Obesity and bariatric surgery: what you need to know
Obesity is a chronic, serious and debilitating disease. Excessive body weight causes significant physical and psychological changes, and often significantly affects the lives of those affected
Energy and the desire to move diminish with every kilo that is added to the body, which is also due to the difficulty in performing movements.
And so, even a walk or playing with one’s children can become difficult due to significant sweating, shortness of breath and pain.
And that’s not all: as numerous studies have shown, it is closely linked to diseases such as diabetes, heart disease, hypertension and cancer.
The good news, however, is that obesity can also be treated with bariatric surgery.
The important thing is to rely on centres with solid experience and specific expertise in the field.
The risks of obesity
Obesity is not only a disease in itself, as is now recognised, but in turn can promote the onset of other diseases.
Excess weight overloads the joints and spinal column, leading to major diseases of the osteo-articular system in the long run.
In addition, it affects sleep, leading to the so-called ‘obstructive sleep apnoea syndrome’, characterised by numerous micro-awakenings of which one is unaware, but which lead to significant fatigue as soon as one wakes up in the morning.
As a result of obesity, serious metabolic diseases also develop that easily become chronic and are difficult to solve with medical therapy
Hypertension, cardiovascular diseases and diabetes mellitus are just some of the most important diseases that are favoured and aggravated by obesity.
Finally, those who suffer from morbid obesity have an increased risk of developing neoplasms (colon, breast), gastro-oesophageal reflux (associated with 30% of patients), urological, dermatological and psychiatric problems.
When diets and drugs are not enough: bariatric surgery
Bariatric surgery or obesity surgery now offers the possibility of achieving weight reduction in patients with morbid obesity resistant to medical, pharmacological, and dietary treatments.
The weight loss achieved with this type of surgery brings about a major change in the patients’ lives.
In addition to fostering an important improvement in the perception of one’s own image, with all the associated psychological benefits, it reduces the risk of developing and aggravating related pathologies.
Particularly in the case of diabetic patients, surgery has been shown in several studies to be more effective than medical therapy alone.
This is why, in the presence of morbid or complicated obesity, the only therapeutic solution is bariatric surgery.
Obesity, when bariatric surgery is indicated
According to the directives of the American Metabolic and Bariatric Surgery Society and the Italian Society of Obesity Surgery, bariatric surgery is only indicated when the patient presents severe morbid obesity, i.e. that form of obesity with a body mass index (BMI or BMI) >40 or when it is between 30 and 39 and is associated with at least 1 major obesity-related pathology: arterial hypertension, diabetes mellitus, sleep apnoea, joint pathologies, etc.
The age of patients eligible for surgery ranges from 18 to 68 years.
Surgery can only be considered in patients with a BMI between 30 and 35 and in patients over 65 years of age if it is approved by a special multidisciplinary team, made up of various professional figures (anaesthetist, surgeon, internist) who, after ascertaining the presence of a reduced quality of life due to obesity and the presence of resulting comorbidities, assess the risk-benefit ratio of the surgical procedure and give the go-ahead for the operation.
Contraindications for the operation are: severe heart failure, unstable angina, terminal pulmonary disease, cancer in active treatment, portal hypertension, alcohol/drug dependence, cognitive impairment.
The preoperative pathway
Of great importance, in view of bariatric surgery, is the pre-operative course, which is fundamental in order to study the patient so as to be able to choose the most suitable surgical procedure, to know his current state of health, to assess the possible presence of misdiagnosed pathologies and to prepare him in the best possible way.
During the pre-operative course, the patient is assessed by several specialists with experience in the field of bariatric surgery.
It is thanks to the collaboration of these different figures both preoperatively and postoperatively that bariatric surgery finds its source of success.
The multidisciplinary team that assesses the patient who is a candidate for bariatric surgery consists of:
- surgeon;
- anaesthetist;
- cardiologist;
- psychologist;
- dietician.
Psychological examinations can detect elements of absolute contraindication to surgery: psychosis, including schizophrenia, drug addiction, frank alcoholism, previous sexual violence, instability in the couple’s or marital relationship, and previous suicide attempts are elements that prevent surgery.
The dietary examination serves to clarify the time and manner of onset of the obesity condition, its course over time, the duration of periods of remission, the appearance and severity of relapses.
A further element is the prominence of the coincidence of eating disorders, and in particular binge-eating, influencing the choice of surgery.
Based on the results of routine blood tests and instrumental evaluations performed (gastroscopy, manometry, abdominal ultrasound, polysomnography) additional evaluations by other specialists, such as the endocrinologist, gastroenterologist/hepatologist, pulmonologist, psychiatrist, may also be required.
The intertwining of different professional figures is indispensable for the correct assessment of the patient, the confirmation of the surgical indication and the choice of the most effective diagnostic-therapeutic strategy, taking into account that every qualified centre has at least one restrictive, mixed or malabsorptive intervention in its baggage.
In patients with gastro-oesophageal reflux symptoms or the presence of oesophagitis, an oesophageal manometry is also performed at the gastroscopy to assess the pressure of the valve between the oesophagus and stomach (LES or lower oesophageal sphincter).
This examination is crucial for the choice of surgery in order to also treat gastric acid reflux.
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