What is Bariatric Surgery?
Bariatric surgery (baros = weight), also called obesity surgery, consists of a set of surgical techniques aimed at the patient's weight loss and resolution of additional medical problems (comorbidities) caused by morbid obesity. Bariatric surgery is not cosmetic surgery.
For more severe cases of obesity, dietary changes and the practice of physical activities are impossible to implement. In these situations, only a more effective medical intervention, such as bariatric surgery (surgery to reduce the size of the stomach), should solve the problem. Most of these cases are those in which the body mass index reaches values above 40 kg/m2.
In these people, the numerous treatments and weight fluctuation, in addition to the genetic potential, aggravate the clinical condition. Diseases associated with grade III obesity (hypertension, arthropathies, dyslipidemias, diabetes, respiratory disorders, etc.) generated the term “morbid obesity”.
These patients undergoing bariatric surgery must be monitored, receiving specific guidance for the development of a balanced diet. Adherence to treatment should be evaluated, as psychologically unstable patients may resort to high-calorie, low-nutritional quality preparations, jeopardizing the success of the intervention. There are contraindications for performing this surgery, such as liver cirrhosis, some severe kidney and psychiatric diseases, addictions (drugs, alcoholism) and hormonal dysfunctions. All must be evaluated by professionals with practice and in-depth knowledge of this subject.
In all cases, the patient must necessarily have full knowledge of the characteristics, needs, risks and limitations of each surgery. We hold meetings with a multi-professional team and with patients who have already undergone surgery so that the patient can be sure of his decision.
People undergoing bariatric surgery need ongoing nutritional guidance to supplement their diet with compounds rich in proteins, vitamins and iron. Special care to avoid cases of malnutrition after surgery are also needed. All types of obesity treatment, from the simplest to the most radical, require commitment and determination. Their motivation is essential to ensure a good level of adherence and therapeutic success.
KNOW THE TYPES OF BARIATRIC SURGERY:
Indications for Bariatric Surgery
Morbidly obese patients with BMI ≥ 40 kg/m2, without comorbidities, who did not respond to conservative treatment (diet, psychotherapy, physical activities, etc.), followed for at least two years;
Morbidly obese patients with BMI ≥ 40 kg/m2 with life-threatening comorbidities;
Patients with a BMI between 35 and 39.9 kg/m2 with chronic diseases triggered or aggravated by obesity;
Exclude obesity due to endocrine disease that should be treated clinically or surgically and not by bariatric surgery. For example, Cushing's syndrome due to adrenal hyperplasia;
The recommended age range is between 16 to 65 years old;
Surgical treatment should not be performed before the growth epiphysis is consolidated in young people;
Patients over 65 years of age may undergo the surgery respecting the general conditions listed above, in addition to individual assessment by a multidisciplinary team, careful assessment of risk-benefit, surgical risk, presence of comorbidities, due expectation and weight loss benefits;
Intellectual capacity to understand all aspects of this project as well as to have constant family support;
Commitment to subsequent follow-up, which must be maintained indefinitely, as the lack of follow-up is one of the causes of serious and sometimes fatal complications;
Absence of severe psychotic disorders, recent history of attempted suicide, alcoholism and chemical dependency on other drugs. Patients with a history of alcoholism and chemical dependency to other drugs must undergo a careful psychological evaluation and release by a psychiatrist.
CFM RESOLUTION No. 2.131 OF NOVEMBER 12, 2015
I am obese and I want to change this reality. How to treat?
Treatment should be based on a change in their eating habits, restricting calorie intake and regular physical activity according to what is appropriate and oriented for each person. All these changes require your active participation and awareness of the importance of your attitudes in the future of your health.
Factors that interfere negatively in the success of your treatment should be detected so that it is sustainable in the long term, before starting the weight loss itself. The first step to be evaluated is whether there is a real motivation for the desire to lose weight. A weight loss program will require dedication and discipline from those who want to lose weight. Every change of habit is initially complicated, but the advantages arising from this change make people keep looking for concrete improvements.
Motivation through information about the difficulties and benefits of the necessary behavior changes and support so that these changes can actually happen are extremely important for the success of the treatment. The history of your eating habits is important both for establishing a dietary plan and for identifying eating behavior disorders, which may prevent you from obtaining satisfactory results. Binge eating, night eating, and the urge to eat induced by certain emotional conditions must be explored and handled with care.
The tendency to gain weight does not disappear with treatment. You need to keep in mind that the predisposition to gain weight is a chronic problem. This helps to adopt changes in eating habits and to understand that the practice of regular physical exercise should persist throughout life. Therefore, it is important that the physical activity to be performed brings pleasure and the dietary plan should start to be part of a normal eating habit.
Changes often require a long period of adaptation and finding alternative sources of pleasure to replace the act of eating. Therefore, the advantages and disadvantages of such changes should be evaluated and you should feel free to decide from a medical perspective.
Stress and depression are conditions that can predispose to lack of control over eating, especially in those who do not feel motivated to start treatment. These conditions, associated with negative self-image and low self-esteem, make social relationships difficult, interfere with sexual behavior and are important factors that lead to a lack of motivation and a feeling of powerlessness regarding the necessary changes. It is important that your doctor is aware and removes these barriers by letting you express your feelings. Learning relaxation techniques, yoga and meditation can help to deal with this type of lack of control over eating.
How is the treatment?
Knowledge about obesity has evolved. These days, many weight-loss strategies have been tried, but losing weight and keeping it off takes a lot of willpower. Weight loss will always depend on a negative energy balance, that is, it depends on a lower food intake in relation to caloric expenditure. This goal is achieved by reducing food intake and increasing physical activity.
What should be taken seriously is not only weight loss, but also the correction of cardiovascular risk factors, which are dependent on insulin resistance. The idea of reducing the body weight of obese individuals to values considered normal, through diets with very low caloric content, has been replaced by less ambitious and more realistic behaviors, due to the impossibility of achieving, in the long term, achieving and maintaining the ideal weight in most cases.
The factor that hinders the success of very calorie-restricted diets, which produce significant short-term weight loss, is the body's physiological tendency to activate compensatory mechanisms to minimize weight loss, through a reduction in the basal metabolism rate. A dietary treatment that results in more modest weight loss but produces more stable changes is probably more favorable. Weight losses between 5 and 10% of the initial weight may be sufficient to produce beneficial changes in blood glucose levels, plasma lipid profile and blood pressure levels.
The total calories to be consumed should be reduced by 500 to 1000 kcal per day, based on the calculation of energy expended by the patient. The diet thus planned is usually sufficient to produce a weight loss of between 0.5 to 1.0 kg/week.
General recommendations should include an increase in fiber intake, which produces a greater degree of satiety, and a reduction in the consumption of sucrose, alcohol and saturated fats. The normal proportion of nutrients must be maintained despite the caloric limitation. Proteins should make up 15 to 20% of the total amount of calories in the diet. Carbohydrates must correspond to 50 to 55% and fats must not exceed 30% of the total caloric content.
You will better adhere to the diet if it adapts to your food preferences, providing you with a variety of menu options. Beside this, the success of the diet fundamentally depends on the process of dietary re-education, which is part of the so-called behavioral therapy.
What should change in eating behavior?
Behavioral therapy helps you improve your eating habits and increase your physical activity, modifying your lifestyle through the adoption of healthier habits that help you lose weight and also maintain the lost weight.
First, you should monitor your own eating behavior, recording the type of food you are used to eating, the places where these foods are consumed, the frequency of consumption and the emotional condition at the time of ingestion. By analyzing these records, you will be able to identify problems that can be corrected, particularly with regard to places and times of the day that facilitate higher calorie intake.
Once the problem is identified, an attempt should be made to break the chain of events that lead to its perpetuation. For example, for someone who comes back from work and has the habit of stopping at a bakery and buying bread and sweets, it would be better to change his way home.
It is critical that your family or friends positively support the behavioral changes you are trying to implement. Weight regain after weight loss is usually evident after 18 months. The best results are obtained with an approach that involves behavior change, greater social contact, increased physical activity, and the help of a psychotherapist.
Are there techniques to control food intake?
Try to eat three main meals during the day, writing down the foods you ate for seven days. Recording the foods you have eaten for seven days and evaluating the calorie content and composition of the diet in terms of macronutrients. Macronutrients provide food with calories. They are: carbohydrates, proteins and fats.
Try to eat every day at the same time and in the same place in the house.
Eat only if you are seated. This avoids consuming small amounts of food, standing in front of the refrigerator, for example.
Concentrate on the foods you are consuming, chewing them well.
Eliminate distractions such as reading or watching television during meals.
Use small plates for food and do not place food platters on the table.
Cook smaller portions of food.
Slow down the meal by resting the cutlery on the table.
Do not use high-calorie condiments such as ketchup, mustard or mayonnaise.
Do not shop for food in supermarkets before meals. This helps to avoid over-purchasing and unnecessary high-calorie foods.
Avoid serving yourself a second time.
Try to assess whether your eating habits favor weight gain or not. If your answer is yes, make a plan to correct the factors that, in your case, favor weight gain.
Try to sleep well. During normal sleep, hormonal regulation favors satiety and regulates the body's metabolism. Leptin, a substance released during sleep, controls body fat, giving signals that we are fed. When the body is deprived of sleep, leptin is reduced, increasing the urge to eat. On average, a healthy adult needs 6 to 8 hours of sleep a day.
Try to eat more fruits, vegetables, nuts and grains.
Reduce sugar and fat in your diet. Switch from animal fats to vegetable fats.
Watch this video of a Bariatric Gastric Bypass Surgery by robotic surgery:
