Introduction

The World Health Organization (WHO) has defined obesity as the epidemic of the 21st century, since the figures have tripled in recent decades, with around 2.8 million people dying in the world each year, due to Obesity and overweight. The WHO explains that this occurs because people tend to consume foods that are very high in calories, without increasing energy expenditure at the same time as physical activity, which leads to overweight and, in most cases, obesity.

On the other hand, obesity triggers other diseases such as diabetes, high blood pressure, cardiovascular diseases, psychological disorders, sleep apnea, uterine and colon cancer, among other pathologies that can be fatal.

What is meant by obesity treatment?

It is the one whose purpose is that the patient can lower his Body Mass Index (BMI), and reach and maintain a healthy weight. Along these lines, the treatments can be multiple and vary from a balanced diet according to the nutritional requirements of each person, added to physical activity.

If the patient does not achieve the goals with a lifestyle change, surgery or endoscopic treatments may be necessary. The most common surgery to combat obesity is called bariatric surgery: l surgery gastric sleeve, gastric banding, and gastric bypass surgery.

The endoscopic treatments are the intragastric balloon for 6 or 12 months and the primary endoscopic surgery Obesity (POSE). These therapies carry a lower surgical risk and a lighter postoperative period.

How do I know if I am a candidate for treatment?

ach person is unique, so various treatments are recommended, which will be chosen depending on the level of overweight and health of the patient. Data from the treatment to be followed will depend on the calculation of the Body Mass Index (BMI) of each patient, which can be obtained by dividing the weight in kilograms by the square of the height in meters.

Therefore, Dr. Carlos Sala explains:

If your BMI is between 25-30 you are overweight, which will probably recommend a treatment based on diet and exercise.
If your BMI is over 30-35 it is defined as mild obesity, so the specialist will likely recommend a dietary or endoscopic treatment or surgery if there are comorbidities (two or more diseases present in the same person, or the interaction between two diseases that may worsen).
If your BMI is between 35-40 it is defined as severe obesity. In these cases, endoscopic or surgical treatment is recommended.
If your BMI is over 40 it is defined as morbid obesity and surgery is recommended to treat it.
If your BMI is greater than 50 it is understood as super obesity and it is only treatable with surgery.
A BMI greater than 60 is synonymous with triple obesity and only surgical treatment is recommended for its treatment, depending on the patient’s health status.

How do I choose my doctor?

In the case of having a BMI less than 30, it is best to visit a Nutritionist or Dietitian, a nutrition specialist and controlled weight loss, which will help the patient to follow a dietary pattern according to their nutritional requirements, which are defined according to age, weight, height, general health conditions, among others.

In addition, this professional will take into account how many calories you are used to consuming vs. those you expend during a normal day. You will also have the opportunity to tell him about your lifestyle in general and what are your main preferences when eating. This nutritional plan can also be accompanied by an exercise regimen which will be in charge by a specialist in everything related to physical conditioning, with a personal trainer, who will also take into account several factors before giving you the specifications of your plan.

On the other hand, if the BMI is greater than 35, which is defined as severe obesity, it is best to consult an endocrinologist or specialist, who will review the patient’s medical history to determine the best treatment (endoscopic, surgical, etc) as each case.

For both cases, it is essential that the doctor has the necessary certifications and verify that the professional has the required degrees from a society endorsed in the country where the intervention will be performed.

As much as possible, the patient must investigate, reading references and testimonials from other patients since it will bring him closer to the best decision when choosing the clinic and doctor that will treat his problem.

What is the first appointment with the bariatric surgeon like?

During the first appointment, the doctor will carry out a complete evaluation of the patient, reviewing the clinical history. In addition, it will explain the different types of treatments that exist and which is the one that will best suit the patient according to:

Age
Weight and BMI
Height
Feeding Habits
Chronic diseases
Possible risks
If you smoke or drink

In addition, during this first consultation, the specialist will indicate, according to the type of intervention, what diet the patient should follow, explain all the pros and cons of the treatment, and will give you an estimate of up to how many kilos you will be able to lose.

Finally, he will also ask you for some pre-operative tests to check that there are no diseases related to obesity or some type of contraindication for the chosen treatment.

During this first appointment, we recommend that the patient be accompanied by a family member or friend so that they can jointly present all doubts or comments about the intervention.

How are the main treatments carried out?

There are various treatments to treat obesity. The appropriate one will be chosen depending on the Body Mass Index (BMI) of each patient. If the person is less than or equal to BMIa of 25 will recommend making a nutritional regimen through an assisted diet for a nutritionist who should assess each case, giving a food guide according to the nutritional requirements of each patient.

Likewise, with this personalized diet, the person will also learn to eat healthily, adapting to the needs of each patient, which will become a dynamic and easy-to-carry treatment.

Finally, the Nutritionist must carry out a follow-up every 15 days to evaluate the weight loss. After the treatment with the ideal weight, the specialist will give the patient a maintenance plan. The most important thing in these cases is willpower and commitment.

Types of bariatric surgery

Experts = explain that people who have a BMI over 35 are recommended to undergo bariatric surgery to combat obesity.

Along these lines, there are three types of bariatric surgery:

Gastric sleeve surgery: this is performed laparoscopically, reducing the stomach by almost 70% of its capacity, which translates into a decrease in ghrelin, the hormone responsible for regulating appetite. It is important to note that in this treatment the stomach is divided without deviation of the food.
Gastric bypass surgery: with this second technique the patient has modified laparoscopically the digestive system, creating a small stomach that will be connected to the small intestine. This will allow the patient to significantly reduce the number of calories and food they eat, feeling satisfied with small portions.
Gastric band: This is a surgery in which an adjustable silicone ring is installed around the upper part of the stomach. In this way, a small bag is created in which the food will be deposited, thus limiting the amount of food that can be consumed. The patient will feel full much faster and will therefore eat less food and lose weight.

In all these surgeries the patient must remain admitted to the clinic since it is used for general anesthesia.

Methods to fight obesity without surgery

Likewise, the specialists the explain that there are various techniques without surgery that are recommended for patients with a BMI greater than or equal to 30 or greater than or equal to 40:

POSE method: in this treatment without surgery, the doctor makes folds under the stomach area, in the gastric fundus, through an endoscopy, which allows the volume to be reduced by almost 80%, stimulating weight loss. In this way, a constant feeling of satiety is generated. The treatment is performed under general anesthesia and usually lasts around 50 minutes.
Gastric Balloon: To reduce the capacity of the stomach, the specialist introduces a gastric balloon through an endoscopy through the esophagus, which will be filled with saline for 6-12 months to allow weight loss.

What are the main benefits of these treatments?

For the aforementioned treatments to be successful, the patient requires commitment, effort, and a lot of perseverance. Obese patients must understand that whatever treatment is chosen, they must be accompanied by a substantial change in their lifestyle and eating habits,

The main benefits of an obesity treatment according to specialists are:

Improvement in the quality of life of the patient
More energy and mobility
Long-term results if there is a commitment on the part of the patient
Substantial improvement in patient health
Improvement in a physical and emotional appearance

How is the recovery from bariatric surgeries?

Recovery will depend on the type of treatment that will be indicated to us according to our BMI index and degree of obesity.

In the case of having to undergo surgery, the recovery will be as follows:

Gastric sleeve: In this case, the surgeon will recommend resting for a few days (between 7 and 10 days) with a fairly restrictive diet during the first weeks. During the first week, the patient will only be able to drink liquids so that the system and the body can adapt to the new size of the stomach; after that time the specialist will prescribe a soft diet composed mainly of baby food. After a month of operation and several medical check-ups, the patient will be prescribed a personalized nutritional guideline that must be followed carefully to achieve the objectives set.
Gastric bypass surgery: the patient will have to spend in the clinic about 3 to 4 days after the surgery and the surgeon will ask him to walk a few steps to prevent the formation of blood clots. In addition, the patient will not be able to eat food for the first 3 days after the operation. They will also prescribe some pain relievers to control the pain. The patient is discharged when he can move without problems and pain. Likewise, according to experts, a post-gastric bypass diet evolves in stages, to help the patient gradually return to eating solid foods. In this regard, experts recommend taking the following into account:
1. 1. Drink at least 2 liters of water a day to avoid dehydration.
  2. Eat and drink very slowly to avoid rapid gastric evacuation.
  3. Avoid drinking fluids between meals. Drink water 30 minutes after eating.
  4. Avoid alcohol.
  5. Once you have passed the liquid stage, the patient should take care to chew the food thoroughly to a pureed consistency before swallowing.
  6. Prefer foods that are lean and rich in protein.
  7. Mix solid foods with liquids like (water, skim milk, and broth).
Gastric Band: requires a hospital stay of about 12-24 hours and the patient can be incorporated into daily life almost immediately. Therefore, the postoperative period is simple. During the first days the patient will have to follow a liquid diet, then a semi-liquid diet until finally reaching a maintenance and control diet.

How is the recovery from bariatric surgeries?

In the case of using treatments without surgery such as the POSE method or the gastric balloon, the recovery will be as follows:

POSE method or stomach reduction without surgery: As it is a non-invasive intervention, the patient is discharged the same day or only for 24 hours depending on the evolution in each case with a restrictive diet in charge of a nutritionist. The patient must attend weekly check-ups to evaluate the evolution of their treatment. Likewise, it is recommended that the stomach reduction treatment without surgery be accompanied by a re-education program on eating habits. With this treatment, you can expect up to a 45% drop in excess weight,
Gastric balloon: During the first week the patient should only eat a liquid diet and be very hydrated. It is also important to avoid carbonated drinks throughout the treatment as they have a ” bloating ” effect on the stomach. Likewise, alcohol consumption should be avoided. In the second week of the diet, soft foods such as soups, porridge, and puree can be incorporated. You can eat foods that are low in fat and sugar. From the third week onwards, the patient will be able to incorporate solid foods, preferably home-prepared and low in fat, with the supervision of a nutritionist.

For any of the cases mentioned above, it is advisable to avoid physical efforts during the first days after treatment or surgery. Likewise, smoking is not recommended to allow correct healing and oxygenation of the blood.

In some cases, patients who lose a lot of weight will feel discomfort in some parts of the body such as the abdomen or arms, so it is recommended to perform a tummy tuck after reaching the goal weight.

Results

For the results to be optimal in any obesity cases, there must be a strong commitment and will on the part of the patient. In addition, you must strictly follow the prescribed diet along with post-operative care as appropriate.

For this reason, regardless of which treatment is chosen, the results that can be obtained are:

Loss of more than 60% of excess weight
Long term results
Better life quality
Substantial improvement in mobility
Relatively fast recovery
Risk reduction of diseases associated with obesity such as diabetes, hypertension, cardiovascular diseases, uterine and colon cancers, among other pathologies
Improves self-esteem and physical appearance

Risks of obesity treatments:

In the cases of surgical procedures, the risks may be :

Adverse reaction to prescription anesthesia or pain relievers
Severe abdominal pain
Wound infection
Nausea or vomiting
Gastroesophageal reflux
Fall back on old eating habits will result in increased weight loss

In the case of non-surgical treatments, recovery is usually faster, but the patient may have:

Abdominal pain
Dry throat and mouth
Wound infection
Adverse reaction to anesthesia
Pain or wounds in the esophagus/stomach

Frequent questions

What treatment is suitable for a person suffering from grade II obesity? The specialists of MIP Salud explain that the most appropriate thing is for the patient to approach the doctor’s office to make an exact diagnosis, through a nutritional genetic study that reveals which foods can be eaten and which cannot. Likewise, it is important to carry out a metabolic study to determine the nutritional plan and treatment to follow.
What are the expected results after 5 to 10 years of bariatric surgery? The mentions that the medium-term results are generally very good, both from the point of view of weight as from the metabolic. Long-term results, after 10 years post-operation, will depend a lot on the patient and their eating habits.
When is a person considered overweight/obese and should they be treated? A person with overweight is considered when his BMI is higher than 25. Likewise, between 30 and 35 mild obesity, and finally between 35 and 40 is considered severe obesity. Finally, patients with more than 40 in their BMI are diagnosed with morbid obesity. For all cases, there is a type of treatment,
Are the so-called miracle diets successful? Miracle diets should be rejected, as they endanger your physical and mental health. In addition, they are full of myths such as not being able to eat fruits at a certain time, or not being able to eat carbohydrates. They also promise quick and magical results, but most have a rebound effect,
Can obesity be caused by an external factor? According to specialists, it is often related to social and economic problems since perhaps the person was not taught to cook healthy things or could not buy them. In addition, eating habits and patterns are repeated in families. If the parents are obese, the chances are that the children will also repeat the same unhealthy behaviors.