LAUSR

Sir, Patients’ perspectives, as suggested by the authors [1], are of the utmost importance for obese people undergoing bariatric surgery (BS) and for physicians and researchers involved in BS. Today we know that BS is not a hit-and-run technical operation, but is a voyage affecting patients’ life for several years; to be succesfull, every voyage should be well prepared in advance, and success in this particular voyage should be measured not only through weight loss, but through resolution of obesity-related morbidities. BS is usually carried out by interdisciplinary groups, and longterm studies are now performed aimed at identifying predictors of success. We know that technical and non-technical factors, such as ineffectiveness of some BS techniques [2], volume of BS activity at surgical institutions [3], insurance [4], compliance to recommended post-surgery behaviours [5], adoption of healthier eating and weight control [6], as well as social and economic problems may all predict good or poor success of BS [7, 8]. As such, obese subjects willing to undergo BS should have correct expectations about what they are going to receive, which improvements of physical and mental health are going to happen, including resolution of psychological problems such as shame and stigmatisation [9], and what they are required to contribute, in particular change of lifestyle. As frequently reported, wrong expectations will reduce BS success [10]. Education is time consuming, and therefore physicians should educate patients honestly and for the time lapse required. Different methods are available to educate patients and to get their feedbacks, from one-toone interviews to social group exchanges [1]. The methods chosen can depend on local facilities and cultural attitudes. For instance, bariatric care groups have the potential to support lifestyle change and weight loss, and may help address the psychological needs of patients [11]; there are also opportunities to improve both the experience and outcomes of adolescent BS through parental education and enhancement of surgical aftercare programmes [12]. We are at the beginning of the process; further research on prospective prediction of BS outcome is needed to guide pre-operative and early post-operative interventions for those at greatest risk of poor outcomes [13].