Soon a more effective management before bariatric intervention
Overweight is a problematic public health issue on more than one level. It is clear that, all over the world, more and more obese people benefit from bariatric surgery. In France, and according to the High Authority of Health, the people operated do not always manage to stabilize their weight and regain their original weight only a few monthsafter the intervention. A studyreveals the flaws in the systemfor the management of “bariatric surgery”.
The data, listed since 2013, allow the HAS to conclude that in the space of six years the number of obese people who have benefited from a specific operation (gastric banding, a bypass or gastrectomy act) has doubled.
A comprehensive assessment
It is on the basis of seven health indicators that the HAS relies to publish results that reflect the French state of play in bariatric pre-surgery. Thanks to these seven indicators, which have been in place for more than three years, the results clearly point toa clear improvementin management before bariatric surgery.
These seven indicators concern:
- Qualitative preoperative information of the patient,
- Endoscopic assessment,
- Evaluation of the main comorbidities with their management,
- Psychological and psychiatric assessment,
- The nutritional balance,
- The multi-professional care strategy,
- Communication to the attending physician of the specialists’ decision.
However, the problem still lies in patient information, comorbidity assessment and collegial decision-making between professionals. Indeed, all these data are not really respected and therefore remain to be improved.
2017 will be the year of change
Currently, 172 institutions out of 501participate voluntarily in this collection, a participation rate of about 34%. However, the HAS informs that these seven indicators will become the norm in all French health facilities from 2017.
Several areas of guidance are thus identified by the High Authority of Health: already on the preoperative information of the patient, where it is now a question of transmitting essential data, on the one hand to the success of the surgical act and, on the other hand, to the maintenance of its effect over the long term. For the assessment of the main comorbidities, the HAS wishes to make their research systematic and not only according to the orientations chosen by the health institutions. Finally, with regard to the communication given to the attending physician on the management strategy, it must be strengthened so that it is better coordinated.
Thus, this extension planned for 2017 aims to refine the knowledge of practices on the national territory and to encourage all professionals to self-assess so that they move towards improvement approaches. in accordance with the general recommendations of the HAS.
It is quite obvious that this follow-up is only one step within a holistic approach to the evaluation of the obese person benefiting from a bariatric intervention. Pre-operative management is an essential step but, for all that,it is part of a more global process with post-operative follow-up which is just as crucial and is no better optimized for it.
When will there be a coherent global and a logical continuation in weight loss? A new look at food intake, physical activity, knowledge of interventions with their risks and long-term consequences is essentialto ensure a frank and honest stabilization of the pounds lost.
Stephen Paul is the lead author and founder of My Health Sponsor. Holder of a diploma in health and well-being coaching with more than 200 articles in the field of health, he makes it a point of honor to offer advice based on reliable information, based on scientific research, and verified by health professionals.