El rol del psicólogo en el equipo Interdisciplinariasciplinario de cirugía bariátrica / The psychologists role in a bariatric Interdisciplinariasciplinary team

RESUMEN

La obesidad ha sido declarada por la OMS como una epidemia y es factor de riesgo para diversas enfermedades tanto físicas como psicológicas, por lo que supone una creciente carga económica para los sistemas de salud. Actualmente el tratamiento que mayor efectividad ha mostrado para tratar la obesidad severa es la cirugía bariátrica; sin embargo, a pesar de los cambios anatómicos realizados por la cirugía, no todos los pacientes se ven beneficiados por la misma. Se ha reportado que el 20% de estas cirugías fracasan y generalmente este fracaso es atribuido a causas psicológicas. El número de cirugías bariátricas realizadas en el mundo está aumentando exponencialmente y dentro de las guías norteamericanas se sugiere el tratamiento Interdisciplinariasciplinario, incluyendo en este el tratamiento psicológico. El trabajo que se informa busca describir el rol del psicólogo en un equipo Interdisciplinariasciplinario de cirugía bariátrica.(AU)

ABSTRACT

Obesity has been declared by the WHO as an epidemic. It has been described as a multicausal disease and that its 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 its 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 dont 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 Interdisciplinariasciplinary approach that includes surgeon, nutritionist, internist, physical rehabilitator and a psychologist. According to the same guidelines, the psychologists 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 Interdisciplinariasciplinary 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 psychologists role in a bariatric surgery Interdisciplinariasciplinary 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.(AU)