El rol del psicólogo en el equipo interdisciplinario de cirugía bariátrica

Abstract

Obesity has been declared by the WHO as an epidemic. It has been described as a multicausal disease and that it's etiology is influenced by biological, psychological, environmental and other factors. It is a risk factor for many diseases not only physical (diabetes, hypertension, hypercholesterolemia, an so on) but also psychological (depression, anxiety, eating behavior disorders, etc.); reason for which it's supposed to be a raising charge for worldwide health systems. Among the approved treatments for overweight and obesity are included: nutritional (caloric restriction), increase physical activity and behavioral therapy. When talking about patients with severe obesity (BMI ≥ 40), the most effective treatment that has been proven is bariatric surgery, indicated for patients with a BMI ≥ 40 or ≥ 35 in case of presenting co morbidities. It has been described that surgical treatment for obesity promotes mayor weight loss, generates significant improvement of the co morbidities associated with the obese condition and helps to prolong life expectancy and to increase quality of life. Despite all of the advantages that this treatment has proven to offer, not all of the patients benefit from it, even with the anatomical changes made by the surgery, some of the patients don't get to loose a significant amount of weight; differences in the variations of weight after the surgery at short and long term have been reported. It has been reported that approximately 20% of bariatric surgeries fail due to poor weight loss and that this failure is generally attributed to psychological or behavioral causes. Nowadays the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines suggest that surgical treatment for obesity must be performed in a interdisciplinary approach that includes surgeon, nutritionist, internist, physical rehabilitator and a psychologist. According to the same guidelines, the psychologist's role in this team consists on initially evaluating surgery candidates in order to determine if there is existing psychopathology and their ability to implement the lifestyle changes needed before and after the procedure, to give psico educational interventions in order to prepare patients for these changes and to make an informed decision about this treatment. This preparation helps patients having realistic expectations about the surgery results, helps to decrease the uncertainty that generates anxiety. For this reason, psychologist's work should be focused on motivation and adherence on lifestyle changes by psycho educational and cognitive behavioral specific interventions. In conclusion, the goal of the psychologist in the bariatric surgery team is to identify possible contraindications for the surgery and to identify possible post-surgical challenges as well as to give behavioral specific strategies in order to cope with those challenges. The prevalence of obesity is rising across the world and, in order to treat it, the increase in the number of bariatric surgeries performed. As ASMBS guidelines suggest a interdisciplinary approach where the psychologist plays a fundamental role in order to get a better prognosis after the surgery, it is important to increase the number of psychologists with the necessary skills to work with these patients, and with knowledge about obesity and bariatric surgery. The present research aims to describe the psychologist's role in a bariatric surgery interdisciplinary clinic and some of the strategies described for psychological obesity treatment suggested to be used before and after the surgery, in order to promote a lifestyle change.