Advice of General Practitioner, of Surgeon, of Endocrinologist, and Self-determination: the Italian Road to Bariatric Surgery.

Abstract

PURPOSE:

Bariatric surgery (BS) is considered the most efficient treatment for severe obesity. International guidelines recommend multidisciplinary approach to BS (general practitioners, endocrinologists, surgeons, psychologists, or psychiatrists), and access to BS should be the final part of a protocol of treatment of obesity. However, there are indications that general practitioners (GPs) are not fully aware of the possible benefits of BS, that specialty physicians are reluctant to refer their patients to surgeons, and that patients with obesity choose self-management of their own obesity, including internet-based choices. There are no data on the pathways chosen by physicians and patients to undergo BS in the real world in Italy.

METHODS:

An exploratory exam was performed for 6 months in three pilot regions (Lombardy, Lazio, Campania) in twenty-three tertiary centers for the treatment of morbid obesity, to describe the real pathways to BS in Italy.

RESULTS:

Charts of 2686 patients (788 men and 1895 women, 75.5% in the age range 30-59 years) were evaluated by physicians and surgeons of the participating centers. A chronic condition of obesity was evident for the majority of patients, as indicated by duration of obesity, by presence of several associated medical problems, and by frequency of previous dietary attempts to weight loss. The vast majority (75.8%) patients were self-presenting or referred by bariatric surgeons, 24.2% patients referred by GPs and other specialists. Self-presenting patients were younger, more educated, more professional, and more mobile than patients referred by other physicians. Patients above the age of 40 years or with a duration of obesity greater than 10 years had a higher prevalence of all associated medical problems.

CONCLUSIONS:

The majority of patients referred to a tertiary center for the treatment of morbid obesity have a valid indication for BS. Most patients self-refer to the centers, with a minority referred by a GP or by specialists. Self-presenting patients are younger, more educated, more professional, and more mobile than patients referred by other physicians. Older patients and with a longer duration of obesity are probably representative of the conservative approach to BS, often regarded as the last resort in an endless story.

• Authors: Antonio E Pontiroli, Geltrude Mingrone, Annamaria Colao, Luigi Barrea, Giulia Cannavale, Ferdinando Pinna, Valerio Ceriani, Stefano Maria De Carli, Giovanni Cesana, Stefano Olmi, Gloria Scolari, Simonetta Sarro, Giuliano Sarro, Claudia Procopio, Alessandro Giovanelli, Lelio Morricone, Giancarlo Micheletto, Alexis Malavazos, Valerio Panizzo, Laura Plebani, Marco Antonio Zappa, Igor Tubazio, Diego Foschi, Silvia Capogrossi, Caterina Conte, Alessandro Saibene, Carlo Socci, Martina Gozza, Sara Testa, Giuseppe Marinari, Stefano Maccatrozzo, Marina Croci, Enrico Mozzi, Ornella Verrastro, Esmeralda Capristo, Marco Raffaelli, Vincenzo Bruni, Andrea Soare, Giuseppe Spagnolo, Silvia Manfrini, Ida Gallo, Giovanni Casella, Lidia Castagneto-Gissey, Mikiko Watanabe, Simona Frontoni, Massimiliano Di Paola, Benedetta Russo, Patrizia Bigarelli, James R Casella-Mariolo, Franca Filippi, Frida Leonetti, Alberto Di Biasio, Gianfranco Silecchia, Valeria Guglielmi, Claudio Arcudi, Antonio Vitiello, Mario Musella, Rita Schiano, Cristiano Giardiello, Michele Giuseppe Iovino, Maurizio De Palma, Salvatore Tolone, Ludovico Docimo, Michele Renzulli, Vincenzo Pilone, Maria Police, Luigi Angrisani, Elena Tagliabue
• Journal: Obesity surgery (Obes Surg) Vol. 32 Issue 6 Pg. 1996-2002 (06 2022) ISSN: 1708-0428 [Electronic] United States
• PMID: 35384575 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Topics

• Adult
• Bariatric Surgery
• Endocrinologists
• Female
• General Practitioners
• Humans
• Male
• Middle Aged
• Obesity, Morbid (surgery)
• Surgeons