The introduction of reference centers and a uniform system of treatment for bariatric patients, i.e. people before and after surgical treatment of obesity and the National Register of Bariatric Operations, is proposed by he alth care experts from the Lazarski University. A pilot project for the implementation of such a system is to be carried out in Poland.

In 2014, more than 2.1 billion people, or almost 30% of the world's population, were overweight or had obesity, including 5% died of obesity or its complications. If the number of cases increases at such a pace, by 2030 almost half of the adult population in the world will be overweight or obese.

There are many of us - there will be more

These dramatic forecasts also apply to Poland. Already, according to the latest update of the World Food Safety Index prepared by the Economist Intelligence Unit (EIU), one in four Poles (exactly: 25.2 percent of the population) suffers from obesity.

The obesity disease is becoming a huge he alth and social problem for us. According to the forecasts of the National He alth Fund, in 2025 we will spend PLN 0.3-1 billion on the treatment of diseases that are complications of obesity (including type 2 diabetes, arterial hypertension, diseases of the gallbladder and biliary tract, sleep apnea, and hormonal disorders) more than in 2022, and the number of adults suffering from obesity will increase to 11.4 million - including 26% of adult women and 30% of adult men.

The growing number of overweight and obese people is putting an increasing financial burden on he alth systems and society. For the patients themselves, excessive body weight is the cause not only of he alth problems, but also of discrimination and stigmatization, and as a result of social withdrawal. In addition to over-spending on he althcare, obesity has social and economic costs due to lost productivity (absenteeism), lower productivity at work (presentaism), mortality and permanent disability.

Disease too severe for the system

The Lazarski University has been carrying out research projects for several years, the aim of which is to search for optimal solutions in the field of the he alth and social care system in Poland. After analyzing the growing problem of obesity disease, specialistsOf the Institute of He althcare Management of this university prepared a special report en titled "A model of comprehensive and coordinated care for an obese patient in Poland treated surgically due to morbid obesity KOS-BAR". This document was presented during a debate with the participation of the Director of the National He alth Fund, Andrzej Jacyna, and representatives of the Agency for He alth Technology Assessment and Tariffication, the Ministry of He alth, the Masovian branch of the National He alth Fund, experts in surgery and bariatric surgery, and patient organizations working for people suffering from obesity. The debate took place on May 30, 2022 at the university.

According to the abovementioned report, indirect costs of lost productivity of obese patients, estimated using the human capital method (GDP per employee) amounted to PLN 77.55 million in 2015, and from PLN 85.14 million in 2016. Year on year dynamics was 110%. In 2015, ZUS expenditure on benefits related to incapacity for work totaled PLN 33,855.7 million, including expenditure on obesity benefits (E66) of PLN 24,207,100 million.

Compared to 2014, we observe an increase in expenditure on obesity benefits by 4.6%. A high increase of 26.9% was recorded in the case of sickness absenteeism expenses. Obesity is a disease that causes both men and women to be temporarily unable to work. In 2016, it was the reason for issuing medical certificates in 5.4 thousand. cases for a total of 102.8 thousand. days of sickness absence. Compared to 2015, the number of medical certificates issued in connection with obesity increased by 15.2%.

How to bring back to life extremely sick people with obesity?

Conservative treatment of obesity at its last stage - 3rd degree obesity, the so-called morbid obesity - it is ineffective and does not give lasting, long-term effects. In many patients, after attempts at conservative treatment, body weight gain again, often to above the baseline value, which leads to the further development of the disease and the emergence of new, serious complications.

Hospitals performing bariatric surgeries (surgical treatment of obesity) estimate that in Poland approximately 700,000 people suffer from obesity of the third degree. And according to international studies, bariatric surgery is the most effective and durable treatment for Grade 3 obesity.

- Currently, according to the results of scientific research, bariatric procedures remain the only method of treating morbid obesity with proven effectiveness. Surgery is no longer just a treatment for excess body weight. The metabolic effects of the procedure are much more important, as they lead to the resolution of complicationsobesity. This is confirmed by numerous studies. It has been proven that the surgical treatment of obese patients extends their life, while significantly improving its quality - says Prof. dr hab. med. Andrzej Budzyński, Collegium Medicum of the Jagiellonian University.

Systemic surgical treatment of obesity

Bariatric surgeries reimbursed by the National He alth Fund are performed by approx. 30 public hospitals in Poland. The costs of bariatric operations incurred by the NHF in 2022 amounted to PLN 43.5 million, which means an increase in the value of services compared to the previous year by nearly PLN 7 million. The service covered 3 781 patients by 510 more than in 2022.

Obesity treatment, bariatric surgery and he alth care specialists emphasize that in order to obtain the best results of morbid obesity treatment and cost optimization, multi-specialist care for bariatric patients is necessary. Experts agree that it is necessary to introduce uniform standards of care for patients treated surgically due to morbid obesity. These standards are primarily:

  • qualification and preparation of the patient for bariatric surgery by a multidisciplinary team of specialists, which should include: internist, surgeon, anesthesiologist, dietician, psychologist / psychiatrist, physiotherapist, nurse or social worker;
  • supervision over the work of the above-mentioned team and the entire treatment should be performed by a doctor with experience in the treatment and care of patients with third degree obesity - preferably a surgeon;
  • bariatric operations should be performed in hospitals with experience in bariatric and metabolic surgery, having both trained specialists and appropriate medical and rehabilitation equipment, etc. adapted to the needs of people with morbid obesity;
  • bariatric patients should be provided with specialist care in these centers, both before and after bariatric surgery.
According to an expert

- Centers interested in the application of bariatric surgery programs and the role of a competence center should meet many conditions necessary to ensure optimal performance of bariatric surgery. Sufficiently significant financial outlays and organizational activities are required to meet the increasingly higher quality parameters related to the use of new medical technologies. The minimum number of bariatric procedures performed in the center in question should be at least 150 operations per year - says Prof. dr hab. n. med. Krzysztof Paśnik, President of the Society of Polish Surgeons.

Bariatric surgery register needed

- According to the concept of Value Base He althcare, the integration of care with the leading role of reference centers plays a special role in the process of improving he alth outcomes. The distinguishing feature of the value-based model is constant monitoring and measurement of effects, which is why it is necessary to create a National Register of Bariatric Operations - argues Dr. Małgorzata Gałązka-Sobotka, Director of the Institute of He althcare Management at the Lazarski University.

The National Register of Bariatric Operations is to be run by a surgery center with many years of experience in bariatric surgery and implementation of he alth programs, using the ICT system and experience relating to the already functioning registers in the field of surgery. The optimal period of keeping the register is to be at least 5 years.

When to pilot the system?

Work is currently underway on supplementing the proposal for a comprehensive care system for bariatric patients.

- In our opinion, it still lacks such an important element as post-bariatric plastic surgeries, which are necessary for patients with huge overhangs of skin after weight reduction to fully return to everyday life: personal, professional and social - says Magdalena Gajda, Social Ombudsman for the Rights of People with Obesity, President of the OD-WAGA Foundation. - We also need to find a way for the reference centers of surgical obesity treatment to contribute to the education of those doctors who we, bariatric patients, come to after operations with other ailments, e.g. primary care physicians, gynecologists, obstetricians, surgeons who used to they will face the necessity to undergo urgent surgery on our altered digestive system.

Representatives of public institutions gathered at the debate at the Lazarski University favorably evaluate the implementation of the pilot project of coordinated treatment and care of bariatric patients. It is realistic that the pilot will be carried out this year. It will probably cover only 1 voivodship for the time being, in order to assess the benefits of its implementation throughout the country.

Important

Poradnikzdrowie.pl supports safe treatment and a dignified life of people suffering from obesity. This article does not contain discriminatory and stigmatizing content of people suffering from obesity.

Magdalena Gajda A specialist in obesity disease and obesity discrimination of people with diseases. President of the Foundation of People with Obesity OD-WAGA, Social Ombudsman for the Rights of People with Obesity in Poland and a representative of Poland in the European Coalition for PeopleLiving with Obesity. By profession - a journalist specializing in he alth issues, as well as a PR, social communication, storytelling and CSR specialist. Privately - obesity since childhood, after bariatric surgery in 2010. Starting weight - 136 kg, current weight - 78 kg.

Category:

Obesity