METABOLIC SURGERY

Obesity, vanity and disease

Obesity is a major risk factor for many medical conditions; especially type 2 diabetes and coronary heart disease. It is for this reason that obesity is now identified as a major public health issue. If it was not for its substantial impact on health, rather than its mere cosmetic importance, obesity would not be on the public health agenda, would remain in the glossy, vanity magazines and would be the subject of dubious commercial medical practices, as it was 30 years ago.

Despite the contradictory opinions regarding the status of obesity as a social, versus a medical, condition, the World Health Organization (WHO) has already designated obesity as a disease, and its prevalence to be of epidemic proportions. Obesity and related conditions fall into the category of ill-health defined by WHO as non-communicable diseases (NCDs) and avoidable chronic diseases.

It is now formally defined as a disease of a ‘classic’ type, being a physiological debilitation and malfunction. However WHO is keen to point out that obesity is also a lifestyle disorder, having social and psychological ramifications, and thus connotations for management.

METABOLIC SURGERY FOR OBESITY

Obesity is a highly visible public health problem. We see it on the high streets, in the shopping malls and in the restaurants and, as the numbers in the population classified as overweight or obese become more common, we sadly seem to be getting immune to it. But becoming immune cannot be a solution; complacency will only serve to further increase the costs of too many people carrying too many pounds of unnecessary body fat for too many years of their lives. For developed nations, and for many developing nations too, obesity and its consequences are possibly the biggest public health problem they face as we reach the end of the first decade of the 21st century. Cigarette smoking still remains a significant cost to health but obesity is quickly outpacing smoking as the number one cause of morbidity and mortality; in addition it proves to be a considerable resource burden on already overstretched healthcare systems. In 40 years time if nothing is done, and the 20% of the population who are now obese turn into 50% of the population, then the consequences will indeed be dire as our healthcare systems, as currently constituted, will simply become bankrupt trying to cope.

Yet, since humans must eat to live, obesity, and its resolution, has proved to be a stubborn public health challenge. For most, getting fat is seen as a natural part of life; adding a few pounds year by year is the expectation of the public. Often weight gain and the change in body shape associated with it is seen as a cosmetic problem rather than a threat to health. As a consequence, motivation to change lifestyle to lose weight for health reasons is often lacking. Ironically weight loss for cosmetic reasons has been turned into a global multi-billion dollar industry with an emphasis on weight loss methods that have more to do with vanity and commerce than improving health. There is herein an interesting paradox. For example, health gyms in the US are now more popular than they have ever been, yet this is at a time when 50% of individuals in the US population are moving towards an obese classification in their BMI measurements.
A solution to the obesity problem, and a reduction in its consequential morbidity and mortality, will only be arrived at through the concerted efforts of governments, other agencies and businesses, communities, the family unit and individuals themselves and  The Metabolic Surgery to treat  this problem of obesity.

METABOLIC SURGERY

To understand the influence and impact of bariatric surgery, it is useful to assess the field periodically worldwide, at least every 5 years. More precisely, now that bariatric surgery has been recognized to be metabolic surgery, it is the state of metabolic/bariatric surgery that needs to be examined. The procedures for weight loss, whether designated as restrictive, restrictive/malabsorptive, malabsorptive, and others, or neuro-hormonal. We define metabolic surgery as the operative manipulation of a normal organ or organ system to achieve a biological result for a potential health gain.

 Metabolic Surgery is the most powerfully treatment of Diabetes Mellitus...

Metabolic Surgery as a Treatment of Diabetes type 2

Surgery for type 2 diabetes

 

The management and prevention of diabetes through lifestyle modifications and weight loss should be the mainstay of therapy in appropriate candidates. Althought over 95% of patients are unable to achieve and maintain any significant weight loss over time. Bariatric surgery for weight loss is an emerging option for more sustainable weight loss in the severely obese subject, especially when obesity is complicated by diabetes or other co-morbidities.

 

Following bariatric surgery most subjects experience improvements in diabetes control, hypertension, dyslipidemia, and other obesity-related conditions.

In patients with impaired glucose tolerance most studies report 99–100% prevention of progression to diabetes, while in subjects with diabetes prior to surgery, resolution of the disease is reported in 64–93% of the cases.

Reports in the literature on outcomes of bariatric surgery for the treatment of obesity demonstrate accumulating data which indicates not only considerable and sustained weight loss following this type of intervention, but also the associated resolution of obesity-related complications, such as type 2 diabetes, hypertension and dyslipidemia.

Bariatric surgery appears to be an effective and beneficial intervention in  patients with diabetes, when medical and nutritional approaches have failed to achieve the desired outcomes. This becomes especially true when metabolic control in these individuals has not been achieved despite aggressive medical therapy. In addition, in obese individuals with pre-diabetes, weight loss through the bariatric approach is clearly an extremely effective intervention to prevent progression to diabetes.

The term bariatric surgery collectively describes the surgical procedures intended to induce weight loss directly, and which are used in the management of obesity and its comorbidities.
Bariatric procedures can prove highly clinically effective, and also cost-effective, and may achieve long-term sustained weight loss and consequent improvement in health and global risk. The surgical management of obesity is a crucial, and increasingly prevalent facet of weight management, and in many people is the only effective method by which a sufficient quantity of weight can be shed,  for such people it is a vital  method of improving health and quality of life. The latest advances in surgical techniques have produced safer, more effective and more cost-effective operations.

La cirugía bariátrica se ha convertido en el patrón de referencia del tratamiento de estos pacientes. En la última década hemos asistido a un verdadero auge en la práctica de la cirugía como alternativa eficaz en el tratamiento de la obesidad a medio y largo plazo.

La obesidad, considerada como el exceso de peso a expensas del tejido adiposo, habitualmente se clasifica, atendiendo al índice de masa corporal (IMC), como la relación del peso (kg) dividida por el cuadrado de la talla (m). La OMS y las sociedades científicas consideran que existe obesidad cuando el IMC es ≥ 30 kg/m2, y obesidad mórbida cuando el IMC es ≥ 40 kg/m2.

Comparados con los adultos con peso normal, aquellos con obesidad mórbida presentan mayor riesgo de padecer diabetes, hipertensión arterial , hipercolesterolemia, asma , artritis  y mala calidad de vida . En relación con el cáncer, en EE.UU. la obesidad es responsable del 14% de todas las muertes por cáncer en hombres y del 20% en mujeres. Pero la Obesidad Morbida es responsable de un incremento del 52% de la tasa de mortalidad en los hombres y del 62% en las mujeres respecto a sujetos con normopeso.
La asociación de Obesidad Morbida con otras neoplasias es sensiblemente superior en el caso de la OM, como sucede con el cáncer de útero  y mama en la mujer y con el cancer en el higado en el hombre.

La obesidad se está convirtiendo en un problema de salud Publica de primera magnitud debido al rápido crecimiento de esta patología en los países occidentales y a las dificultades que entraña tanto su prevención como tratamiento. La obesidad es responsable directa del incremento progresivo en la incidencia de diabetes mellitus tipo 2, resistencia a la insulina, hipertensión arterial o dislipemia, factores que incrementan el riesgo cardiovascular. La obesidad se acompaña también de un aumento del riesgo de padecer otras comorbilidades que merman la capacidad física del individuo: síndrome de hipoventilación y trastornos respiratorios del sueño, reflujo gastroesofágico, colelitiasis, hígado graso, degeneración articular, disfunción hormonal femenina(amenorrea, infertilidad e hirsutismo), incontinencia urinaria y diferentes tipos de neoplasias (próstata, colon, mama, útero…), entre otras