The chat of this month :
Do you know about \"sleeve gastrectomy\" and what do, you think of it?
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Practical corner |
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| There is no
obesity.
The feeling of being overweight is not based on objective
medical grounds. Some fat can nevertheless be present, even in slim persons.
Weight-loss methods are not relevant for this group of people. The presence of
fat is only associated with aesthetic problems (refer to the
chapter on Plastic surgery, localised
obesity) | | | This is a simple weight-excess.
However it should not be neglected because there exists an important statistical risk in this group for related diseases.
Here are some options available for
treatment:
>> Common sense and simple dietetic and health principles
Include more physical activities in
your lifestyle (walk at least 20 minutes a day, walk up the stairs etc.), avoid
high calorie intake and foods with a high fat content, as well as snacking
in-between meals and while watching TV.
>> Diet support
We shall not
address this issue in detail here, nor favour one diet option over another. A
lot of alternatives are available: balanced low-calorie diets, high-protein
diets (combined with the former), dieting under surveillance in a
health-institution etc. These require a nutritional evaluation and a food-intake
study, as well as scheduled consultations with a dedicated physician.
>> Drugs
Drugs are usually
prescribed for the complications linked to obesity. They are not designed as a
first-line treatment of obesity. However, certain drugs can be prescribed by
dedicated physicians (refer to the chapter on Drugs).
>> Digestive surgery
Digestive surgery is not indicated in patients with this BMI
range.
>> Plastic surgery
Plastic surgery is performed after a
large weight-loss of usually more than 20 kilograms, which does not apply to
this range of BMIs, or to localised obesity (refer to chapter in Localised
Obesity)
>> Intragastric balloon
The balloon is not a validated treatment for this range of patients. However, it has been proposed for BMIs of 27 to 30 where severe co-morbidities such as unstable diabetes were present, or after traditional therapies had failed. | | | Here we are dealing with severe obesity, according to the definition of the World Health Organisation (WHO). Medical care is mandatory.
The main options for
treatment are:
>> Common sense and simple dietetic and health principles
Include more physical activities in your lifestyle (walk at least 20 minutes a day, walk up the stairs etc.), avoid high calorie intake and foods with a high fat content, as well as snacking in-between meals and while watching TV.
These principles
are always recommended, whatever therapeutic option has been chosen.
>> Diet support
We shall not address this issue in
detail here, nor favour one diet option over another. A lot of alternatives are
available: balanced low-calorie diets, high-protein diets (combined with the
former), dieting under surveillance in a health-institution etc. These require a
nutritional evaluation and a food-intake study, as well as scheduled
consultations with a dedicated physician. Psychological support can also be
necessary.
>> Drugs
Drugs are usually
prescribed for the complications linked to obesity. They are not designed as a
first-line treatment of obesity. However, certain drugs can be prescribed by
dedicated physicians (refer to the chapter on Drugs).
>> Digestive surgery
Digestive surgery (gastroplasties and other
operations) is not indicated in patients with this BMI range. It addresses only
morbid obesity.
>> Plastic surgery
Plastic
surgery is performed after a large weight-loss of usually more than 20
kilograms, provided the weight has stabilised (refer to chapter on Plastic
Surgery)
>> Intragastric balloon
The balloon can be placed in this group of patients, but is not a validated nor a widely available treatment. Refer to the chapter on Other Treatments | | | |
This range describes severe obesity, or even morbid obesity if associated with additional related
diseases, such as diabetes, hypertension, hypercholesterolemia, cardiac or
respiratory failures etc.
Whatever, the risk is important enough to require medical
cares.
>> Common sense and simple dietetic and health principles
Include
more physical activities in your lifestyle (walk at least 20 minutes a day, walk
up the stairs etc.), avoid high calorie intake and foods with a high fat
content, as well as snacking in-between meals and while watching TV. These
principles are always recommended, whatever therapeutic option has been
chosen.
>> Diet support
We shall not address this issue in detail here, nor favour
one diet option over another. A lot of alternatives are available: balanced
low-calorie diets, high-protein diets (combined with the former), dieting under
surveillance in a health-institution etc. These require a nutritional evaluation
and a food-intake study, as well as scheduled consultations with a dedicated
physician. Psychological support can also be
necessary.
>> Drugs
Drugs are usually
prescribed for the complications linked to obesity. They are not designed as a
first-line treatment of obesity. However, certain drugs can be prescribed by
dedicated physicians (refer to the chapter on Drugs).
>> Digestive surgery
Digestive surgery (gastroplasties and
other operations, refer to chapter on Digestive Surgery) may be indicated if
there are co-morbidities, i.e. diseases related to
obesity.
And provided: | - | Usual therapies (diet support) have been carried out for at least one year under scrutiny, and have demonstrated evidence of failure. | | - | The patient is aged over 18 years and less than 60 years. | | - | The last significant weight-loss (more than 5 kilos) dates back to more than 6 months, ideally more than one year. | | - | The onset of obesity dates back to at least 5 years. | If the operation is chosen, one must emphasise the need for psychological and nutritional support, which are mandatory before operation and in the long-term follow-up.
Because of its own risks, surgery is never a first choice
therapy, and even less a necessary and urgent option.
>> Plastic surgery
Plastic surgery is performed after a
large weight-loss of usually more than 20 kilograms, provided the weight has
stabilised for one year (refer to the chapter on Plastic
Surgery)
>> Intragastric balloon
The balloon can be used for this group of patients, but is not a validated or largely available treatment. Refer to the chapter on Other Treatments | | | Here we are dealing with morbid obesity, which is a life-threatening burden, and dramatically increases
the risk for cardiovascular or metabolic diseases (diabetes). Stronger
treatments are required. Among them surgery has emerged and become an
interesting option, although it should be chosen with
caution.
>> Common sense and simple dietetic and health principles
Include more physical activities in
your lifestyle (walk at least 20 minutes a day, walk up the stairs etc.), avoid
high calorie intake and foods with a high fat content, as well as snacking
in-between meals and while watching TV. These principles are always recommended,
whatever therapeutic option has been chosen.
>> Diet support
We shall not address this issue in detail here, nor favour
one diet option over another. A lot of alternatives are available: balanced
low-calorie diets, high-protein diets (combined with the former), dieting under
surveillance in a health-institution etc. These require a nutritional evaluation
and a food-intake study, as well as scheduled consultations with a dedicated
physician. Psychological support can also be necessary.
>> Drugs
Drugs are usually prescribed for the complications linked to obesity. They are not designed as a first-line treatment of obesity. However, certain drugs can be prescribed by dedicated physicians (refer to the chapter on Drugs).
>> Digestive surgery
Digestive surgery (gastroplasties and other operations,
refer to chapter on Digestive Surgery) may be indicated if there are
co-morbidities, i.e. diseases related to obesity, or just because of the
BMI.
And provided: | - | Usual therapies (diet support) have been carried out for at least one year under scrutiny, and have demonstrated evidence of failure. | | - | The patient is aged over 18 years and less than 60 years. | | - | The last significant weight-loss (more than 5 kilos) dates back to more than 6 months, ideally more than one year. | | - | The onset of obesity dates back to at least 5 years. | Some
reservations can be made regarding the placement of a prosthetic treatment under
the age of 40 years. If the operation is chosen, one must emphasise the need for
psychological and nutritional support, which are mandatory before operation and
in the long-term follow-up.
Because of its own risks, surgery is never a first choice therapy, and even less a necessary and urgent option.
For more details, refer to chapter Digestive Surgery.
>> Plastic surgery
Plastic surgery is performed after a
large weight-loss of usually more than 20 kilograms, provided the weight has
stabilised for one year (refer to the chapter on Plastic
Surgery)
>> Intragastric balloon
The balloon can be used for this group of patients, but is not a validated or largely available treatment. Refer to the chapter on Other Treatments | | | We are dealing with what is called 'superobesity', with a maximum risk for health. In the United
States, where such cases are not rare, one has even defined a 'triple obesity',
with BMI above 60.
Refer to the description on morbid obesity (BMI above 40), as the criteria are the same. Let us point out some
facts:
>> Digestive surgery
Digestive surgery is often a realistic
procedure for such patients, although there are numerous risks of
failures.
>> Reconstructive surgery
It
is almost always necessary to perform reconstruction after huge weight-loss,
because very large amounts of skin remain.
>> Intragastric balloon
The balloon is obviously not suitable for superobese-patients. However, some teams have advocated it in two cases: | - | When one wishes a rapid and significant weight-loss in order to facilitate a requested surgical procedure that would be too risky because of the patient's weight (e.g. hip replacement). | | - | Before a specific bariatric procedure, such as a gastroplasty, in order to ease its technical performance and the follow-up. This indication is under scrutiny. | | |
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