title: A Novel Technique for Improving Bodily Experience in a Non-operable Super-Super Obesity Case.
abstract: BACKGROUND
  The available clinical guidelines for super-super obese patients (i.e., with body mass index (BMI) > 60 kg/m(2)) 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.
  
  
  METHODS
  We report the case of a non-operable super-super obesity - a 37 year old woman with a BMI of 62 kg/m(2) - 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, MilanItaly; Department of Psychology, Università Cattolica del Sacro Cuore, MilanItaly.
authors.forename: Silvia
authors.initials: S
authors.lastname: Serino
authors.affiliation: "Rita Levi Montalcini" Department of Neuroscience, University of Turin, TurinItaly; Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, PiancavalloItaly.
authors.forename: Federica
authors.initials: F
authors.lastname: Scarpina
authors.affiliation: Department of Experimental Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht Netherlands.
authors.forename: Anouk
authors.initials: A
authors.lastname: Keizer
authors.affiliation: Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Pedroli
authors.affiliation: Department of Brain and Behavioral Sciences, University of Pavia, PaviaItaly; Department of Surgery and Interdisciplinary Medicine, University of Milano-Bicocca, MilanItaly.
authors.forename: Antonios
authors.initials: A
authors.lastname: Dakanalis
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore, MilanItaly; Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, PiancavalloItaly.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Castelnuovo
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore, Milan Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Chirico
authors.affiliation: Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, Ospedale San Giuseppe, Piancavallo Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Novelli
authors.affiliation: Centre for Integrated Research, Area of Diagnostic Imaging, University Campus Bio-Medico, RomeItaly; Department of Neuroscience, Functional Pharmacology, Uppsala University, UppsalaSweden.
authors.forename: Santino
authors.initials: S
authors.lastname: Gaudio
authors.affiliation: Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, MilanItaly; Department of Psychology, Università Cattolica del Sacro Cuore, MilanItaly.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Riva
keywords: bodily illusion; body dissatisfaction; body-size distortions; super–super obesity; virtual reality