Multidisciplinary Follow-Up After Surgical Treatment of Obesity and Metabolic Diseases: Proposal of a Portuguese Model
DOI:
https://doi.org/10.34635/rpc.1146Keywords:
Bariatric Surgery, Obesity/surgery, Patient Care Team, Treatment OutcomeAbstract
Obesity is a growing public health problem and one of the leading causes of morbidity and mortality. Surgical treatment is the most effective approach for achieving sustained weight loss and controlling associated comorbidities; therefore, lifelong follow- up should be mandatory.
The Portuguese Society for Obesity and Metabolic Diseases Surgery (SPCO) developed the present proposal for multidisciplinary follow- up of patients with obesity undergoing bariatric and metabolic surgery (BMS), with the aim of supporting healthcare professionals involved in their care- namely Surgeons, Endocrinologists/Internal Medicine Physicians, Nurses, Dietitians, Psychologists and/or Psychiatrists, and General Practitioners/Family Physicians. This proposal seeks to provide a structured set of information to enable appropriate clinical follow- up, contribute to the prevention of complications, and ensure continuity and quality of care. The implementation of a standardized follow- up protocol will also promote effective coordination among professionals, improve quality of care and patient safety, and allow systematic collection of clinical data, which is essential for rigorous outcome assessment and continuous improvement of delivered care.
This patient- centred, multidisciplinary follow- up- emphasizing weight monitoring, nutritional surveillance, psychological support, and metabolic assessment- should be provided at hospital level by the entire multidisciplinary bariatric surgery team for a minimum period of three years. After this period, responsibility for follow- up should be gradually transferred to Primary Health Care, while maintaining annual hospital- based reviews in surgery and nutrition, and in other specialty clinics when clinically justified. Within this follow- up model, guidance is provided regarding laboratory monitoring for potential nutritional deficiencies, management of late dumping syndrome, pregnancy counselling, nutritional intervention, as well as psychological assessment and intervention. Integration of care between hospital- based multidisciplinary teams and Primary Health Care in the follow- up of patients undergoing BMS is a key determinant of the long- term effectiveness of surgical treatment for obesity.
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