Page 15 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Since several studies have shown that patients with diabetes mellitus and a BMI be- tween30.0and34.9kg/m2 alsobenefitfromsurgery,thesecriteriamightchangesoon 51-53. In addition, is it advised that pre-operative evaluation also includesassessment of motivation, willingness to life-long follow-up andacceptance of lifestyle modification 17,18. Consequently, the following contra-indications for bariatric surgery should also be assessed at the multidisciplinary screening 17,18:
• Absence of identifiable medical management
• Unable to participate in prolonged medical follow-up
• Non-stabilized psychotic disorder, severe depression, personality and eating dis-
orders, unless specifically advised by a psychiatrist experienced in obesity
• Alcohol abuse and/or drug dependencies
• Disease threatening life in short term
• Patients who are unable to care for themselves and have no long-term family or
social support
NEDERLANDSE OBESITAS KLINIEK
The Nederlandse Obesitas Kliniek (NOK, Dutch Obesity Clinic) is the largest clinic for treatment of people with morbid obesity in the Netherlands. The NOK has eight loca- tions throughout the country in which about 6,000 new patients are treated each year. The multidisciplinary teams consist of a physician, dietician, physiotherapist and psy- chologist. This team performs the screening according to the IFSO criteria, to assess whether apatient qualifies for bariatric surgery. This assessment is then discussed with an internist and bariatric surgeon. When patients are accepted for surgery, they start the treatment program, which is carried out by the multidisciplinary team.
The treatment program consists of group counselling before and after bariatric sur- gery. Group counselling is focused on long-term behavioural change. Patients are prepared for the changes they will have to make in their habits, eating and physical activity, in order for the surgery to be successful. Moreover, counselling is dedicated to the causes of obesity, for example, developing new copingstrategies and improve- ment of self-care are also part of the program. Before surgery patients participate in six group sessions led by the multidisciplinary teams, each with a duration of three hours. After surgery patients participate in these group sessions up to 1,5 year after surgery, also with a duration of three hours per session. Then patients have a yearly follow-up with themultidisciplinary team starting 2 years after surgery and ending at 5 years after surgery.
ROUX-EN-Y GASTRIC BYPASS
In the Netherlands, the RYGB is the most popular type of bariatric surgery: 6,897
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