Treatment Obesity

Obesity is a multifactor chronical disease, with genetic and medical-environmental factors, characterised by an excess of body fat as consequence of a maintained positive energetic balance. It is shown with an increase of weight and volume in the body.

Besides the limitations obesity concedes in everyday life, its healt importance is given above all to metabolic, cardiovascular, breathing, skeleton and other moral issues that frequently are associated and which increase the morbidity and mortality of the obese people.

Obesity develops progressively. In the different phases in the disease, indications of treatment vary and we must choose the most convenient of them.

The Obesity Unit is destined to offer attention and treatment to people presenting a ponder excess of high degree. The attention and treatment is carried out following a multidisciplinary program and protocols of action that adequate to requiremtns of patient and the pathology, offering an acurate, personalized and highly-qualified professional assistance

  • Measure of degree of obesity and classification 
  • Diseases associated to obesity (comorbidities)
  • Evaluation and study
  • Medical Treatment
  • Intragastric Baloon
  • Surgical Treatment
  • Professionals

Measure of degree of obesity and classification

The most common way to measure obesity is the ICM (Index of Corporal Mass), obtained by dividing weight in Kg. by height in squared meters. According to this index, SEEDO (Spanish Society for the Study of Obesity) establishes the following table:

  • Insufficient weight <18.5
  • Normoweight: 18.6- 24.9
  • Overweight degree I: 25- 26.9
  • Overweight degree II: 27-29.9
  • Severe Obesity I: 30-34.9
  • Severe Obesity II: 35-39.9
  • Severe Obesity III (morbid): 40-49.9
  • Severe Obesity IV (extreme): = o > 50

Diseases associated to obesity (comorbidities)

Morbid obesity, besides limiting the patient for everyday life, it is associated to a series of diseases or comorbidities that worsen the life expectation of these patients. Major comorbidities are:

  • Diabetes type 2
  • Arterial hypertension
  • Cardiovascular diseases 
  • Dislipemia
  • Sleep Apnea Syndrome  / Syndrom of Underventilation ? obesity
  • Severe Osteoarthropaty in burden joints

Generally correction of obesity implies improvement or cure of comorbidities. 

Evaluation and Study

The Initial value is carried out  by an endocrinologist.

  • Clinical story and physical exploration oriented to problems and possible pathologies associated to ponderal excess 
  • Evaluation of degree of obesity
  • Pertinent complementary explorations
  • Diagnostic orientation. Ponderal goal.
  • Therapeutical Orientation 

Evaluation by dietist

  • Evaluation of common diet and diet habits
  • Elaboration and explanation of therapeutical diet, following indications carried out by endocrinologist..

Medical treatment

The endocrinologist evaluates the complementary explorations carried out and sets the therapeutical pattern to follow, which may be based on:

  • Diet/ behaviour therapy exclusively,
  • Diet therapy combined with pharmacological treatment, 
  • Support of behaviour and/or psychological treatment added to previous and
  • The instrumental or surgical techniques that will cause reduction of gastric capacity and/or limitation in the absorpton of ingested foods

The Dietist evaluates the patient's common diet and elaborates the therapeutical diet.

The pacient must go periodically to visit the endocrinologist and dietist.

In obesity degrees I and II and motivated pacients, the setup of an Intragastric Balloon is indicated.

Patients presenting morbid or extreme obesity are candidates to surgery treatments.

Intragastric Balloon

It consists of an sphere of silicon inserted in the stomach by endoscopy and full of serum.

The occupation of the gastric fundus provokes a distension in the stomach wall, which causes a feeling of satisfaction and makes easier the observance of therapeutical diets, as the patient is no hungry any more and feels full soon.

This effect is blatant in the first 3 months and diminishes progressively. Diet must be modified according to needs, so it is essential to do strict observance in the obesity clinic.

Patients presenting moderate degrees of obesity and having been treated in several occasions need an alternative therapeutical way. The setup of an intragastric balloon is a good option for these patients.

The setup of a balloon is carried out by endoscopy and under sedation. It is removed 6 months after implant the same harmless way. It does not need hospital admission.

Once the balloon is out, it is recommended to be supervised by the obesity unit to stabilize weight and diet habits.

Surgical treatment

In patients with severe obesity with long evolution, nowadays the only successful treatment in the long term regarding weight loss is bariatric surgery.

Candidates for this surgery are those with ICM > 40 kg/m2  or  > 35 kg/ m2 with associated major comorbidities, with an acceptable surgery risk and those having failed in conservative obesity treatments. 

The mechanisms in surgery to attain weight loss are basically two:: 1- Gastric restriction. It consists of reducing the stomach capacity and therefore causing early and permanent satisfaction, which will help modify food habits. 2- Bad absorption. It consists of deviating food from normal intestinal circulation, shortening the useful gut surface to reduce the absolrption fo foods. Combining both factors we obtain the distinct surgical techniques for obesity: pure restrictive, which only act on stomach, or mixt which combine both mechanisms.

The techniques we use are:

  • Tubular gastrectomy (also called gastric tubulation, gastric hose or sleeve gastrectomy): restrictive technique
  • Gastric bypass: mixt technique (based on creating a small gastric reservoir)
  • Duodenal Crossing: Combined technique
Tubular gastrectomy Gastric Bypass Duodenal Crossing

They are major surgery interventions carried out under general anaesthesia, under hospital admission and involving certain risks of complication, not frequent but potentially severe.

They can be carried out by laparoscopy with the advantages implied of pain reduction and faster recovery.

After the operation, patients must follow periodic controls for the progressive adaptation to new diets and supplementation of proteins, minerals and vitamints, according to the surgical technique used.

Professionals

  • Marta Gensana
  • Elena O'Callaghan
  • Rosa Rosell Montagut
  • Florenci Salvans Mestre
    - Degree in Medicine and Surgery
    - Specialist in General and Digestive Surgery
    - Member of the Societat Catalana de Cirurgia
    - Member of the Asociaciķn Espaņola de Cirujanos
    - Member of the Sociedad Espaņola de Cirugia de la Obesidad