OBESITY: WHEN DIETING ISN’T ENOUGH
More than 19 million people in Egypt suffer from OBESITY, of which 2% is of pathological cases. Surgery may be successful in 60-80% of cases. LAPAROSCOPIC SURGERY is one of the most innovative techniques.
Author Dr. Davide Maged; MSc, PhD in Biomedical Science and Public Health, Department of Public Health, Faculty of Medicine, università cattolica del sacro cuore Roma (Italy).
Obesity is a topical problem. There are more than a billion obese people in the world with a mortality rate of over 2,5 million deaths per year, three times more the number of deaths caused by colon and breast cancer combined together.
Such a problem affects many countries around the world. From the West where the United States has long occupied the first position to the East with China where bicycles have been replaced by cars and Oceania where fast food has recently spread; thus identifying some of the most important causes of obesity: a sedentary lifestyle and poor nutrition even in childhood.
There are many ways to classify the degree of obesity; the simplest and most used is the Body Mass Index (BMI) given by the ratio between weight expressed in kg and body surface area expressed in meters per square. There is a moment in the life of the obese person when something changes. It is the perception that those extra pounds change the quality of his life because of physical limitations, which, in turn, affect the personal psychological, socio-employment, and relational sphere.
This often leads to a vicious circle that, unfortunately, leads to increasing degrees of obesity, resulting in a series of diseases, involving various systems, worsening the health condition.
The inevitable consequence is a significant reduction in life expectancy, which today, for normal body weight, is about 80 years; for obese individuals, it is reduced to about 65 years, so almost a quarter in less years to live. The medical diet therapy of obesity, although supported by an adequate and valuable psychological support treatment, while obtains considerable success in the short term sometimes, in the long term, rarely sees consolidated results.
To date, the success rate of any type of medical therapy for the most serious cases is less than 5%, and this percentage decreases with BMI above 35. Surgery achieves satisfactory results in 60-80% of cases with a 90% reduction in mortality.
The advent of laparoscopic surgery has then profoundly changed the scenario; the concept of mini-invasiveness has imposed itself in the world of surgery and, above all, in the patients’ life for the greater comfort offered by this kind of surgery. Less post-operative pain, early mobilization, and faster functional recovery are objectives for all surgery and for all types of patients, but even more for the obese one for whom prolonged bedding is in itself a complication for the respiratory and cardiovascular problems that may arise.
Laparoscopic bariatric surgery represents a proper resource to treat severe obesity, and this was officially recognized by a European Consensus Conference in 2004 and by an American Consensus Conference in 2005 with the codification and development of the surgical technique for the various types of universally recognized and accepted bariatric interventions, which are essentially divided into three types: restrictive, metabolic, malabsorptive.
Depending on the patient’s needs, the restrictive method is proposed with the now consolidated use of the positioning of the adjustable gastric bandage, or the metabolic intervention of gastric bypass, or the malabsorption intervention of bilio-pancreatic diversion.
For some time now, sleeve gastrectomy has been considered as an alternative restrictive intervention in particular cases to be adopted as a first step with the possibility of continuing in a second phase towards the metabolic intervention of gastric bypass or towards the malabsorption intervention of pancreatic biliary diversion duodenal switch. Only the knowledge and awareness of the existence of these methods makes the patient free to “get advice from the Specialist” and make an informed choice when the clinical condition requires a resolution.