Overweight is a problem!
Obesity is a common problem, so much is common knowledge ! But it is not so well known, how pressing it is. 30% of the UAE population is adipose, close to the top values in the world. The USA is still higher up with 35% , but that is no consolation, if you think of the consequences. Overweight, defined as a Body Mass Index of 25 and over, carries a 15% increase in mortality, the likelihood to die. Adiposity I, 30 – 35, increases the risk by 44% , adiposity II ( 35 to 39,9 ) by 97% and adiposity III ( > 40 ) by 173 %, thats scary ! Another staging system, the EOSS, takes in all the related diseases, which are plentiful : A 3 times higher risk of Diabetes, gall stones, high fat levels in the blood, fatty liver, lung disease and sleep apnoe; cardiovascular disease, high blood pressure, gout, reflux will be 2 – 3 times more frequent and cancer, infertility and joint problems 1 – 2 times. And one aspect , which comes up in a very literal sense whenever one talks to adipose people is the reflux with heart burn, with 10% not rare amongst normweight patients, but with 37 to 72 % rather common amongst the adipose population.
How do we deal with adipositas? For the overweight we offer a whole array of lifestyle changes and diets, and from a BMI of 28 with metabolic disease one includes drugs like Orlistat. But once the BMI rises over 30, the socalled adiposity I, surgery becomes a therapeutic option. There are however only a few `hard ´ recommendations: If the BMI is above 35, and there is no control of a diabetic sugar level despite medication, and if the BMI is above 40, and the patient suffers from Diabetes 2, treated or not, surgery is recommended. In reality patients come late, the median BMI of candidates for surgery in the UAE is 44 .
In the Gulf the most popular operation with 60% is the socalled gastric sleeve, which reduces the stomach volume and excludes a hormonally important area from the food passage. 40% are bypass operations, where pancreatic and biliary flow are diverted as well, and marked malabsorption is the consequence.
And how do weight and blood sugar levels change over time ? In one recent study the endpoints were decrease of the HbA1c under 6 ( reflecting the normalisation of blood suger levels over time ) and weight after three years. Medication and diet alone : 5% and 4,2% of the patients respectively
Gastric Sleeve : 24% and 21,1%
Bypass: 38% and 24,5%
Not all problems are solved by the sleeve though. Reflux and heartburn are actually increasing , following different studies this can be between 12 and 47%. Inflammation of the stomach, erosive gastritis, might increase by 16,7 to 66,7%. Bypass patients require vitamines and supplements for life ( As a surgeon famously quipped, one makes out of a healthy fat patient a sick thin one )
These are encouraging but not exactly perfect results for the surgical solution of the problem. We are only at the beginning , thats for sure !
A word from the Plastic Surgeon to point out one interesting aspect. It is safely established , that the skin and tissue excess, which is inevitable , should be excised, as otherwise the likelihood of a refill is much higher !!! The difference in a group of 95 patients followed up over 2,5 years was on average a higher permanent weight loss . We are part of the solution, and its not just liposuction like in the papers.