Abstract
Introduction: The available clinical guidelines for super-super obese patients (i.e., with body mass index (BMI) > 60 kg/m2) that are not suitable for bariatric surgery mandate a palliative multidisciplinary treatment (i.e., production and maintenance of weight loss) provided in a center of excellence. However, the modality and the impact of this approach are still controversial. Moreover, it is not able to address the high level of body dissatisfaction and body distortions that are common among these patients.Clinical Presentation: We report the case of a non-operable super–super obesity – a 37 year old woman with a BMI of 62 kg/m2 – receiving a specialized treatment for her obstructive sleep apnea. She entered a multidisciplinary program that promoted healthy behaviors, including physical activities and psychological intervention. To improve body dissatisfaction, which was linked to a significant multisensory impairment of body perception, she also entered a virtual reality (VR) body-swapping illusion protocol. At the end of the current investigation, the patient continued her multidisciplinary program, reporting an increase in the motivation for undertaking healthy behavior and a decrease in the anxiety feelings associated with her clinical condition.Conclusion: 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 is not able to address them. Interestingly, the use of a VR body-swapping illusion protocol seems to be able to improve not only the experience of the body in these patients but their motivation for change, too.
Highlights
The available clinical guidelines for super-super obese patients (i.e., with body mass index (BMI) > 60 kg/m2) that are not suitable for bariatric surgery mandate a palliative multidisciplinary treatment provided in a center of excellence
The results from these well-validated body representation tasks showed that the patient presented profound body-size distortions. She showed underestimation of the width of her body size, and profound overestimation of her body circumference and of tactile distances, suggesting a multisensory impairment of body perception. Since this significant negative bodily experience, we decided to intervene during the first week of her recovery period using the virtual reality (VR) body-swapping illusion (Gutiérrez-Maldonado et al, 2016; Riva et al, 2016; Serino et al, 2016; Figure 1)
At the end of her recovery, the patient had lost 5.1 kg. This case provides preliminary evidence that both body dissatisfaction and body-size distortions of non-operable supersuper obesity patients could be addressed by a VR bodyswapping protocol, which is important because the palliative multidisciplinary treatment recommended for these patients (Somers and Carter, 2015) is not able to adress them
Summary
The available clinical guidelines for super-super obese patients (i.e., with body mass index (BMI) > 60 kg/m2) that are not suitable for bariatric surgery mandate a palliative multidisciplinary treatment (i.e., production and maintenance of weight loss) provided in a center of excellence. Clinical Presentation: We report the case of a non-operable super–super obesity – a 37 year old woman with a BMI of 62 kg/m2 – receiving a specialized treatment for her obstructive sleep apnea. She entered a multidisciplinary program that promoted healthy behaviors, including physical activities and psychological intervention. At the end of the current investigation, the patient continued her multidisciplinary program, reporting an increase in the motivation for undertaking healthy behavior and a decrease in the anxiety feelings associated with her clinical condition
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