Improving Post-Bariatric Treatment and Care in Europe

Improving Post-Bariatric Treatment and Care in Europe

EASO is pleased to interview Professor Luca Busetto, associate professor of Internal Medicine at University of Padova in Italy. Dr Busetto is co-chair of the EASO Obesity Management Task Force (OMTF).

Dr Busetto, congratulations on the publication of Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management in Obesity Facts.

These guidelines present a key new development in bariatric care in Europe. Can you tell us why they are so important?

Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by all the relevant guidelines for the management of obesity in adults. The combination of these factors coupled with the obesity epidemic led to a huge increase in the total number of bariatric procedures performed yearly in Europe as well in other continents.

Bariatric surgery is generally safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. Therefore, special knowledge and skill is required for clinicians so that they may deliver appropriate and effective care to the post-bariatric patient. Multidisciplinary long-term follow-up is recommended after bariatric surgery, and the provision of a suitable follow-up programme is mandatory for bariatric centres. However, given the increasing number of bariatric patients, follow-up should be, at least in part, transferred to primary care over time.

The major aim of our new guidelines is precisely this: to provide to all health care professionals involved in the care of post-bariatric patients the basic constructs and tools needed to provide appropriate first-level medical care to these particular patients. I am very happy to have had the opportunity to coordinate with Dror Dicker from Israel, and a fantastic group of European colleagues who have fully understood this goal and have worked together in developing the guidelines.

Please describe the way this set of recommendations differs from previous guidelines

In developing these guidelines, we tried to be as comprehensive and practical as possible.

Several specific aspects of post-bariatric care have been already covered by previous and recent guidelines, but in this position statement we tried to put all the components together into a single paper. Thus our multidisciplinary writing group, composed of distinguished experts across the various thematic specialties, worked to convey basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management. In particular, I think that the chapters dedicated to the management of co-morbidities after surgery, type 2 diabetes in particular, and to the planning and management of pregnancy in a women having had bariatric surgery are very novel and really needed.

At the same time, we tried also to be very practical. For each single item or clinical problem, practical solutions are proposed whenever possible.  Working on current evidences and existing guidelines, we included a short list of clinical practical recommendations for each clinical item, grading them according to levels of evidence and grades.

The recommendations indeed appear to be both comprehensive and practical. Can you tell us who will be using the guidelines?

The primary care physician is probably our first target audience for these guidelines. However, patients having had bariatric surgery may interact with obesity specialists, dieticians, nurses and other health care professionals not specifically trained in bariatric medicine and therefore not completely prepared to face  unknown clinical problems in their professional practice. It remains clear that referral to a bariatric multidisciplinary centre, preferably the centre performing the original procedure, should be considered in the event of complex clinical situations, but we believe that throughout the dissemination of appropriate knowledge, many problems may be resolved in more basic and less expensive settings. 

Multidisciplinary long-term follow-up care is a crucial component of care from the patient perspective; do you see these guidelines as “patient centred”?

I agree that multidisciplinary log-term follow-up care remains essential; we also need to remain as much close as possible to the real life of our patients. Patients may have been moved away from the city or the state were they living in when they had bariatric surgery, or they may have received surgery at a location quite distant from their homes, particularly in those European countries were bariatric surgery availability is less diffuse. We need therefore to balance the provision of multidisciplinary complex care by tertiary care highly specialized bariatric centres, with medical coverage of basic aspects of bariatric medicine in a less specialized — and less costly environment at a general practice (GP) level. In my opinion, this is the only way to increase use of bariatric surgery while simultaneously providing appropriate follow-on patients care.

Read the open access article Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management here in Obesity Facts:

Name: Luca Busetto

Birth place: Venezia – Italy. Date of birth: 1st November 1961
Degree in Medicine (Maximum) at the University of Padova, 1987.
PhD in Experimental and Clinical Gerontology at the University of Padova, 1994.
Post-degree in Geriatrics at the University of Padova, 1995.

Dr Luca Busetto is Associate Professor of Internal Medicine in the Department of Medicine, University of Padova and is affiliated with the

Centre for the Study and the Integrated Management of Obesity at Padova University Hospital

Professor Busetto is the author of 99 publications in peer-reviewed international journals including Obesity Research, International Journal of Obesity, Obesity Facts, Obesity Surgery, Surgery for Obesity and Related Diseases, New England Journal of Medicine, Annals of Internal Medicine, Chest, Journal of Pathology, Hormone and Metabolic Research, Journal of Nutrition, Nutrition Metabolism and Cardiovascular Diseases, Clinical Nutrition, Annals of Nutrition and Metabolism, Health and Aging, Annals of Clinical and Laboratory Science. (Total Impact Factor JCR 2015: 396. Total citation number Scopus: 3176. H-INDEX Scopus: 34).

In addition, Professor Busetto is member of the Editorial Board for the followings international journals: Surgery for Obesity and Related Diseases (associate editor), Obesity Surgery, Eating and Weight Disorders, Mediterranean Journal of Nutrition and Metabolism.

Co-chairman of the Obesity Management Task Force (OMTF) of the European Association for the Study of Obesity (EASO), Dr Busetto is also a

member of the Position Statements/Standard Committee of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) and is a former member of the National Board of the Italian Obesity Society (SIO) and the National Board of the Italian Society for Bariatric and Metabolic Surgery (SICOb).