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. 2022 Jun;32(6):1996-2002.
doi: 10.1007/s11695-022-06042-8. Epub 2022 Apr 6.

Advice of General Practitioner, of Surgeon, of Endocrinologist, and Self-determination: the Italian Road to Bariatric Surgery

Antonio E Pontiroli  1   2 , Geltrude Mingrone  3 , Annamaria Colao  4 , Luigi Barrea  4 , Giulia Cannavale  5 , Ferdinando Pinna  5 , Valerio Ceriani  5 , Stefano Maria De Carli  6 , Giovanni Cesana  6 , Stefano Olmi  6 , Gloria Scolari  7 , Simonetta Sarro  7 , Giuliano Sarro  7   8 , Claudia Procopio  9   10 , Alessandro Giovanelli  9   10 , Lelio Morricone  9   10 , Giancarlo Micheletto  9   10 , Alexis Malavazos  9   10 , Valerio Panizzo  9   10 , Laura Plebani  11 , Marco Antonio Zappa  11 , Igor Tubazio  11 , Diego Foschi  11 , Silvia Capogrossi  12 , Caterina Conte  12 , Alessandro Saibene  12 , Carlo Socci  12 , Martina Gozza  13 , Sara Testa  13 , Giuseppe Marinari  13 , Stefano Maccatrozzo  14 , Marina Croci  14 , Enrico Mozzi  14 , Ornella Verrastro  15 , Esmeralda Capristo  15 , Marco Raffaelli  15 , Vincenzo Bruni  16 , Andrea Soare  16 , Giuseppe Spagnolo  16 , Silvia Manfrini  16 , Ida Gallo  16 , Giovanni Casella  17 , Lidia Castagneto-Gissey  17 , Mikiko Watanabe  17 , Simona Frontoni  17 , Massimiliano Di Paola  18 , Benedetta Russo  18 , Patrizia Bigarelli  18 , James R Casella-Mariolo  18 , Franca Filippi  18 , Frida Leonetti  19 , Alberto Di Biasio  19 , Gianfranco Silecchia  19 , Valeria Guglielmi  20 , Claudio Arcudi  20 , Antonio Vitiello  4 , Mario Musella  4 , Rita Schiano  21 , Cristiano Giardiello  21 , Michele Giuseppe Iovino  22 , Maurizio De Palma  22 , Salvatore Tolone  23 , Ludovico Docimo  23 , Michele Renzulli  24 , Vincenzo Pilone  24 , Maria Police  25 , Luigi Angrisani  25 , Elena Tagliabue  5
Affiliations

Advice of General Practitioner, of Surgeon, of Endocrinologist, and Self-determination: the Italian Road to Bariatric Surgery

Antonio E Pontiroli et al. Obes Surg. 2022 Jun.

Erratum in

  • Correction: Advice of General Practitioner, of Surgeon, of Endocrinologist, and Self-Determination: the Italian Road to Bariatric Surgery.
    Pontiroli AE, Mingrone G, Colao A, Barrea L, Cannavale G, Pinna F, Ceriani V, De Carli SM, Cesana G, Olmi S, Scolari G, Sarro S, Sarro G, Procopio C, Giovanelli A, Morricone L, Micheletto G, Malavazos A, Panizzo V, Plebani L, Zappa MA, Tubazio I, Foschi D, Capogrossi S, Conte C, Saibene A, Socci C, Gozza M, Testa S, Marinari G, Maccatrozzo S, Croci M, Mozzi E, Verrastro O, Capristo E, Raffaelli M, Bruni V, Soare A, Spagnolo G, Manfrini S, Gallo I, Casella G, Gissey LC, Watanabe M, Frontoni S, Di Paola M, Russo B, Bigarelli P, Mariolo JRC, Filippi F, Leonetti F, Di Biasio A, Silecchia G, Guglielmi V, Arcudi C, Gentileschi P, Sbraccia P, Vitiello A, Musella M, Schiano R, Giardiello C, Iovino MG, De Palma M, Tolone S, Docimo L, Renzulli M, Pilone V, Police M, Angrisani L, Tagliabue E. Pontiroli AE, et al. Obes Surg. 2022 Oct;32(10):3487-3488. doi: 10.1007/s11695-022-06234-2. Obes Surg. 2022. PMID: 35921027 No abstract available.

Abstract

Purpose: Bariatric surgery (BS) is considered the most efficient treatment for severe obesity. International guidelines recommend multidisciplinary approach to BS (general practitioners, endocrinologists, surgeons, psychologists, or psychiatrists), and access to BS should be the final part of a protocol of treatment of obesity. However, there are indications that general practitioners (GPs) are not fully aware of the possible benefits of BS, that specialty physicians are reluctant to refer their patients to surgeons, and that patients with obesity choose self-management of their own obesity, including internet-based choices. There are no data on the pathways chosen by physicians and patients to undergo BS in the real world in Italy.

Methods: An exploratory exam was performed for 6 months in three pilot regions (Lombardy, Lazio, Campania) in twenty-three tertiary centers for the treatment of morbid obesity, to describe the real pathways to BS in Italy.

Results: Charts of 2686 patients (788 men and 1895 women, 75.5% in the age range 30-59 years) were evaluated by physicians and surgeons of the participating centers. A chronic condition of obesity was evident for the majority of patients, as indicated by duration of obesity, by presence of several associated medical problems, and by frequency of previous dietary attempts to weight loss. The vast majority (75.8%) patients were self-presenting or referred by bariatric surgeons, 24.2% patients referred by GPs and other specialists. Self-presenting patients were younger, more educated, more professional, and more mobile than patients referred by other physicians. Patients above the age of 40 years or with a duration of obesity greater than 10 years had a higher prevalence of all associated medical problems.

Conclusions: The majority of patients referred to a tertiary center for the treatment of morbid obesity have a valid indication for BS. Most patients self-refer to the centers, with a minority referred by a GP or by specialists. Self-presenting patients are younger, more educated, more professional, and more mobile than patients referred by other physicians. Older patients and with a longer duration of obesity are probably representative of the conservative approach to BS, often regarded as the last resort in an endless story.

Keywords: Bariatric surgeons; Bariatric surgery; Endocrinologists; General practitioners; Obesity; Sanitary tourism; Self-referral.

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