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Treatments for Morbid Obesity

The term ‘morbid obesity’

Not all obesity is the same. If you are overweight with a body mass index of 30 or higher, your risk of obesity-related diseases increases significantly. Recently, it is called ‘morbid obesity’ to properly inform the seriousness of obesity.

Risks of morbid obesity

Morbid obesity greatly increases the risk of developing metabolic diseases such as type 2 diabetes, dyslipidemia, insulin resistance, metabolic syndrome, gallbladder disease, coronary artery disease, hypertension, and cancer. Statistically, the contribution of obesity to these complications is known to be 75% for hypertension, 33% for cancer, 44% for diabetes, and 23% for ischemic heart disease. In addition, it affects sleep apnea, joint disease, gout, gastrointestinal diseases, allergies, and infertility due to a decrease in male and female fertility.

Limitations of exercise and diet

Treatment of mild obesity is primarily achieved through changes in diet, exercise, and lifestyle. If there is difficulty in improving with these basic methods alone, drug therapy is added. In general, if the body mass index is 25 or more, or if it is 23 or more and is accompanied by metabolic complications, drug treatment is recommended.

However, in the case of morbid obesity with a body mass index of 30 or higher, it is difficult to lose weight through exercise, diet, or drug therapy. This has already been proven by research. The effects of nonsurgical treatment (diet, exercise, drugs) and bariatric surgery were compared in patients with morbid obesity. As a result, the surgical treatment showed good results with a large difference in the amount of weight change at 2 years (30.5 kg in the surgical group, 8.0 kg in the non-surgical group).

In addition, the Swedish SOS study, one of the most famous studies in the treatment of obesity, presented the results of a long-term follow-up of over 20 years that studied the effects of non-surgical treatment and bariatric surgery on a large number of over 4,000 patients. As a result, it was confirmed that the weight loss effect of bariatric surgery was clear and maintained for a long time compared to non-surgical treatment.

Indications for bariatric surgery

Bariatric surgery is performed for morbidly obese patients who cannot lose weight effectively even with non-surgical treatments such as lifestyle changes. It can be considered if the patient is morbidly obese (BMI 35 or higher) or has cardiovascular disease, hypertension, type 2 diabetes, sleep apnea, joint disease, gastroesophageal reflux, hyperlipidemia, asthma, etc. and has a BMI of 30 or higher. Additionally, patients with type 2 diabetes with a body mass index of 27.5 or higher may be considered for sleeve gastrectomy or Roux-en-Y gastric bypass.

Types of bariatric surgery

There are two types of bariatric surgery: restrictive surgery to limit food intake by reducing the volume of the stomach, surgery to suppress the absorption of nutrients, and a combination of these two methods. Currently, laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass are the most widely used surgical methods recognized worldwide for their usefulness. Sleeve gastrectomy reduces food intake by shrinking the stomach, and Roux-en-Y gastric bypass reduces food intake by shrinking the stomach and bypasses it to the small intestine to reduce the absorption of nutrients.

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