Obesity is a terribly complex disease. Many factors contribute to its onset, biological but also social, cultural and economic, which must be considered when choosing to generate awareness in the population with a view to prevention. And this is the objective of the Guidelines for the prevention and fight against overweight and obesity, drawn up by the Working Table set up by the Ministry of Health and adopted last July. The document underlines the importance of a multidisciplinary approach to the problem, which takes into account all the socio-cultural, environmental, relational and emotional determinants that influence the habits and lifestyle of citizens in order to prevent the onset of the disease and the complications that takes with him. “This is a fundamental aspect of the management of the obese patient”, comments Marco Antonio Zappa, President of the Italian Society of Surgery for Obesity (SICOB) and Director of the General Surgery Operative Unit, ASST Fatebenefratelli – Sacco of Milan. Today we have a multiplicity of therapeutic tools available to deal with the disease, both surgical and pharmacological, but we have to use them within a multidisciplinary process outside of which the results are not brilliant”.
A path – underline the Guidelines again – of a preventive-diagnostic-therapeutic-assistance (PPDTA) type integrated and shared between the preventive and clinical areas, for an early, synergistic and simultaneous classification of overweight and obese people. The team that must assist and follow up the obese patient, continues Zappa, today must include, for example, the psychologist of eating behavior, who has the task of investigating the reasons behind the wrong habits, but also the nutritionist who will be able to suggest the most suitable diet before and after the therapy, and then the endocrinologist, the diabetologist, and of course the surgeon in case the therapeutic strategy foresees the passage to the operating theatre. “In this case, after having chosen the type of operation, it is important to immediately think about the follow-up”, continues Zappa, “a post-operative check which, again, must be the responsibility of the entire team: all the specialists must monitor the conditions of the operated patient, to guarantee the result of the therapy”.
As far as the surgical approach is concerned, the importance of a complete and multifaceted look at the obese patient is also underlined by the very recent Guidelines of the American Society for Metabolic and Bariatric Surgery (ASMBS) and of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), whose drafting was attended by Maurizio De Luca, Director of the Complex Operational Unit of General Surgery of the Rovigo, Adria and Trecenta Hospitals and member of the Scientific Committee of the IFSO. “In this work we have tried to focus on the patient in its entirety, addressing all of his problems: the metabolic, mechanical (respiratory, osteoarticular, muscular), then the mental ones – his psychological or psychiatric state – and finally the social ones . In fact, let us not forget that the obese patient has a cost for the community, often unable to go to work or even not finding a job. This is why it is necessary to broaden the spectrum of problems related to the obesity sphere that we must take into account”.
In short, the important thing is that the obese patient is freed from the stigma that sees him only as an individual unable to contain himself, and that the idea that willpower is enough to heal is eliminated. It is no coincidence – underlines De Luca – if in Italy the National Health Service recognizes obesity as a pathology, so much so that bariatric surgery and post-bariatric plastic surgery are included in the Essential Levels of Assistance (LEA). “Naturally it is important to establish with stringent criteria which patients should be sent for surgery – concludes De Luca – and in this case it is important not to be “kilocentric” as we have been up to now, and to decide only on the basis of the Body Mass Index ( BMI, i.e. the ratio between weight and height): instead, in the global perspective adopted by the guidelines, we must also look at comorbidities, and based on those, decide how to initiate the obese patient towards a therapeutic path that leads him to regain a good quality of life, reducing risk factors for other diseases”.