According to the World Health Organization, in the developed countries of Europe, from 45% to 70% of residents are overweight (relative to the United States, this figure is even higher). In Russia, despite the fact that the standard of living is lower there, over 60% of residents are overweight, and 20-30% have severe symptoms of obesity.
In the Republic of Belarus, over 30% of the country's population are overweight and obese. Obesity is not only a medical, but also a social problem. It is sad, but this disease is an inseparable companion and a direct result of technological progress.
Hypodynamia, stress, poor ecology and, paradoxically, abundant, high-calorie, what we usually call "quality", nutrition – all these factors often lead a person to overweight, and sometimes to extreme obesity.
Types of obesity. Surgical treatment: indications and contraindications
What types of obesity surgeons treat?
In about 2-6% of adults obesity takes on forms that are dangerous to health and life. This is the so-called "morbid" obesity, i.e. obesity, combined with other diseases (arterial hypertension, diabetes mellitus, diseases of the joints, spine, veins of the lower extremities, respiratory failure, coronary heart disease and a number of other diseases). The danger of morbid obesity is obvious: the life expectancy of such patients is reduced by an average of 12-15 years, and the mortality rate of patients between the ages of 25 and 35 is 12 times higher than that of their peers with normal body weight.
Indications for surgical treatment
Surgical treatment can be offered to patients in whom:
1) Attempts to reduce body weight by conservative methods did not bring a positive result.
2) Overweight is more than 45-50 kg, compared with the norm;
Body mass index (BMI) over 40 kg/m2
3) There are other diseases associated with excess body weight
In the presence of serious diseases associated with obesity (arterial hypertension, type 2 diabetes mellitus, sleep apnea syndrome), surgical treatment can also be offered to people with a body mass index of more than 35 kg/m2
Surgical treatment is carried out at any age over 18 years
Surgical treatment is not performed to patients suffering from:
- Severe mental illness
In smokers, the risk of developing of postoperative complications is increased. Patients with severe cardiac and respiratory failure may need preoperative, rather lengthy preparation.
There are 3 directions of surgical treatment of obesity:
- Restrictive operations – gastric ballooning, gastric banding
- Shunt operations – accelerate the passage of food through the gastrointestinal tract (ileo-shunting operations)
- Combined operations – a combination of restrictive and shunt operations
The choice of operation should be strictly individual!!!
How long does weight loss occur?
The most intense weight loss occurs during the first six months after surgery, then it gradually slows down. On average, the period of weight loss is from one and a half to two years. By this time, the patient has already formed a certain stereotype of eating behavior, habituation to a new power mode.
What is this mode?
For example, with a three-time power mode, the amount of food at one time is reduced to 100-150 milliliters, regardless of whether it is solid food or liquid. It is imperative to develop the habit of stopping food intake as soon as a feeling of fullness appears. Even one extra sip can cause vomiting, a feeling of pressure behind the sternum, pain.
It is equally important to chew food thoroughly while eating, as large, not chewed pieces of it can cause blockage of the exit from a small part of the stomach and the same unpleasant sensations. When eating, it is recommended to use a teaspoon, paying attention to the taste of the food.
Thus, the duration of each meal increases to 30-40 minutes. It is practically impossible to adhere to these recommendations in full for an unoperated patient suffering from grade 3-4 obesity, while a patient who has undergone the surgery does this every day. Gustatory preferences also change: many patients cease to love meat and flour products, sweets.
Most patients tolerate painlessly the transition to a qualitatively new power mode and relatively quickly get used to it. Each operated patient is given a special memo.
It is very important to know for the operated patient:
After any surgery for morbid obesity, the patient should be followed up by a specialist for life. Sometimes in the long term it may be also necessary to carry out diagnostic and therapeutic procedures.
During the first year after surgery, monitoring is carried out every three months. The dynamics of body weight loss, the course of the diseases that the patient suffered before the operation are evaluated. After stabilization of body weight, control examinations are required annually.
Risks associated with the surgical treatment of obesity
What is the risk of the operation itself, if we take into account the presence of concomitant diseases?
The risk of any operation for patients with severe forms of obesity exists, and the greater the initial body weight and the more severe the diseases associated with obesity, the higher it is. At the same time, determining the indications for surgery, we proceed from the risk to the health and life of the patient without such an operation.
The approach to assessing the degree of risk for each patient is strictly individual. Especially severe ill before surgery may be recommended preliminary treatment aimed at reducing body weight.
Is there a risk of exhaustion due to excessive weight loss?
After any operation, body weight, as a rule, stabilizes on numbers slightly exceeding ideal indicators for a given patient. Subject to the necessary recommendations and sufficient physical activity of the patient for one and a half to two years body weight can come close to ideal characteristics.
If the rate of weight loss exceeds average, a specialist consultation is necessary. The appearance of vomiting after each meal and liquid should serve as the basis for immediate consultation, as in addition to exhaustion, in this case there is a risk of unwanted metabolic disturbances.
Fortunately, in our practice, cases of excessive exhaustion of the operated patients were not observed.
What are the cosmetic consequences of such operations?
Significant weight loss as a result of surgery can lead to the formation of skin-fat folds on the anterior abdominal wall, buttocks, shoulders and hips. In some patients, such folds, especially on the anterior abdominal wall, reach significant sizes, which creates inconvenience in everyday life and causes back pain.
These effects are relatively easily eliminated by surgery after completion of weight loss. If the patient intends to achieve a more complete cosmetic effect, plastic surgery can be performed in several stages.