Bariatric surgeries are the most effective method of treating obesity of the third degree, the so-called enormous. Statistics are alarming! The number of people suffering from obesity is constantly growing. In Poland, there are already approx. 27 percent. obese people. When diet and exercise fail, a surgeon can help. For whom can bariatric surgery be the only rescue? What are the indications and contraindications for bariatric surgery?
Bariatric surgeries- the topic of this method of treating obesity is increasingly appearing in the media. We talk to prof. CMKP dr hab. med. Wiesław Tarnowski, the head of the Department of General Surgery and the Alimentary Tract at the Hospital. W. Orłowski in Warsaw, who has been dealing with the surgical treatment of obesity for many years.
Obesity statistics are a living effect of well-being?
Prof. Wiesław Tarnowski : Among others. Most of us eat too much and move too little. Yes, you can eat a lot, but only when we work hard physically or play sports intensively. Then the calories turn into muscles. If the activity is limited to operating the TV remote control, the body has no chance to use the calories supplied to it and quickly turns them into fat. When the diet is dominated by highly processed food that is absorbed by itself - it is not difficult to make a catastrophe.
And can obesity be inherited from parents?
» W.T.:Some time ago, it was indeed the news that scientists had discovered the obesity gene. It is now known that not one gene, but many, can contribute to obesity. Only the impact is small. Speaking of inheritance, it is rather incorrect eating habits and inactive forms of spending free time taken from the family home. That is why I repeat: people who are prone to overweight or are already overweight, and especially those suffering from obesity, should pay attention to what, how much and when they eat. And they can't give up traffic! Remember, however, that in addition to improper nutrition, other diseases are also responsible for weight gain, such as hypothyroidism or hormonal disorders, anddrugs. By treating the underlying disease, you can keep the kilos in check. As a curiosity, the Swedes have proved that children's obesity is caused, among others, by no sleep. Contemporary obesity is a very complicated disease. It is caused by many factors at the same time. The environmental ones, popularly known as unhe althy lifestyle, are the main ones. But there are also hormonal factors, i.e. disruptions in the work of hunger and satiety hormones, as well as metabolic and psychological factors.
Read also : Obesity - Causes, Treatment and Consequences
Obesity is said to be the second leading cause of premature death after smoking. It does not seem to impress us?
» W.T.:Probably not, because the number of overweight and obese people is constantly growing. Obesity in itself is not a fatal condition. But the complications that result from obesity can lead to death. The complications associated with the metabolic syndrome are at the fore. It consists of glucose intolerance, i.e. diabetes, arterial hypertension, and lipid (fat) disorders. In short, a person suffering from metabolic syndrome has atherosclerosis, diabetes and ischemic heart disease. He is more likely to develop cancer. Many people develop breathing problems, which also shorten their lives. A person with obesity lives an average of 10 years less than a person with a normal weight. If people don't start treating obesity, doctors will only have to deal with the aftermath of obesity.
Loss of he alth is the only consequence of obesity?
» W.T .:Obesity very often leads to a situation where we fall out of many social roles - personal and professional. A man with obesity is ridiculed, pointed with fingers, discriminated against, so he avoids contacts. Easily succumbs to depressive moods. People with obesity hide their frustration under the mask of coarse and cuddly "fat people". In fact, they suffer a lot.
Read also:Weightism, so I hate you because you're fat.
In people with morbid obesity, most diets do not work. The surgeons offer them a bariatric surgery. What is it?
» W.T .:Surgical treatment of obesity can be divided into three large groups of operations: restrictive treatments, disabling treatments, and a combination of both. Simply put, a restrictive procedure involves reducing the capacity of the stomach. For this purpose, special, adjustable bands are used, or a sleeve gastrectomy is performed. Thanks to this, the patient eats much less, feels satiated faster, and as a result of supplying a smaller portion to the bodyyou lose calories. A procedure that reduces the absorption of nutrients from food, i.e. gastric by-pass, involves cutting the duodenum from the stomach with bile and pancreatic ducts flowing into it. The stomach then connects to the end of the small intestine. A fragment of the duodenum with biliary and pancreatic ducts fuses with the small intestine. The technique that combines both methods is to divide the stomach into two separate parts. The small intestine joins the smaller intestine, it is the so-called food loop. The rest of the stomach with the duodenum and a fragment of the jejunum, the so-called bile loop, connects to the ileum. Regardless of the chosen operating technique, the goal is always the same - to supply the body with fewer calories. One more important thing is worth mentioning. In obese people, a hormone called ghrelin is released in large amounts, which we call the hunger hormone. It is produced in the stomach. During an operation involving the removal of a part of the stomach, we excise the part of the stomach where ghrelin is formed. So, after the surgery, these people do not feel hungry.
Is stomach reduction in obese people enough? After all, some nutrients are absorbed in the intestines.
» W.T.:Let's look at it from a different angle. The average person with obesity of the last, third degree, i.e. giant can eat up to about a kilogram of products for one meal. After restrictive surgery, he will be able to eat as little as 100 ml per meal. So he loses excess body weight, which is colloquially speaking he is losing weight. But that doesn't quite solve the problem. There are people who are addicted to consuming calories. It is the same addiction as smoking or drinking alcohol. If such a person cannot eat a lot, he will find another way to obtain calories, e.g. he will eat ice cream with chocolate and drink a cola.
So, apart from medical indications for bariatric surgery, the mental attitude of the patient is also important?
» W.T.:Of course. The conversation with the psychologist and his opinion about the patient's motivation to undergo surgery are always taken into account. Before we decide to undergo the procedure, we must be sure that the patient is ready to change the current diet and that there are no psychological disturbances. If in doubt, we withdraw from the operation. We cannot expose the patient to the risks associated with the procedure. We often offer psychological help then. If the patient is not mentally ready to undergo surgery, there is no point in performing it, because after the surgery he will try by all means togain calories.
Are bariatric surgeries performed using traditional techniques?
» W.T.:We use laparoscopic techniques, which are considered traditional in many surgical procedures. I understand that you are asking about the possible need to cut the abdominal wall, which is technically a laparotomy. This is usually not done in bariatric surgery. Laparoscopy is enough. There are small scars on the body and the wound healing process is much faster.
Who can get such treatment? How much does a bariatric surgery cost?
»W.T.: There are specific indications for carrying out such operations. The basic criterion is BMI, i.e. body mass index over 35, and metabolic syndrome or some of the diseases that make up it, e.g. hypertension and diabetes. The second group of patients qualified for surgery are people with a BMI of 40 and more, but with no additional illnesses. Bariatric operations are reimbursed by the National He alth Fund.
What are the contraindications for bariatric surgery?
» W.T.:These are primarily mental disorders and addictions. The operation is also not performed on people who suffer from serious respiratory, circulatory and kidney diseases. In any case, you should weigh the pros and cons. Sometimes it is worth taking a risk if there is a chance that treating obesity will reduce the discomfort it has caused.
How often are complications after bariatric surgery?
» W.T.:Fortunately rare. For example, after a sleeve gastrectomy, the complication rate remains within 1%. It has also been proven that there are significantly fewer complications after bariatric surgery than after hip replacement surgery. With an unfavorable combination of events, bariatric surgery may lead to pulmonary embolism, respiratory failure, and wound infection. There may be a hemorrhage, an anastomotic leak. Later, gallstones or nutritional deficiencies may appear. The patient may also die, but this is how any operation may end.
Despite this, there are obese patients who believe that it is a slimming method.
» W.T.:This is a silly approach. It is sad, but there are still patients who think that they do not have to take care of their he alth and start treating overweight and obesity in stage I or II, because surgery is possible. But that's not true!
What should an obese patient who decides to undergo bariatric surgery should know?
» W.T.:First of all, it'smajor surgery, included in the so-called major surgery. We have already mentioned possible complications. Therefore, surgical treatment of obesity is most often performed by people who have undergone several weight loss courses without success. Before the operation, you have to go to the hospital for a few days, where the tests will be performed. It is assessed, inter alia, respiratory and cardiovascular capacity. We do basic hormonal tests to make sure that obesity is not caused by a disrupted hormonal balance. We make heart echo, holter etc.
What after bariatric surgery?
» W.T.:It depends on the condition of the patient. Usually, on the second day after surgery, you can go home. Everyone has a diet that is right for them. He knows what he can and cannot eat. For 2-3 weeks, he has to eat in a certain way and supplement the missing vitamins and minerals. People who do not follow the set rules do not lose weight. Surgical treatment of obesity does not guarantee that you will get rid of excess pounds in 100%. If the patient lacks the motivation to persevere - he will simply lose his chance.
What was the most serious challenge you had to face?
» W.T.:The patient weighed over 200 kg. We do not operate on heavier people, because our table is able to withstand just that much. Of course, in our country there are tables adapted to the operation of people with a greater body weight, but we do not have one.
How does Polish bariatrics compare to the world?
» W.T.:The first surgical treatment of obesity was carried out in Poland in the 1970s. We are one of the pioneers of bariatrics and this field of surgery continues to develop in our country. But there are also problems. Morbidly obese patients are referred too late for surgery because doctors believe it is a cosmetic operation. It is not so! Patients with malignant obesity simply fight for their lives. If someone is 160 cm tall and weighs 180 kg, he is constantly in a life-threatening condition. According to estimates, there are about 700,000 in Poland. people with BMI 40 + and about 1 million 200 thousand people with BMI 35+ and diseases that are complications of obesity. Unfortunately, we cannot help everyone, because only 2-3 thousand such procedures are carried out in the whole country each year.
ImportantPoradnikzdrowie.pl supports safe treatment and a dignified life of people suffering from obesity.
This article does not contain discriminatory and stigmatizing content for people suffering from obesity.