Surgical treatment of obesity

Obesity is a chronic, lifelong, multifactorial, genetically conditioned, life-threatening disease caused by excessive accumulation of fat in the body, leading to serious medical, social and economic consequences (definition of the International Federation of Obesity Surgery, 1997).

The accumulation of excess fat in the body goes only through food.

Currently, for reasons related to obesity, about 300 thousand Americans die per year. Persons aged 25 to 35 years who suffer from morbid obesity die 12 times more often than their normally weighted peers, and those aged 35 to 45 years are six times more likely. The increase in body weight by only 0.4 kg increases the risk of death by 2% in persons aged 50 to 62 years.

Obesity contributes to the development of cancer of the uterus, mammary glands, colon, prostate. It leads to a decrease in physical and mental capacity for work, causes severe psychological discomfort, the development of depressive states. Some of the problems that patients face in connection with obesity do not fit into the medical diagnosis, but they constantly prevent them from feeling full-fledged in society and lead an active lifestyle. In especially severe cases, patients become deeply disabled, unable to perform even elementary actions.

There is, it would seem, a simple formula, the pursuit of which will certainly ensure the result in the fight against excess weight: “Less eat and move more.” It works only if the formula is adhered to consistently and unconditionally.

The accumulation of energy “in reserve” in the form of fat deposits in highly organized living beings is programmed in the course of a long evolutionary process. The so-called “saving genotype” allowed our distant ancestors to survive in the difficult conditions of prolonged starvation and wars. Nowadays, in civilized countries where the majority of the population has free access to food, the process of accumulation of excess body fat in genetically predisposed individuals (and such majority) acquires a continuously progressive nature. Many find it difficult to resist the temptation to eat well and tasty. Food is the most important, natural source of pleasure, stress relief (there is even the concept of “eating stress”). With a continuing habit of frequent overeating, especially high-fat fatty foods with a sedentary lifestyle, the predisposition to obesity becomes obvious.

Available in the arsenal of non-surgical methods of treating obesity give a temporary effect.

Medication for obesity

Despite a large number of drugs and nutritional supplements, recommended including. and in the media, today two types of drugs are widely used.

The drug is a central action aimed at suppressing the appetite (Meridia). Treatment with the drug “Meridia” should be performed by a specialist therapist, taking into account possible limitations and contraindications to treatment.

The drug “Xenical“, whose action is aimed at reducing the absorption of edible fat in the intestine. “Xenical” prevents the assimilation of up to 30% of food fat coming from food, so you need to keep in mind the high likelihood of diarrhoea (sometimes quite pronounced) against the background of taking the drug.

Dietary methods include treatment with balanced low and ultra-low calorie diets.

Psychotherapeutic methods of influence are aimed at the formation of negative emotions (feelings of fear) for the abuse of food with increased energy value (motivated emotional suggestion).

The purpose of reflexotherapy is to influence reflexogenic zones by acupuncture, which in the end is intended to contribute to a decrease in appetite.

The goal of surgical treatment is to significantly reduce the weight of the body by influencing the course of obesity-related diseases, to improve the quality of life, and to postpone the threat of premature death. The main advantage of surgical methods of treatment before nonsurgical is their resistance (weight loss after surgery is lifelong). Over time, a new quality of life is formed in the operated patients, restoring work capacity. It is no coincidence that many of them compare the effect of surgery with a second birth, a return from non-existence.

Absolute contraindication to surgery is:

  • Exacerbation of peptic ulcer of the stomach and duodenum;
  • Pregnancy;
  • Alcoholism, drug addiction, severe mental illness;
  • Oncological diseases;
  • Severe irreversible changes on the part of vital organs.

The age of patients (less than 18 years old and over 60 years old) is considered a relative restriction. The surgical and anaesthetic risk in patients with severe forms of obesity always exists, and it is higher, the greater the initial weight of the body and the heavier the obesity-related diseases. Surgical treatment of obesity should in no case be replaced by the concepts of “abdominoplasty” and “liposuction”. These operations are used in cosmetology and plastic surgery to eliminate the defects of the figure, but not for the treatment of obesity. Operations used to reduce body weight (bariatric operations) are operations on the organs of the digestive tract, which result in either a significant reduction in the amount of food consumed or limited absorption in the intestinal tract.

Surgical methods for treating obesity are known since the 50s of the 20th century. Today all types of presented operations are performed both in the open way and using less traumatic laparoscopic methods, i.e. through several small punctures on the abdominal wall.

This is one of the minimally invasive methods of reducing body weight, quite common in Europe. By complexity, this technique is comparable to conventional gastroscopy. In this case, under the control of the endoscope, a balloon specially designed for this purpose is placed in the stomach, which is filled with 400-700 ml of liquid and remains in the lumen of the stomach. The removal of the balloon is a somewhat more complicated procedure, requiring the application of a gentle anesthesia.