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Obesity is a worldwide health problem, under surveillance by multiple international organizations. As a highly complex pathology, with overlapping contributing factors, it requires a systematic treatment with multiple interventions by an integrated team. In this presentation, Dr. Di Lorenzo explains the multidisciplinary approach to obesity.
In recent decades, bariatric surgery has grown exponentially, yielding spectacular results on comorbidity resolution and lowering mortality rates in these patients. Cardiovascular, orthopedic, endocrinological, psychiatric and even oncological benefits have been reported. Optimal care includes standardization of the different surgical techniques, but also treatment and lifelong follow-up by different non-surgical specialists. To achieve such goals, the creation of an obesity unit is necessary. It should include an endocrinologist, dietitian, psychologist, exercise physiologist, and surgeon. More recent studies show that this team should be expanded with endoscopists, orthopedists, plastic surgeons, anesthesiologists, among others. There should be no competition, offering both surgical and non-surgical treatments under a more comprehensive strategy.
There are several challenges an obesity unit faces:
Moving to an interdisciplinary approach: a step further from multidisciplinary. All members of the team should work together rather than limit to their own specialty. Shared medical appointments have shown to improve results.
Transferring research to practice: with the application of guidelines and protocols. As different societies can contribute to the study and treatment of obesity, joint efforts are being made to generate more comprehensive data.
High volume: the trend to refer patients to high volume centers yields better short-term outcomes. Nevertheless, the cohort of patients scheduled for lifelong follow-up might be too large and many are lost. This should be resolved.
Accreditation of surgeons and hospitals: there is no clear legislation for obesity units (as there is for breast units), but standards should be met.
Quality improvement: registry and benchmarking are key.
Evolving with the technology: new tools could help in the treatment and surveillance of these patients, such as connected medical devices and artificial intelligence.
In summary, an obesity unit should be developed as a strong network of specialists that engages the patient in playing an active role in their disease.
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