Surgical treatment of obesity requires nearly 2 million Poles. Meanwhile, only about 3,000 bariatric surgeries are performed annually. What to do to inhibit the development of obesity in the first stages of the disease? What should a coordinated obesity treatment system look like? These are the main topics of the Multidisciplinary Conference "Faces of Polish Bariatry - New Horizons", which took place in May as part of the European Obesity Day 2022 in Poland.

Conference Fri. "Faces of Polish Bariatry - Nowe Horyzonty" gathered outstanding Polish experts in the field of obesity, i.e. obesity treatment, and bariatric surgery teams from hospitals all over the country, incl. from Warsaw, Kraków, Gdańsk, Głogów, Olsztyn and Toruń.

- This year we are celebrating an unofficial anniversary in the development of modern Polish bariatric surgery - reminded prof. dr hab. Krzysztof Paśnik, President of the Society of Polish Surgeons, during the conference opening lecture. - Although the surgical treatment of obesity was performed in our country in the 1970s, the first scientific conference devoted to this area of ​​surgery took place 23 years ago.

The current meeting of experts, however, was the first in the history of national obesitology, in which active partners in the discussion were non-governmental organizations representing obese patients: the Obesity People Foundation OD-WAGA and the CHLO Bariatric Patients Association.

- When in 1995 I decided to undergo the first operation, the term was not used yet: bariatric surgery, but surgical treatment of obesity, colloquially: gastric reduction surgery. Such procedures were carried out by 2 or 3 hospitals throughout the country, treating them as still an experimental method. Currently, bariatric surgery is one of the most dynamically developing disciplines of Polish surgery - said Magdalena Gajda, Social Ombudsman for Obesity Patients and President of the OD-WAGA Foundation, who delivered the second lecture opening the conference.

More and more operations

In 2010 … 4 million people worldwide died from obesity and its complications. It is estimated that by 2035 no Pole will have a correct body mass index, i.e. BMI. Current statistics show that obesity is sick in our countryabout 27 percent people. In this, according to the estimates of hospitals performing bariatric procedures, about 1 million 200 thousand Poles suffer from obesity of the 2nd degree and diseases that are complications of obesity, and with obesity of the 3rd degree - approx. 700 thousand. It is patients from these two groups that are dedicated to bariatric surgery as the most effective method of treatment.

- From January 1, 2022, bariatric surgeries are reimbursed in Poland. Annually, about 3 thousand of them are carried out by us. This is not much so far, but we are seeing that this number is growing year by year. There is also an increasing number of hospitals that decide to include bariatric surgeries in the scope of surgical procedures. We have about 30 of them in Poland. Surgical techniques are also developing. 98 percent we perform bariatric procedures using the laparoscopic method - said prof. dr hab. Grzegorz Wallner, National Consultant in the field of General Surgery, one of the conference guests.

There are many hospitals implementing bariatric procedures, but still too few for the needs of patients. Queues for treatments are getting longer. In some hospitals, due to several-stage preparation procedures. In others, due to the exhaustion of the limit of treatments contracted by the facility at the National He alth Fund. In search of an earlier date of surgery, patients often decide to undergo the procedure in a city hundreds of kilometers away from their place of residence.

- From the patient's point of view, what is missing in Polish bariatry is a uniform system of qualification and diagnostics for all clinical centers before bariatric surgery, the implementation of the surgery itself and monitoring of the patient after the surgery - said Magdalena Gajda.

Multidisciplinary Bariatrics

Bariatric surgeries inhibit the development of obesity, and thus protect the patient against developing other serious diseases, against disability, dependence on the care of other people and death. The aim of the surgery is to bring the weight reduction to a safe level and keep it as long as possible. To achieve this, a whole team of specialists is needed for the treatment and care of the patient.

- Multidisciplinary teams are nothing new in Polish medicine. The first ones were created to treat oncological patients. This solution is used in therapeutic areas with high expenditure and socially sensitive, e.g. in the treatment of obesity - reminded prof. dr hab. Radosław Oczwuk, National Consultant in the field of Anaesthesiology and Intensive Therapy, another guest of the conference en titled "Faces of Polish Bariatry - New Horizons."

In a modern approach to surgerybariatric, the so-called the multidisciplinary bariatric team consists of: surgeon, anesthesiologist, dietician, psychologist, physiotherapist and nurse. What roles do they fulfill? Briefly, it is as follows. The surgeon refers the patient to consultations, monitors the course of preparations, performs the operation and guides the patient after the procedure. The anaesthesiologist checks whether the patient is physically, dietarily and psychologically prepared for the operation, anesthetizes the patient, monitors the course of anesthesia, and watches over the patient after the procedure.

Problem

Do you know that: - approx. 30 percent primary care physicians have never been referred for bariatric surgery. - about 81 percent GPs do not know any indications for bariatric surgery. - about 75 percent GPs do not know about the methods of bariatric surgeries.

The scope of activities of a dietitian, psychologist and physiotherapist also varies depending on the stage of bariatric treatment. Before the operation, the dietitian assesses the patient's diet, determines an appropriately selected individual reduction diet leading to the required weight reduction, and after the surgery he monitors its progress and helps to change the diet depending on the treatment progress. Psychologist incl. prepares the patient emotionally for surgery, detects mental diseases and eating disorders that could influence the decision about surgery and the correct course of treatment after it, as well as helps in their treatment, supports the patient in a permanent change of eating habits. The tasks of the physiotherapist include helping the patient to increase physical activity before surgery to increase the efficiency of his body and at the same time support weight reduction, as well as activate him or her physically right after the surgery, during the most important, first year after surgery and at further stages of treatment.

The nurse's views are of no less importance in the multidisciplinary bariatric team. Both at this initial stage of informing the patient about collecting the necessary documents, everyday items necessary during the stay in the hospital, preparing the patient for surgery, etc., but also after the procedure. It is the nurse who deals with administering medications, dressing postoperative wounds, supporting rehabilitation, but also educating the patient about further treatment after surgery.

If we were to cure obesity from being overweight …

It wouldn't be that many obese patients requiring surgery. This is one of the main conclusions that were heard during the expert debate on the coordinated obesity treatment system in Poland. The panel that concluded the Multidisciplinary Conference en titled "Faces of Polish Bariatry -New Horizons". led by Dr. Małgorzata Sobotka-Gałązka, Director of the Institute of He althcare Management at the Lazarski University.

What legal and organizational solutions should be implemented in the Polish he althcare to effectively treat obesity? According to prof. dr hab. Magdalena Olszanecka-Glinianowicz, President of the Polish Society for Obesity Research, advocate of introducing the obesity specialist specialization in Poland, it is necessary to educate primary care physicians in the treatment of obesity in the first stages of the disease development - overweight, obesity 1st and 2nd degree, and specialists supporting: dieticians, psychologists and physiotherapists. In the opinion of prof. Krzysztof Paśnik, we need to create bariatric reference centers in Poland that would provide obese patients with comprehensive treatment and care.

- We only hope that "obesity treatment centers" will treat obesity patients, not obese people from all other diseases. So that instead of a system integrating people with obesity into the he alth care system, we do not create a "medical ghetto" for one group of patients - warned Magdalena Gajda from the OD-WAGA Foundation.

Photo: Medtronic Polska press materials

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.

About the authorMagdalena Gajda A specialist in obesity disease and obesity discrimination of people with diseases. President of the OD-WAGA Foundation of People with Obesity, Social Ombudsman for the Rights of People with Obesity in Poland and a representative of Poland in the European Coalition for People Living 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.

OD-WAGA Foundation

Category:

Obesity