membership: What does the future hold?

BackgroundMotivations for joining and maintaining surgical society memberships include networking, educational, and social opportunities. We hypothesized surgeons have membership lapses despite these benefits. We aimed to assess society members motivations for joining, satisfaction with membership, any lapses and if so, reasons for these lapses. MethodsA survey was sent via email to members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), American Society for Metabolic and Bariatric Surgery (ASMBS), and the Society for Surgery of the Alimentary Tract (SSAT), using society directories. ResultsThe majority (60%) of respondents felt satisfied with membership. However, 68% reported a lapse in membership. The most common reason for lapse was cost, followed closely by time constraints. ConclusionDespite a high rate of member satisfaction, a majority of respondents had allowed a membership to lapse, with cost and time constraints being the most common reasons. Surgical societies should take these trends into account as they expand and recruit new membership.