JOINT BASE LEWIS-MCCHORD, Wash. -- Madigan Army Medical Center's bariatric program earned the designation of a full center of excellence by the American College of Surgeons' Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

The program earned the highest level of this international accreditation in April after a nearly year-long process that included multiple applications and a site visit by the accrediting body.

"It certifies that we have all of the specialties and subspecialties to take care of (our patients), no matter what problem they could develop. It demonstrates that we are committed to not only running a good bariatric program but to continuously improving it," said Col. (Dr.) Matt Martin, Madigan's metabolic and bariatric surgery director.

Martin is also one of five Madigan bariatric surgeons who are now considered to be center of excellence-approved surgeons; they all meet the criteria for the number of bariatric surgeries they perform, their continued education, and their participation in running the bariatric program here.

The accreditation looked at not just the bariatric surgery program itself, but also at supporting subspecialties such as emergency medicine and interventional radiology; Martin explained that nutrition care, behavioral health, physical and occupational therapy, and pharmacy are all also a part of the multidisciplinary team that cares for bariatric patients.

"We have to show that the whole hospital is invested in this program," said Barb Rix, Madigan's metabolic and bariatric surgery coordinator and clinical reviewer.

The quality of Madigan's program resulted in an immediate accreditation after the site visit, which provided recommendations just for more bariatric chairs in the waiting areas and more bariatric toilets.

As an accredited program, Madigan will now contribute to a national bariatric database that will let the program see how it performs nationally compared to similar centers, and will allow other centers to learn about Madigan's best practices as well.

Madigan's bariatric program performs 120 to 180 surgeries on average each year with the intent to address diseases related to increased weight.

"The full list of diseases is about 100 diseases long from head to toe that are obesity-related and can be improved with significant weight loss," Martin said.

Common obesity-related diseases include high blood pressure, high cholesterol, sleep apnea and other pulmonary problems, and diabetes; the results of bariatric surgeries can also positively affect joint diseases such as arthritis, degenerative joint disease, and degenerative spine disease. In some cases, potential knee replacement patients may find that after weight loss they no longer need a replacement, or that with the loss it is finally safe for them to undergo the needed surgery.

"Obviously a lot of those (diseases) can cluster together. Hypertensive patients can have high cholesterol and diabetes, and when you get multiple of those factors together it's called metabolic syndrome, which is one of the reasons why the name was changed from just bariatric surgery to metabolic and bariatric surgery. Bariatric just refers to weight loss, and our focus is not on weight loss; it's on metabolic health of the patients," Martin said.

To be eligible for bariatric surgeries, patients need to have a body mass index of 40 or above, or a BMI of 35 or above if they have obesity-related diseases, or a BMI of 30 or above if they show that they tried and repeatedly failed to control diabetes with medical management.

Martin said he hopes that even more patients take advantage of Madigan's bariatric program because he knows the substantial improvements in health they can experience afterwards. The program is working currently with Naval Hospital Bremerton and Veterans Affairs to encourage their patients to take advantage of the bariatric services here.

Since primary care providers are the gatekeepers for referrals to the bariatric program, Martin is reaching out to them as well; he realizes that some providers may still be reluctant to write referrals due to perceptions of bariatric surgeries that occurred 20 or 30 years ago.

"If you look at outcomes in the modern world, they're excellent. The rates of complications are extremely low; our complication rates are extremely low, so I think it's just about getting that word out and making sure that we aren't having any major obstacles to referral," he said.

In the meantime, the bariatric program leadership plan to continue their investment in quality services.

"We do regular quality improvement projects to make sure that the experience for the program is better, the pathway is not too cumbersome, and the process is easy for the patients to understand," Rix said. "We're continuously growing and trying to improve ourselves."