In western countries the continual rise in the number of obese people is a sign of an alarming trend. At present it is estimated that in Europe 15 % of the male population and 20% of the female population is obese; more than 50% of the overall population is overweight and the increase in occurrence of this condition is accelerating.




We cannot ascribe the onset of this disorder to one single cause; the combined influence of genetic, metabolic, psychological, social and behavioural factors means that obesity can only be understood and dealt with via a multidisciplinary approach. Today, studies based on evidence have provided the various medical and psychological disciplines with precise knowledge and skills for dealing with this phenomenon and evidence shows that the techniques deriving from this knowledge become highly effective when they interact in synergy. Within this type of setup the role of the psychologist strengthens the work of the endocrinologist who, together with the dietician, prepares the best platform for the surgeon based on the logic of biunivocal relations in a scenario which becomes excellent. This is why integration of methods using team work is not just an option but a moral and ethical must.



Team work therefore does not just represents excellence but an absolute necessity. An approach which excludes a multidisciplinary concept is an approach which is destined to fail. Proof of this is in all the biographies of those who have restricted their therapeutic attention to a single psychological, dietary or pharmacological sphere. In these cases each individual far too often talks of the numerous times weight has been lost only to be put back on again within a few months. We are talking about people who often go on to lose all hope even when faced with achievable targets.



Those who work in the field of eating disorders and obesity have the duty to promote the development of balanced outlooks, counteracting the two opposite extremes encountered in those affected by the problem of obesity, in other words, on the one hand those who have become convinced that any kind of treatment is bound to be a total waste of time and those who still believe in the myth of an easy and miraculous solution. Working in the field of obesity means stimulating the person's energies to help them accept appropriate results and systematically motivate the individual to do something every day to achieve their aims even when they seem far away and unreachable. Obesity is to all effects and purposes a chronic disease while at the same time remaining a disorder which can be dealt with. A team which deals with cases of obesity essentially works on this assumption.
Within a project of this kind, the psychotherapist plays a fundamental role during the phase to assess candidates for surgery, evaluating their eligibility for surgery, taking care of those patients who are not yet ready for this type of scenario and managing groups of patients who have already begun their treatment program.



The assessment phase aims to identify mental pathologies and aspects of the patient's personality which may make them unsuitable candidates for surgery or could limit the potential results of the same. This stage is made up of two meetings in which an in depth investigation is carried out to identify how the problem began, looking into the patient's personal history, his/her relationship with their family members, their motivation to change and the behaviour dynamics in play. During this phase test material of very high internal and statistical value is used. Specifically the CBA test is designed to evaluate aspects linked to anxiety, depression, somatization tendencies, specific phobias and obsessive-compulsive disorders. The MMPI test on the other hand sets out to investigate aspects of an individual's personality to obtain a clear profile of the patient's disposition and attitudes. In order to investigate those aspects linked to dyscontrol and compulsive eating and body image, the BES, TFEQ, SCL-90 and BIA-O tests are used.



If clinical pathologies are found these can be dealt with by specific psychotherapy, postponing any surgery to a later date when the person is free from disorders of a psychological nature.

Taking into consideration the need to follow patients over the long-term, the psychotherapist also manages group therapy sessions made up of persons who have already undergone surgery. These groups aim to provide an opportunity for patients to share personal experiences linked to the treatment program and an important chance to develop, through psycho-educational and cognitive behavioural techniques (assertiveness training, relaxation training, etc.), skills connected to stress management and the acquisition of a lifestyle which is compatible with the bariatric program as well as relational and communication skills.