Performance Under Pressure in Sport: A Position Statement from Exercise and Sports Science Australia (ESSA).

Decades of addressing the global burden of obesity and type 2 diabetes (T2D) have resulted in robust evidence demonstrating that metabolic/bariatric surgery (MBS) achieves the most effective long-term reduction of body mass index (BMI) and T2D [–]. Yet, MBS is significantly underutilized in the worldwide treatment algorithm; < 1.0% of patients who may benefit from MBS receive it, regardless of continental variations in healthcare systems and reimbursement models [, ]. Multiple factors influence the deficient utilization of MBS. These include low physician referral rates and patients’ fear of undergoing the surgery due to the misperception that MBS is very invasive and carries a high risk of early and late complications without the option of reversibility [–]. While MBS, like all therapies for obesity and T2D, requires continued follow-up and dietary observation, it is predominantly—and increasingly—minimally invasive surgery (MIS) with a low perioperative mortality rate comparable to laparoscopic cholecystectomy (approximately 0.1%) []. In most cases, MBS is revisable if needed. Intensive technical innovation in MBS continues to lower the already modest risk profile and contribute to broader adoption of this most effective therapy. Recently, MIS single-anastomosis and magnetic procedures inaugurated a new era of less complex MBS operations. For example, use of gradual, incisionless, magnetic compression anastomosis (MCA) as an alternative to intraoperative cutting, stapling, and suturing to form an anastomosis has shown reduced invasiveness and increased safety in indirect comparisons []. In addition, early clinical outcomes of magnetic gastrointestinal (GI) procedures, such as side-to-side magnetic duodeno-ileostomy (MagDI), provide evidence of efficacy equivalent to that of MBS procedures that involve stapled/sutured anastomoses [–].