Morbid obesity is a chronic disease characterized by excessive accumulation of fat in the body to a point where it threatens the health and life of the individual. It is considered morbid obesity when the body mass index (BMI) is 35% or more. When this exceeds 40% the patient is a candidate for surgical treatment.
Morbid obesity, causes
There is no defined genetic predisposition. From statistics we know some causes as well as its prevalence:
- It is more frequent in women than in men
- The prevalence of OM is between 45-64 years old.
- It is more frequent in rural areas than in urban areas.
- It is more prevalent in the lower socio-economic level.
- The abuse of fatty foods, the deterioration of the Mediterranean diet and bad habits increase the OM.
- Sedentary lifestyle
Morbid obesity, health implications
Morbid obesity in itself conditions a decrease in the quantity and quality of life. It affects directly by systems, by importance and frequency:
(a) Arteriosclerotic cardiovascular disease: ischemic heart disease; cerebrovascular disease.
b) Other cardiorespiratory disorders: congestive heart failure; arterial hypertension; ventilatory failure; obstructive sleep apnea syndrome.
c) Metabolic disorders: insulin resistance and type 2 diabetes; atherogenic dyslipidemia; hyperuricemia.
d) Alterations in women: Menstrual dysfunction; Polycystic ovary syndrome; Infertility; Increased perinatal risk; Urinary incontinence.
d) Digestive: cholelithiasis; hepatic steatosis, non-alcoholic steatohepatitis; cirrhosis; gastroesophageal reflux, hiatal hernia.
e) Musculoskeletal: Arthrosis; Joint injuries; Bone deformities:
f) Other alterations: Peripheral venous insufficiency; Thromboembolic disease; Cancer (female: gallbladder and biliary tract, breast and endometrium in postmenopause; male: colon, rectum and prostate). Benign endocranial hypertension. Skin alterations (stretch marks, acanthosis nigricans, hirsutism, folliculitis, intertrigo). Psychological disorders (eating disorders). Psychosocial alterations.
g) Decreased quality of life.
Morbid obesity, operation
a) For borderline obesity (below or around 40% of BMI), our unit uses the ability system and in its absence the intragastric balloon. The ABILITY SYSTEM has a mechanism of action that is included in the operative sheet and detects the intake and feeds back to the stomach with a sensation of satiety, helping to re-educate the intake.
b) For obesities above 40%, short gastric bypass with associated gastric reduction.
c) Superobesity (above 50%), intragastric balloon first and long gastric bypass later.
Morbid obesity, postoperative period
Recovery will depend in each case on the intervention performed.
In the case of short or long gastric by-pass with gastric reduction, oral feeding is restarted in 48 hours and after no more than 5 days, if there are no incidences, the patient can be discharged. A process of dietary re-education is started, which will last for months, but with a resumption of the usual physical activity and even work in no more than 4-6 weeks.
In the case of ability, the time is substantially reduced, having a character of ambulatory surgery with admission shortened to no more than 2 days. Resumption of physical activity and work in 2 weeks.
In the case of the intragastric balloon, it is an endoscopic approach that does not interfere with normal life.
Results of the operation
The gastric bypass is the most effective technique with the least side effects of those described. Approximately 95% of the patients reduce their weight and almost 85-90% of those operated maintain their weight loss after 5 years.
Regarding ability, there is evidence of a parallel behavior at 5 years of maintenance of weight loss but a percentage of weight reduction lower than 95% of the by-pass.
As the intragastric balloon is a temporary or transitory situation, it cannot be evaluated according to these criteria. In general, most individuals, if they do not undergo another action (when it is the first step) or if the need for weight loss ceases (the example of hip replacement surgery mentioned above), regain weight.