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‘Returning to surgery’ – the views of bariatric and metabolic experts

Thu, 08/06/2020 - 11:01
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As bariatric and metabolic surgery restarts across the world, Bariatric News spoke to Monika Proczko-Stepaniak about how the bariatric community can safely resume surgery... 

1. You recently co-authored a paper, ‘Bariatric Surgery During COVID-19 Pandemic from Patients’ Point of View—The Results of a National Survey’, looking at the pandemic from the patients’ viewpoint. What were the keys findings?

The national survey was based on the concept of reaching as many bariatric patients as possible. Only by via social media and communicating with patient organizations were we able to contact a large group of patients. The study was designed as an online survey containing multiple open questions about bariatric care during the COVID-19 pandemic. The survey was conducted among pre- and post-operative bariatric patients.

Monika Proczko-Stepaniak
Monika Proczko-Stepaniak

The majority of participants felt more anxiety about their health compared with their pre-pandemic state. Many (over 70%) were aware of the fact that obesity is a significant risk factor for the severity of COVID-19. More than one-third of patients changed their eating habits during the epidemic, it was observed less often among the group of post-bariatric patients.

Due to lock-down more than 9 in 10 patients didn’t increase their physical activity. Half of respondents have claimed they didn’t gain weight, but almost 30% of respondents confessed to gaining weight – that was observed more often among the preoperative patients. Large group of patients declared disruptions in the preparation process for bariatric surgery and also poor access to the bariatric center. Similarly, patients after surgery at the initial stage of the pandemic didn’t have the possibility of specialistic consultations and follow-up visits.

All the dates for bariatric surgery were suspended since the WHO declared the pandemic. Regardless of the risk of becoming infected with COVID-19, many patients would like to visit a bariatric clinic, this was especially important for the preoperative group. The majority of patients accepted and were satisfied with online contact with a specialist. This underlines the necessity of the continuous support of bariatric surgeons, dietician nutritionists and psychologists.

2. Huge numbers of pre-bariatric surgery patients have had their operations postponed, what help and advice would you offer to them to help them to manage their physical and mental health (bad eating habits, lack of physical exercise and psychological distress) in the coming months?

Due to the need to support patients, especially during the preparatory period – bariatric centers have maintained possibility of online contact with a psychologist and dietitian. There were a lot of virtual meetings of support groups.

At the time of restarting bariatric surgery (my center – IFSO Centre of Excellence – University Hospital in Gdańsk, Poland - restarted from 16 of May 2020), patients felt even more motivated to work on themselves and prepare for surgery.  Of course, all the patients require re-qualification for surgery, but most receive it without major problems.

3. When you consider all the recommendations and best practices around the globe, what do you think is the first priority for your respective country to focus in terms of managing obese patients during & after C19?

There is no global consensus how to restart bariatric surgery, in the regions of the world, the situation is different. In some, the procedures have not been restarted yet, in others there’s normal surgery flow. Each country, region or bariatric center must develop its own standards depending on the current epidemiological situation. Undoubtedly, the general message must be patient safety.

Patients with morbid obesity have unfortunately become the victims of two global pandemics - obesity and COVID. That’s why all the efforts should directed on better understanding the goal of bariatric surgery, and not just as a ‘life-style’ surgery.

Considering all the complications associated with morbid obesity and the costs for national healthcare system, and as bariatric surgery is the only effective treatment, it should be considered as a priority treatment.

The COVID epidemic provides further evidence how serious a health problem morbid obesity is. It’s a known fact that the majority of patients who required ICU treatment due to the severity of COVID-19 had obesity. This particular situation should force the WHO and EU to create more strategic programs to solve or at least diminish the progress of obesity and its serious complications.

The 'Return to work' survey and interviews with bariatric and metabolic specialists were carried out in partnership with Medtronic Inc.