Obesity is a global health problem
Obesity has become a serious public health problem worldwide. This must be properly addressed through different therapeutic means in order to reduce the medical complications of this disease: temporary or permanent disabilities, the decrease in life expectancy and the medical costs necessary to care for this population category.
Gastric bypass and other surgical procedures used for weight loss are known under the general name of bariatric surgery and are based on limiting the capacity of food intake or absorption of nutrients at the gastro-intestinal level.
Post-interventional, patients must follow a strict diet, with reduced food intake, consisting initially of liquid foods to favor the healing processes at the gastric level. The transition to solid food is done gradually, first you eat semi-solid foods, then you switch to solid food.
Physical exercise is an important aspect in the treatment of obesity, after bariatric intervention a slow transition to more intense training is recommended. The resumption of professional activity and involvement in sports activities is done in accordance with the evolution of the postoperative healing processes and the indications received from the doctor during the recovery stage after bariatric surgery .
Obesity in numbers
According to the World Health Organization , overweight and obesity are defined as an abnormal or excessive accumulation of adipose tissue in the body, and it is estimated that in the absence of drastic prevention and treatment measures, over 50% of the global population will suffer from obesity until in 2025.
According to the figures reported by Eurostat, in 2019, over half of the adults in the European Union were overweight, taking into account the Body Mass Index (BMI) :
- 45% - normal weight (normal weight)
- 36% - pre-obesity
- 17% - obesity
- 3% - underweight (lower weight than the normal average) .
Body mass index (BMI)
The body mass index represents a parameter relating the weight in kilograms of an individual to his height. BMI was developed by the World Health Organization for the classification of overweight and obesity in adults. For the adult population, the body mass index is defined as the ratio between weight in kg and height in as follows:
BMI / Interpretation:
≤18.49 - Underweight
18.5-24.99 - normal weight
25-29.9 - Overweight
30-34.99 - Grade I obesity
35-39.9 - Grade II obesity
≥40 - Morbid obesity
In the case of children, the determination of the body mass index includes the age of the minor and is defined as follows:
- Overweight when the weight compared to the height is > than 2 standard deviations compared to the WHO average of growth standards;
- Obesity when the weight in relation to the height is > than 3 standard deviations compared to the WHO average of growth standards.
The causes of obesity
The main cause of overweight in children and obesity in adults is represented by the energy imbalance between caloric intake and consumption, but along with this there are other risk factors involved in the deposition of adipose tissue represented by:
- Family lifestyle: obesity tends to manifest in several members of the same family due to genetics, lifestyle and common eating habits;
- Sedentarism: most modern professional activities exclude physical movement and favor the accumulation of fats in various tissues and organs;
- Unhealthy diet: junk food represented by overprocessed fast food type foods rich in lipids and sugars and hypercaloric drinks;
- Genetics: genes determine the appearance of overweight by influencing the way of distribution of adipose tissue and metabolism;
- Certain medical conditions such as Prader Willi syndrome, Down syndrome or Cushing syndrome, hypothyroidism, polycystic ovary syndrome, favor the appearance of excess weight in certain categories of patients;
- Medication: certain therapies can cause weight gain in the absence of adaptation of eating habits and living conditions to the background treatment;
- Age: the slowing of the basal metabolism and the physiological hormonal changes that occur with advancing age predispose to the appearance of obesity;
- Pregnancy: weight gain during pregnancy can favor the appearance of obesity in women.
Surgical treatment of obesity - when is it recommended?
The treatment options in the case of overweight and obesity are adopted depending on the general condition of the patient, the associated comorbidities, the body mass index and last but not least the degree of compliance and understanding of the patient . Bariatric surgery is a surgical treatment method used in the case of obese patients, when satisfactory results are not obtained through diet and sports. Surgical treatment of obesity is indicated for patients with one of the following conditions:
- Body Mass Index (BMI) > 40;
- BMI > 35 which associates comorbidities due to obesity;
- Obesity diagnosed more than 5 years ago;
- The failure of conventional therapies represented by diet and sports.
The preoperative evaluation of the candidate patient for bariatric surgery is performed by the surgeon and the nutritionist. This includes the adoption of a diet that contributes to the loss of 5% of the body weight before the intervention.
The evaluation and monitoring of the patient in the preoperative phase is multidisciplinary in most cases and includes the contribution of several doctors: surgeon, pulmonologist, psychiatrist, anesthesiologist and nutritionist.
Bariatric surgery - types of interventions, risks and benefits
The main types of bariatric surgery are:
- Gastric bypass
- Gastric sleeve (longitudinal gastrectomy)
- Gastric diversion (biliopancreatic diversion).
The applied method is chosen depending on the patient's body mass index, eating habits and comorbidities associated with obesity .
Bariatric surgery, like any surgical intervention, presents both benefits and risks . In the short term, digestive bleeding, surgical wound infection, anesthetic complications, thrombosis, respiratory dysfunction and, in rare cases, death may occur.
In certain situations, late postoperative complications (occurring more than 4 weeks after the intervention) that can occur after bariatric surgery are represented by: intestinal obstruction, dumping syndrome (abdominal cramps, diarrhea, flush, tachycardia, hypotension, sweating ), gallstones, hernias, hypoglycemia, malnutrition, gastro-duodenal ulcers, vomiting and gastric reflux disease.
Longitudinal gastrectomy (gastric sleeve) is currently recognized as a type II diabetes treatment method, having favorable effects on the following conditions associated with obesity:
- Improvement of cardiovascular diseases, hypertension and the risk of stroke;
- Remission of the sleep apnea syndrome with the improvement of the quality of sleep and the quality of the patient's life;
- Reduction of the progression of nonalcoholic hepatic steatosis and steatohepatitis;
- Improvement of menstrual irregularities, infertility and sterility;
- Alleviation of lumbago and knee joint pain as a result of reducing excess weight;
- Improvement of urinary incontinence until its disappearance.
