Obesity or bariatric surgery
What is obesity?
Obesity is possibly the most common metabolic disorder in the Western world.
It is currently estimated that around 1.1 billion people worldwide are obese or overweight and the problem is expected to worsen in the future. Various forms of non-surgical treatment (diet, exercise, drugs) have been tried to reduce pathological body weight, but, in the long term, the only treatment with proven efficacy, obtaining permanent and stable results in a high percentage of patients, is bariatric surgery.
Calculate your BMI
Specialists define obesity as an excess of body weight, due to an increase in adipose tissue in the body, in relation to a given age, sex and height. The most commonly used measure of whether a person is obese is the Body Mass Index (BMI), which is calculated by dividing the weight in kilograms by the height in metres squared (BMI = weight / height in m2).
Obesity is classified according to Body Mass Index into:
BMI
Overweight 25 - 29,9
Obese 30 - 34,9
Severe obesity 35 - 39,9
Morbidly obese 40 and above
What are the complications of obesity?
The risk of obesity-related diseases and their complications generally increases the greater the degree of obesity, the longer the obesity is maintained and the older the person is. Mortality in morbidly obese people is twelve times higher than in the normal population. There is an increase in total cholesterol and triglyceride levels. This increase has been linked to an increased risk of coronary heart disease. The risk of diabetes mellitus increases with the degree and duration of obesity. Weight gain precedes the onset of diabetes and increases insulin requirements. Increased risk of respiratory and cardiovascular diseases: respiratory failure, sleep apnoea syndrome, arterial hypertension, myocardial infarction, heart failure, peripheral vascular insufficiency and varicose veins. Obese patients have an increased risk of certain tumours. In general, obese women have an increased incidence of carcinomas of the gallbladder and bile ducts, breast (in postmenopausal women), ovary, cervix and endometrium. Obese men have an increased risk of rectal and prostate cancer. Other common problems include osteoarthritis, gout, herniated disc, reflux and hiatus hernia, fatty liver and gallstones.
What should I do if I am obese?
Treatment must be individualised, taking into account the causes that are causing or maintaining obesity (sedentary lifestyle, alcoholism, menopause, emotional, social or work-related stress, drugs, pregnancy, etc.), as well as previous attempts to lose weight and their results, and setting achievable, realistic goals agreed with the patient. through a comprehensive treatment programme that includes:
- Meal plan.
- Physical exercise.
- Behavioural modification.
- Pharmacotherapy.
The greatest weight loss will occur in the first 2 weeks of the diet. A loss of 0.5-1kg is advisable. per week.
When should I have surgery?
Patients with a BMI over 40, or over 35 if they have serious associated pathology, are candidates for surgical treatment. It is important that patients have undergone adequate dietary treatment associated with lifestyle changes (physical exercise) directed and controlled by endocrinology, and have not obtained satisfactory and/or maintained weight loss within healthy limits.
What are the surgical techniques for treating obesity?
There are three types:
- Restrictive: reduce the volume of the stomach so that weight loss is due to less food being eaten.
- Malaabsorptive: cause a decrease in the absorption of the food that is ingested.
- Mixed: combine the two previous procedures. Less food is ingested by the patient and less is absorbed.
What is gastric banding?
Gastric banding is a restrictive bariatric surgery technique in which, through the introduction of an adjustable ring around the entrance of the stomach, its capacity is limited so that the patient is satiated sooner and eats less. Although it was the most commonly performed surgical technique in the early decades of the century, it is now rarely performed. It is a very attractive technique for many patients with obesity because of its reversibility and because it is simple and safe, although its effectiveness and its effect on metabolic disease are clearly less than other techniques such as gastric sleeve or bypass. Continuous monitoring of the filling of the ring is necessary and medium and long-term problems have been described due to the pressure that the ring exerts on the stomach wall, which has led to its progressive abandonment.
What is Sleeve Gastrectomy?
It is a restrictive technique that consists of reducing the capacity of the stomach by removing, vertically, the left portion of the stomach (the 80%). On the one hand, we permanently reduce the capacity of the stomach by 80% (volume restriction) and, on the other hand, the gastric fundus is removed, as this is where a hormone that stimulates appetite (ghrelin) is produced. In this way, the patient will have a feeling of fullness and satisfaction after eating a small amount of food. This feeling of fullness and satisfaction makes it easier for the patient to comply with the diet programme. On the other hand, by reducing ghrelin production, the patient will notice a significant reduction in appetite. It is the most commonly performed surgical technique in the world as the technique is relatively simple and the results are excellent. However, if complications arise, they can be very serious and difficult to treat. It is very important to know whether or not the patient has gastro-oesophageal reflux before it is indicated.
What is Gastric Bypass?
The Gastric Bypass is the obesity intervention on which all other operations are compared. It is what we call the "gold-standard". It consists of reducing the gastric capacity by creating a small reservoir from which food is diverted directly to the small intestine. It also reduces the amount of intestine capable of absorbing food. It prevents the patient from eating food quickly and in large quantities, as well as preventing food from following its normal course through the digestive tract. The patient feels satiated (i.e. "full") with less food. The weight loss is due to less food intake and poor absorption of food as it reaches the intestine without passing through the duodenum. Due to increasingly known hormonal effects, diabetes mellitus control is achieved, making it the most commonly used technique if the obese patient also has diabetes mellitus.
Which patients are candidates for gastric bypass?
This technique is mainly recommended in obese patients with diabetes mellitus and in those with gastro-oesophageal reflux disease. It is technically more complex to perform than vertical gastrectomy, so it is not usually performed in patients with severe associated diseases or large excess weight.
Dietary recommendations after surgery
During the first 4 weeks, the patient must take a liquid and semi-liquid diet, which includes food supplements. Subsequently, a balanced diet can be followed, eating five times a day, avoiding meals out of hours. Especially in malabsorptive techniques, vitamin supplements are recommended for life.
Are all these techniques performed laparoscopically?
Minimally invasive surgery is one of the greatest advances in medicine. When performed in the abdominal cavity, it is called laparoscopic surgery. It consists of operating using specific instruments and an optic inserted into the abdomen through a high-resolution microcamera, which transmits the image to a television monitor. To perform this surgical technique, small wounds of between half a centimetre and one centimetre are used.
The advantages of performing vertical gastrectomy and gastric bypass laparoscopically are:
- Rapid post-operative recovery
- Rapid recovery of bowel function
- Pain reduction
- Reduced risk of developing eventrations