PALERMO (ITALPRESS) – Obesity is a chronic relapsing disease and affects more than 10 percent of the national population with regional peaks exceeding 12-13 percent. Among these is Sicily so much so that surgery in this field is the second figure to weigh in the negative balance of the island’s health mobility, which in 2023 reached 131 million euros. Data reported in the two-year period 2022-2023 lead to an estimate that 4 out of 10 adults are overweight with data that in the Island are even higher than the national average where one out of two adults is affected by a more or less severe form of obesity. Obesity is the main cause of the onset or aggravation of many diseases (cardiovascular, bronchopulmonary, metabolic diseases etc), reducing life span, even by 10 years compared to that of a peer with normal weight, and worsening its quality. According to the latest available estimates, more than 5 million deaths worldwide (accounting for 9% of all deaths) would be attributable to it. In Italy it is estimated to be responsible for more than 64,000 deaths (or 10% of all deaths). One of the new frontiers for the treatment of obesity is bariatric surgery, and Sicily is one of the regions in the vanguard, having created, in concert with the regional health department, a diagnostic therapeutic care pathway (Pdta) for the treatment of adult obesity. A path decided in concert between professionals working in the public and private sectors to create a regional network with defined protocols. And that allows to affect the negative balance of health mobility that characterizes the Island. Surgery, in fact, is only the last step in an overall strategy against obesity that must start with a necessary evaluation in which the patient is followed by a team of specialists (psychologists, nutritionists, endocrinologists, among others) to determine whether the operation is really indicated. In addition, “the effectiveness of social-health policies to counter the spread of chronic noncommunicable diseases associated with obesity and overweight calls into question both the responsibility of individuals in adopting healthy behaviors and habits and of the institutions in charge, in a multisectoral and multidisciplinary effort,” explains Dr. Franco Pisello, who coordinates a special center at the Candela clinic established 13 years ago at the behest of Giuseppe Mastrandrea, who was part of the work to implement the Pdta guidelines. Along with the coordinator, the center today is assisted by Angelo Lo Iacono. In 2012 it was recognized as an Affiliated Center by the Italian Society of Obesity Surgery and today, following the approval of the Regional Pdta for the integrated treatment of obesity in adults (2019), it is a level II center (i.e., a spoke for the treatment of obesity). During 2023 (latest data available so far), the Treatment Center performed about 300 interventions per year, making it, in fact, the second largest facility in the regional health system in terms of volume of services provided to the population with severe obesity. Some 60, on the other hand, will be performed in the first two months of 2025. “All surgeries are performed laparoscopically, which combined with modern and effective management of the perioperative period, allows the patient to benefit from a faster recovery, a short hospital stay, and reduced postoperative pain,” the coordinator adds. But the team that must follow up with the patient is also important: “Following bariatric surgery, the patient must follow a long follow-up course to ensure the successful outcome of the surgery through weight maintenance and reduction of possible side effects of bariatric procedures. In carrying out our clinical practice, we are facing new challenges, first and foremost that of relapsing obesity, and Candela Nursing Home is at the forefront thanks to the multidisciplinary team (Endocrinologists, nutritionists, endoscopists and surgeons) that will take care of the person with this issue, thanks to appropriate therapeutic pathways.” But there are several interdisciplinary collaborations with the center, “one example among all is the close collaboration between the bariatric group and the group of gynecologists who deal with fertility,” adds Pisello, “known in fact the correlation between obesity and infertility in young adults. In fact, many young women with fertility problems have polycystic ovary syndrome and are obese. Data from the international literature have shown that losing excess weight allows these young women to regain fertility status.” Finally, without forgetting also the collaboration with the post-bariatric plastic surgery service: often, after a major weight loss resulting from obesity or bariatric surgery (sleeve gastrectomy, gastric by-pass, gastric banding), although the weight problem is solved, another one has to be faced, namely excess skin and related problems. This is why at Candela Nursing Home, in line with the regional pdta, the Plastic Surgery Service has been activated. “This service provides outpatient and inpatient services to evaluate and correct the outcomes of the imposing slimming resulting from bariatric surgery. Post-bariatric plastic surgery aims to correct post-bariatric deformities through safe and innovative surgical techniques planned to obviate functional and aesthetic limitations, restoring psychological well-being to the patient,” Pisello concludes. – Aiop photo source-(ITALPRESS).
