Management of Extreme Obesity (BMI > 60 kg/m2)

Abstract

The management of extreme obesity (BMI >60) is becoming a modern necessity. A significant proportion of these patients may not be suitable for surgical intervention, and need palliative management. Those thought suitable for surgical intervention will require thorough specialist multidisciplinary team assessment led by the bariatric surgeon. Assessment should include input from the bariatric physician, psychologist, dietitian, and anesthetist.Preparation for surgery must take account of the operating and ward environment. Many of these massive patients will require bespoke environmental and handling solutions.The choice of surgical procedure should be determined by an experienced bariatric surgeon confi dent in undertaking treatment of such patients. Any procedure will achieve weight loss, the imperative is for a safe and straightforward perioperative course.Post operatively, specifi c adjustments to the general course of post-op bariatric care are required for this group. The need for long-term dietetic, psychological, and plastic reconstructive input is established. Keywords

A Novel Technique for Improving Bodily Experience in a Non-operable Super–Super Obesity Case

“…This case provides preliminary evidence that both body dissatisfaction and body-size distortions of non-operable super-super obesity patients could be addressed by a VR body-swapping protocol, which is important because the palliative multidisciplinary treatment recommended for these patients ( Somers and Carter, 2015 ) is not able to adress them. Specifically, the patient showed a significant body dissatisfaction associated to an underestimation of the width of her body size, and profound overestimation of her body circumference and of tactile distances.…”

“…The most recent available data estimated that 6.4% of the US adults are morbidly obese ( Ogden et al, 2014 ), suggesting that over a million of individuals suffers from super-super obesity ( Finkelstein et al, 2012 ; Somers and Carter, 2015 ). For obesity, bariatric surgery is currently considered the most effective option and has been the treatment of choice in the last decade ( Buchwald and Oien, 2013 ), but the importance of stand-alone and/or combined treatment options, particularly for obese patients with being eating pathology, has also been heightened in the literature (e.g., Grilo et al, 2011 ; McElroy et al, 2015 ).…”

“…For obesity, bariatric surgery is currently considered the most effective option and has been the treatment of choice in the last decade ( Buchwald and Oien, 2013 ), but the importance of stand-alone and/or combined treatment options, particularly for obese patients with being eating pathology, has also been heightened in the literature (e.g., Grilo et al, 2011 ; McElroy et al, 2015 ). However, bariatric surgery is not a clear treatment option for a significant proportion of super-super obese patients (i.e., those with body mass index (BMI) > 60 kg/m 2 ) not suitable for surgical intervention: surgical treatment of these patients is associated with higher incidence of major complications and mortality ( Buchwald et al, 2007 ; Somers and Carter, 2015 ). The available clinical guidelines for these patients recommend as mandatory a palliative treatment (i.e., diet, physical activity, and behavior modification) provided in a center of excellence (e.g., Somers and Carter, 2015 ).…”

“…However, bariatric surgery is not a clear treatment option for a significant proportion of super-super obese patients (i.e., those with body mass index (BMI) > 60 kg/m 2 ) not suitable for surgical intervention: surgical treatment of these patients is associated with higher incidence of major complications and mortality ( Buchwald et al, 2007 ; Somers and Carter, 2015 ). The available clinical guidelines for these patients recommend as mandatory a palliative treatment (i.e., diet, physical activity, and behavior modification) provided in a center of excellence (e.g., Somers and Carter, 2015 ). Yet, the modality and the impact of this approach are still controversial ( Somers and Carter, 2015 ).…”

“…The available clinical guidelines for these patients recommend as mandatory a palliative treatment (i.e., diet, physical activity, and behavior modification) provided in a center of excellence (e.g., Somers and Carter, 2015 ). Yet, the modality and the impact of this approach are still controversial ( Somers and Carter, 2015 ). Moreover, this approach is not able to address the high level of body dissatisfaction ( Rosenberger et al, 2006 ; Ghai et al, 2014 ) and body-size distortions ( Guardia et al, 2013 ; Scarpina et al, 2014 ), which are common among these patients and have a significant impact on their quality of life and psychosocial functioning ( Schwartz and Brownell, 2004 ; Docteur et al, 2010 ).…”