Fausta Micanti, Claudio Caiazza, Mario Musella, Emanuela Paone, Giuseppe Navarra
Department of Time-Dependent Network, Psychiatry, and Psychology: Eating Disorders, Obesity, and Bariatric Surgery Unit, University Hospital "Federico II", Via Sergio Pansini N.5, University Hospital, Edificio 18, Psichiatria, ZIP 80131, Naples, Italy.
Bariatric Surgery Department of General Surgery. Bariatric Surgery, University Hospital "Federico II", Naples, Italy.
Updates Surg. 2024 Dec 7. doi: 10.1007/s13304-024-02053-5.
Obesity is a multifactorial and chronic disease, constantly growing in prevalence. Metabolic and Bariatric Surgery (MBS) is among the most effective therapies for obesity, determining consistent long-term weight loss and maintenance. Increasing evidence suggests a relevant mental health contribution to obesity pathogenesis. European and International Guidelines for MBS emphasize the importance of a pre-surgical psychological/psychiatric assessment and a post-surgical follow-up to improve MBS outcomes. Yet, no standard psychological/psychiatric procedures currently exist.
This paper overviews the psychological/psychiatric procedures which Italian mental health providers currently perform on MBS candidates to provide psychological support through every step of the MBS, from the assessment to the postsurgical follow-up, to evaluate eligibility, prevent mental health flare-ups and weight regain, as endorsed by the Board of the Italian Society of Surgery for Obesity and Metabolic Diseases (SICOB).
The psychological/psychiatric procedures should encompass two phases: pre-surgical assessment and post-surgical follow-up. Pre-surgical assessment should investigate every condition that might reduce the MBS effectiveness or contraindicate the surgical process. It must include a mental state evaluation, weight history, eating behavior, body image, psychosocial conditions, and motivation. The post-surgical follow-up should offer psychological support to patients in achieving weight loss and maintenance. It should also prevent the onset or recurrence of psychiatric disorders that may affect clinical outcomes.
This paper is the first to introduce a standardized protocol for psychological/psychiatric procedures for each phase of the surgical process, to allow MBS candidates to receive similar care despite geographical differences. It also serves as a potential clinical model for assessing mental eligibility or contraindications prior to MBS, and subsequently support the individual behavioral and lifestyle changes to achieve and maintain weight loss.
肥胖是一种多因素的慢性疾病，其患病率持续上升。代谢与减重手术（MBS）是治疗肥胖最有效的方法之一，能实现持续的长期体重减轻及维持。越来越多的证据表明心理健康对肥胖发病机制有重要影响。欧洲和国际MBS指南强调术前心理/精神评估及术后随访对改善MBS效果的重要性。然而，目前尚无标准的心理/精神程序。
本文概述了意大利心理健康服务提供者目前对MBS候选者所采用的心理/精神程序，旨在通过MBS的各个阶段，从评估到术后随访，提供心理支持，以评估资格、预防心理健康问题发作及体重反弹，该程序得到了意大利肥胖与代谢疾病外科学会（SICOB）理事会的认可。
心理/精神程序应包括两个阶段：术前评估和术后随访。术前评估应调查可能降低MBS效果或禁忌手术过程的每种情况。它必须包括精神状态评估、体重史、饮食行为、身体形象、心理社会状况和动机。术后随访应为患者提供实现体重减轻和维持体重的心理支持。它还应预防可能影响临床结果的精神障碍的发作或复发。
本文首次为手术过程的每个阶段引入了心理/精神程序的标准化方案，以使MBS候选者无论地域差异都能获得类似的护理。它还可作为MBS术前评估心理资格或禁忌证的潜在临床模型，并随后支持个体行为和生活方式的改变，以实现和维持体重减轻。
