Obesity is due to excess nutrients in the body, resulting in excessive accumulation of body fat. This state can be influenced by a variety of factors such as genetics, environment, diet, and lifestyle.
In 2013, the American Medical Association officially recognized obesity as a disease. Body mass index (BMI) is usually used as a criterion for determining obesity.
Studies have confirmed that obesity, as a metabolic disease, is associated with the occurrence of more than 200 chronic diseases, such as diabetes, hypertension, stroke, coronary heart disease, obstructive sleep apnea syndrome, osteoarthritis, etc., and can increase the risk of many cancers including colorectal cancer and esophageal cancer.
Obesity can also cause harm to mental health, leading to the occurrence of mental illnesses such as depression, bulimia and anxiety.
General weight-loss methods include lifestyle intervention (strengthening exercise and diet management), drug therapy, etc., but all of them have limitations such as long treatment time, difficult maintenance, and easy rebound, which often lead to weight loss failure.
Bariatric surgery is considered the most effective treatment for patients who are obese or obese with comorbidities.
Bariatric surgery refers to the use of surgery to reduce gastric volume and gastrointestinal absorption or change the redistribution of gastrointestinal hormone levels, and to achieve the purpose of reducing body weight and alleviating obesity complications by restricting nutrient absorption or regulating metabolism, so the exact name should be "bariatric metabolic surgery".
Bariatric surgery was first started in 1953, when it was basically open surgery, which was invasive and risky, and was not widely promoted.
In recent years, with the widespread use of laparoscopic techniques, bariatric surgery has developed rapidly, with extremely less invasiveness, better and better safety, and lower mortality rates than cholecystectomy and hysterectomy.
Bariatric surgery is currently recognized as the only treatment that can achieve long-term effective weight loss, and the results can be maintained for more than 10 years.
Bariatric surgery can reduce body mass index while alleviating the incidence of diabetes, hypertension, non-alcoholic fatty liver disease, obstructive sleep apnea syndrome and other diseases, and the most important thing is to reduce the obesity-related mortality rate by 30%~40%, and improve the quality of life of 95% of patients!
If you're an obese patient, just ask if you can move your mind?!
In the United States, the number of obese patients undergoing bariatric surgery has increased from 30,000~40,000 to about 200,000 per year. In 2000, laparoscopic minimally invasive bariatric surgery was introduced to the mainland, and by 2023, more than 35,000 bariatric surgeries have been performed in the mainland.
However, I don't have to be fat for me to have bariatric surgery. In order to succeed, doctors must practice basic skills, and patients must choose indications.
For patients with simple obesity, the Chinese Guidelines for the Surgical Treatment of Obesity and Type 2 Diabetes Mellitus (2019 Edition) proposes the following indications for surgery:
BMI ≥37.5，建议积极手术；
32.5≤ BMI <37.5，推荐手术；
27.5≤ BMI <32.5, difficult to control with lifestyle changes and medical treatment, and at least 2 components of metabolic syndrome, or other diseases, surgery can be considered after comprehensive evaluation;
Waist circumference ≥ 90 cm for ≥men and 85 cm for women, with reference to imaging examination showing central obesity, the surgical recommendation level can be increased as appropriate after extensive consultation by the multidisciplinary team;
The recommended age for surgery is 16~65 years old.
The two most commonly used bariatric surgeries are laparoscopic gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). Clinical studies have shown that the weight loss results of both types of surgery are comparable.
The vast majority of obese patients with metabolic syndrome may choose to undergo sleeve gastrectomy, such as hiatal hernia (HH), and it is recommended to repair the hiatal hernia at the same time during surgery, or to switch to gastric bypass. Gastric bypass is recommended as a preference for the following patients:
Patients with moderate to severe gastroesophageal reflux disease, especially those whose symptoms are not relieved or do not remission significantly after the application of antacids;
Patients with type 2 diabetes mellitus, especially those with a long history or poor islet function;
Patients whose primary purpose is to treat type 2 diabetes;
Super obese patients.
In patients with precancerous gastric lesions, or in cases with a family history of gastric cancer, gastric bypass should be carefully chosen.
Within 8~12 months after bariatric surgery, patients can lose weight rapidly. However, if the patient also maintains a lifestyle of overeating and physical inactivity, the weight will regain over time.
Therefore, the real weight loss effect is inseparable from the cooperation of lifestyle habits, such as a healthy diet and moderate exercise.
Remember: the purpose of losing weight is not to drop the scales, but to make us live healthier.