LAUSR

Dear editor, Bariatric surgery is changing. Nowadays, the obesity epidemic has reached enormous proportions, even in developing countries [1]. Secondly, the presence of concomitant disease and also comorbidities makes the treatment even more challenging. Based on our clinical experience and the individual experience of our patients with several treatment protocols, we recognized that there is more than only the pure medical side of the treatment of obesity and that there is need for a change. Nowadays, there is a rise of multidisciplinary treatment groups and treatment protocols have changed drastically [2–4]. Long-term follow-up schedules are present nowadays (mean follow-up in most Dutch obesity centers is 5 years), with frequent visits to a surgeon, psychologist, and nutritionist as standard care. However, there still is a missing link in the current surgical treatment of obesity. Comparing nowadays with 20 years ago, a lot has changed, but there is more to come. The most important factor is that patients scheduled for bariatric surgery need to be educated that surgery is a life-changing experience. As stated in recent studies by Wilcox et al. [4] and Tarrant et al. [3], the patients’ perspective is very important in perioperative bariatric treatment protocols. Group programs can be beneficial for patients in terms of helping and sustaining a permanent lifestyle change. Patients’ narratives centered on the emergence of a sense of self-based upon their participation in the group: establishing psychological connections to other patients, or shared social identity, were regarded as key mechanisms through which the programs educational material was accessed, and underpinned the experience of social support within the group. Through interaction with other patients, involving the sharing of personal experiences and challenges, participants came to experience their weight Bproblem^ through a collective lens that they felt empowered them to initiate and sustain individual lifestyle change. In our opinion, group programs can also be beneficial to increase adherence to postoperative follow-up visits, which is confirmed by the study of Pontiroli et al. [2]. In current Dutch practice, several new patient participation platforms are created, used to interact with each other and if necessary, to ask questions to the medical professional affiliated to an obesity center. These kinds of platforms are also used to give patients the opportunity to help improve our bariatric program. Bariatric care groups have the potential to support lifestyle change and weight loss and may help address the psychological needs of patients. Nurturing a sense of shared social identity amongst patients withmorbid obesity should be a core aim of the care pathway and may provide the foundation for successful translation of dietetic content in-group programs [3, 4]. Therefore, our patients are the most important for improving our treatment program. Basically, the bariatric surgical procedure and the perioperative treatment program are just tools for patients to achieve their goals in terms of weight loss and remission of comorbidities. In our opinion, patient * Sjaak Pouwels [email protected]