Surgical treatment of obesity

Surgical treatment of obesity

Professor Mariusz Wyleżoł
Bariatrics Consultant

Obesity is a serious condition involving excessive accumulation of adipose tissue (fat). Not only does it lead to numerous complications that affect the quality of life, but it also contributes to significant reduction in life expectancy. The disease is often the underlying cause of various personal traumas related to the widespread discrimination of obese patients and their non-acceptance. This is often reflected in the impossibility to find a loving relationship or have children. Studies show that obese patients are also discriminated in their professional life, which results in limited opportunities to find a job or get a promotion.

From the medical point of view, obesity is caused by disorders in the neuro-hormonal regulation of food consumption in the form of excessive secretion of orexigenic agents (leading to excessive consumption of food) and reduced secretion of anorexigenic agents (which leads to delayed sense of satiety or even its complete absence). The above pathological changes are often followed by excessive food consumption, leading to a positive energy balance and accumulation of excess body fat. However, it should be noted that obesity does not necessarily have to result from excessive consumption of food, because when the thermogenesis (heat generation) is limited, an individual will also develop a positive energy balance even if food consumption stays at the same level. Over the past years, the role of intestinal bacteria in the development of obesity has gained increasing attention. They may contribute to the digestion and absorption of nutrients which are often considered as deprived of energy values. As a result, our body can also utilise these seemingly unavailable sources of energy. A crucial role in the development of obesity is also played by our life style, which is so much different from that in which out biological mechanisms were shaped.

In Poland, excessive body mass is currently diagnosed in more than half of the adult population. Every fifth adult Pole suffers from obesity. What is also alarming are the studies conducted amongst children and adolescents, which indicated that every fourth individual in this age group is affected by excessive body mass.

There is no doubt that we all should take care of our health, including proper body mass. However, when we gain excessive weight, we should undertake intense actions to reduce it. In the first place, such actions boil down to the verification of our eating habits and life style. However, in many cases the disease continues to develop and may become autonomous, meaning that we will not be able to influence its course and progression. When obesity develops, we can start taking medicines, whose range and efficacy are still very limited. The costs of pharmacological treatment of obesity are also very high and range from a few hundred to a few thousand zlotys per month.

One should be aware that obesity as a disease develops in a deceitful manner. At the onset, our body produces adaptive mechanisms and we often do not see how devastated our body becomes due to this disease. In the meanwhile, obesity sufferers develop the related complications. These, in particular, include: type-2 diabetes, arterial hypertension, degenerative joint lesions and many others. Extensive scientific evidence also indicates that the incidence of malignancies is common amongst obese patients. British studies revealed that cancers are 40% more common in obese women compared to female patients with proper body mass.

It often appears that, despite the fact that obesity could be defined as the most easily identifiable disease, it is at the same time the most difficult condition to treat. Not only are all the efforts to reduce body mass ineffective, but they indeed lead to degeneration of the disease.

In such cases, it is worth remembering that modern medicine is able to relieve helpless patients through surgical treatment of the most advanced stages of obesity, or the so-called morbid obesity. Morbid obesity is currently defined on the basis of the so-called body mass index. For example, a person measuring 160 cm in height will be diagnosed with this condition when the body mass reaches 102 kg, and a person measuring 170 cm - when the mass is 116 kg. In exceptional cases, when obesity has already caused other complications (some of which have been mentioned above), the surgery is indicated also for less heavy patients. Needless to say, the surgical treatment of obesity, like every other surgery, bears the risks of complications, both early and late, with such a risk being similar to that during cholecystectomy (gallbladder excision). However, numerous studies demonstrated that, in the case of many patients who experience constant progression of the disease through increasing body mass, development of obesity-related complications or disability, surgical treatment may be considered as a life-saving procedure which is currently the only method with proven therapeutic efficiency. Thanks to the progress over the recent years, the above-mentioned surgery is performed using minimally-invasive (laparoscopic) methods. They involve the introduction of anatomical changes within the gastrointestinal tract, which frequently restore proper functioning of the disturbed mechanisms of the body’s energy balance, thus leading to the reduction of body mass and – most importantly – to the regression of numerous pathologies related to the disease. Whether or not to undergo surgical treatment of obesity should always be an informed decision. While taking this decision, we should ask ourselves not only about the risk of the treatment, but also about our resignation in order to think what will happen to us in one, two or five years if the disease is not controlled. Sometimes, all we need to do is look back into the not so distant past and realise what has happened over the last year or two, that is to say how much weight we have gained and whether we are able to stop the progression of the disease in any way. Answering such basic questions may often help us make the decision. It is also important to remember to talk about it with our nearest family and consider their opinion while making the decision. However, the opinion of our family should not be egoistic and ought to take into account, above all, the risks arising out of further progression of the disease and the threats to the patient’s life.

Bariatric surgery cannot be performed “off-the-cuff”. It should be preceded by adequate preparation, examinations (usually requiring hospitalisation) and, quite often, a preparatory surgical procedure before the final surgery. It involves a temporary insertion of a gastric balloon to achieve initial reduction of body mass and, as a result, the possibility of performing the surgery in a safe manner.

The decision on the final course of treatment can be made after appropriate examinations and consultation with a bariatric surgeon (i.e. one that specialises in the surgical treatment of obesity).

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