Surgical treatment of obesity – features, effectiveness and…

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Obesity is an extremely important and growing public health problem in both economically developed and developing regions of the world. In 2008, more than 1.4 billion adults worldwide were overweight, of which more than 200 million men and nearly 300 million women were obese. This number has doubled since the 1980s. It is currently estimated that 33% of the world’s population of 7.08 billion – a staggering 2.36 billion – are overweight or obese. Every second, 2.5 people are added to the world population, and one of them will be obese or overweight. According to statistics, 35.7% of the adult population in the United States is obese. In Russia, as of the end of 2016, 23.5 million obese people were registered.

Why is obesity dangerous?

Obesity is associated with markedly reduced life expectancy, making it the leading cause of preventable death. Obesity has been shown to be associated with hypertension, hyperlipidemia, coronary artery disease, increased glucose tolerance or diabetes, sleep apnea, non-alcoholic fatty liver disease, and certain cancers, including the esophagus, pancreas, kidney cells, breast, endometrium, neck and prostate cancer. Even more worrying is that at least 2.8 million people worldwide die each year as a direct result of being overweight or obese.

Causes of Mass Obesity

The World Health Organization (WHO) defines obesity as a condition of excessive accumulation of body fat to the extent that it adversely affects health and well-being.

Our bodies are designed to perform best in environments where food is fickle and a high level of physical activity is required for food and shelter, and transportation. This used to be enough to allow most people to maintain a healthy weight without conscious effort. But today everything is different. Providing food and shelter and moving around in the environment do not require the high levels of physical activity required in the past. Now you can be productive while leading a sedentary lifestyle.

Advances in technology in the workplace and a reduction in manual labor have led to lower energy costs. The very life in the city with its infrastructure – the availability of public and private transport, the density and location of food stores and restaurants – contribute to an unhealthy lifestyle. Significant changes have taken place in the food environment with the increased availability of inexpensive food. Prices for high-calorie food and beverages have declined significantly, in contrast to rising prices for fresh fruits, vegetables, meats and dairy products, contributing to increased consumption of unhealthy foods with larger portion sizes.

Under such conditions, weight gain can only be prevented through conscious attempts to eat less or be physically active.

Rich and poor: who is more at risk of obesity

Obesity rates are rising among people of all income and education levels, but absolute rates are lower among those with higher incomes and education levels. The cheapest foods are those that are high in fat and sugar. The biological preference for these foods, combined with easy availability, contributes to overeating. In addition, low-income people may engage in less physical activity than other segments of the population. One reason for this discrepancy may be that safety concerns in low-income areas may prevent adults and children from exercising outdoors. Add to this the fatigue from work and a lot of everyday problems that do not leave strength for sports. People who have more financial resources cope more easily with these circumstances and are therefore more physically active and less obese than those who have fewer resources.

Surgical methods for the treatment of obesity

In the most severe cases, when other methods no longer help in the treatment of obesity, they resort to surgical operations.

What are the current indications for surgery?

1) With a body mass index of more than 40, regardless of the presence of concomitant diseases;

2) with a body mass index above 35 with the addition of obesity-related diseases;

3) if the previous conservative treatment was ineffective;

4) if a patient with severe obesity managed to reduce body weight, but subsequently it began to recover.

Modern operations used in obesity:

Installation of an intragastric balloon – a minimally invasive method of weight loss, comparable in complexity to conventional gastroscopy (insertion of a probe through the mouth into the stomach – ed.). Filling part of the volume of the stomach, the balloon contributes to early satiety, and due to the quantitative restriction of food intake, the patient loses weight. The technique is used in individuals with a body mass index of 30 to 40, when surgical treatment is still premature, and also as a stage of preparation for surgery in patients with morbid (life-threatening – ed.) obesity.

Longitudinal resection of the stomach – the lateral part of the stomach is removed, while the most important physiological valves of the stomach are preserved. From a voluminous bag, the stomach turns into a narrow tube, where food does not linger for a long time and quickly goes into the intestine. Also, during PRV, that part of the stomach that secretes the hunger hormone – ghrelin is removed, and therefore, after such an operation, the need for food is significantly reduced in patients after such an operation. In 70% of cases, the phenomena of type 2 diabetes mellitus are compensated or completely leveled. Longitudinal resection can be considered as the operation of choice in patients with moderate overweight up to 35 to 45, as well as in cases where more complex operations are unacceptable or impossible.

gastric bypass surgery is a complex combined operation that combines a reduction in the volume of the stomach and reconstruction of the small intestine, aimed at limiting the absorption of food components. As a result of the operation, the amount of food consumed is reduced several times. At the same time, the early entry of food into the small intestine causes a steady and quickly coming feeling of fullness. The advantages of the operation are a pronounced decrease in body weight, as well as an effective effect on the course of type 2 diabetes mellitus and blood lipid composition. The main disadvantage is the need for lifelong intake of vitamin and mineral complexes.

Biliopancreatic shunt surgery – is used to treat severe forms of obesity, refers to combined methods and combines a decrease in the volume of the stomach and a bypass component, that is, the reconstruction of the small intestine, aimed at reducing the absorption of food. The BPS operation is by far the most complex, but at the same time the most effective for the treatment of morbid obesity. The advantages of the operation are in a significant and most stable long-term weight loss, an effective therapeutic effect on type 2 diabetes, as well as compensation for concomitant diseases. However, as with gastric bypass surgery, vitamin and mineral supplements must be taken systematically and throughout life after BPD.

In conclusion, there is a clear need to raise public awareness and education about the complex etiology of obesity and the significant barriers to sustained weight loss. The prevailing societal and media messages that reinforce the guilt of people who are obese should be replaced by messages that obesity is a chronic disease with a complex etiology.

Photo: Vostock Photo

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