Sunday 26 May 2019
The treatment of pathogenic obesity


Interview with k.Konstantino Constantinides, Director General & Laparoscopic Surgery at the Medical Center of Athens

Q: When we say that a person is obese and that when suffering from morbid obesity?

A: In clinical practice we use body mass index (BMI), which is the ratio of weight divided by height squared.

Body Mass Index (BMI) = Weight (kg) / Height 2 (m)

Normal weight people have a BMI 18,5-24,9. People with BMIs of 25-30 are overweight and those over 30 are considered obese. Since BMI 35 and obesity is on the 2nd level and risk for the health of a person is serious. Since BMI 40 and above the risk is very serious and obesity characterized disease.

Q: Could you give an example?

A: Absolutely. A woman with a height of 165 weighing 63 kg has a BMI of 63 / 2.72 ie 23.16 and weight is normal. A woman with a height of 165 but who weighs 110 pounds has a BMI 110 / 2.72 ie 40.44 therefore suffers from morbid obesity.

Q: Why is characterized as a disease is obesity?

A: Because with increasing BMI also increased and the effects on patients' health. These patients have increased blood pressure, cardiac and respiratory disorders, diabetes, hyperlipidemia and hypercholesterolemia, arthritis, back pain, thromboembolic problems, increased likelihood of some cancers, endocrine disorders, infertility, etc.

Q: How common is the problem of obesity?

A: Very often. In Europe, 40% of men and 30% of women are overweight and another 20% of men and 25% of women considered obese. Rates and are increasing. For Greece there is no clear epidemiological studies. From the Communications Program of the European Investigation into Cancer and pandemic emerges, however, obesity found in recent years in our country and which is assigned to one in three premature deaths, twenty deaths a day.

Q: Why is obesity?

A: Obesity is a multifactorial disease and is in principle related to the increased caloric intake, the distribution of meals, occasional meals, sedentary lifestyle and lack of physical activity. Very important role is also played by genetic predisposition, and psychological and social components. There are of course other factors that may lead to obesity such as endocrine disorders, taking some drugs, or smoking cessation.

Q: We hear more and last longer for the surgical treatment of obesity. What is the position of surgical treatment?

A: In very severe, morbid obesity, where BMI over 35-40 surgical therapy has a key role. These people suffer from a chronic, multifactorial disease and are usually inherited predisposition. The implications for the health and psychological, social and economic impact of disease on their lives is devastating, and lead these people to despair. The probability of premature death is very high. These individuals generally fail and have failed in the past all other methods of addressing the problem, exouthenonontas patients physically, psychologically and economically. Often they have lost weight in the past and have take back many times have gotten even more. When you come to the surgeon, patients are disappointed, but usually determined to solve this major problem and to change their lives. The scientific data over the past decade clearly demonstrate that surgical treatment is an indication when other efforts have failed, because it's too rare to enable such a patient to lose even 10% of its weight and then keep it.

Q: You follow a procedure before surgery?

A: Before the surgery necessary to exclude other factors that may have led to obesity such as hypothyroidism, Cushing's disease, etc. We also do a full assessment by the surgeon, a psychologist, a gastroenterologist, endocrinologist and a dietitian, and upper abdominal ultrasound and gastroscopy.

Q: What are the most well-established interventions that are made for obesity and what you prefer?

A: The surgery for obesity is far more common in the world is laparoscopic gastric ring placement (Lap-Band). This is the second most common gastric bypass. H is the third vertical gastric partitioning, and then other more complex interventions that have evidence for people with BMI greater than 55-60, ie people over 180-200 kg. The interference in our clinic we prefer the laparoscopic placement of an adjustable ring. The gastric ring is easily installed and removed laparoscopically and is considered a method with few complications because it destroys the anatomy of the stomach. It gives a permanent solution to the problem of obesity and rarely reclaimed the weight is lost. The additional advantage of this method is that there POSSIBILITY span ring the surgery surgeon. So even if the patient has may take back some pounds to lose so. The hospitalization for laparoscopic placement of adjustable ring is usually 2-3 days or less. Other interventions require much longer treatment.

Q: What complications may arise from the laparoscopic gastric ring placement and what is the cost of surgery?

A: The intraoperative and postoperative complications after such surgery are minimal because the incisions are very small, not destroyed the root canal treatment and surgery is bloodless. There is no need to stay patient postoperatively to snorkel or kilon risk of postoperative complications and the trauma found in open surgery. The patient gets the same day, much less post-operative analgesics and has a speedy recovery. What we must watch the patient is to follow the postoperative diet, not eating sweets, avoid alcohol in large quantities, to walk and be active when it is allowed. Weight loss will affect a very positive psychological and mainly improve the individual health problems increase significantly the risk of premature death. The total cost of surgery is much less than the total cost of previous methods in which the patient resorted to weaken.

Q: What conditions must be met by the surgeon to make such an operation?

A: The surgeon should have dealt with this issue globally and is specialized in laparoscopic surgery for obesity.

Questions - Answers