UPMC Institute for Health Chianciano has opened a bariatric surgery outpatient clinic, with the collaboration and involvement of Dr. Costantino Voglino and Dr. Andrea Tirone. The aim of the clinic is to perform diagnostic tests and assess candidates to bariatric surgery, and carry out specialty follow-up.
Obesity is one of the major public health challenges of the twenty-first century. Body Mass Index (BMI) is a first indicator of overweight and obesity, and is calculated dividing a person’s weight in kilograms by his or her height in meters squared. A person with a BMI equal to or greater than 25 is considered overweight. A person with a BMI equal to or greater than 30 is generally considered obese. Since the 1980s, the prevalence of obesity has almost tripled in many European countries and the number of those affected continues to grow at an alarming rate. In Italy, the incidence of obesity is estimated at approximately 10% (about 6 million cases) with significant differences between the North and South of the country.
Excess weight, in addition to causing physical disabilities and psychological problems that affect a person’s social life, drastically increases the risk of developing cardiovascular diseases, cancer and diabetes, among others.
Bariatric surgery is a branch of surgery that deals with the treatment of obesity and its complications. Its primary goals are not only limited to weight loss (with a subsequent benefit in terms of quality of life), but also to improving, or resolving, the many diseases related to obesity, such as type 2 diabetes mellitus, hypercholesterolemia, and arterial hypertension. More specifically, as far as glycemic compensation is concerned, many clinical studies have shown significant improvement or even a resolution of type 2 diabetes, regardless of the weight loss obtained after bariatric surgery.
The validity of this surgical approach has been widely demonstrated by the drastic and continuous increase in the number of procedures performed every year.
SURGICAL ASSESSMENT AND INDICATION TO SURGERY
To present date, bariatric surgery can be recommended with:
– BMI ≥ 40.
– BMI ≥ 35 and presence of diseases related to obesity.
– BMI ≥ 30 and presence of type 2 diabetes mellitus.
The criterion used for indication to surgery is the demonstrated inability to lose weight with other therapeutic approaches.
Once the patient is assessed, a multidisciplinary team, consisting of endocrinologist, surgeon, dietitian, and psychologist/psychiatrist, proposes the indication to bariatric surgery.
DIFFERENT TYPES OF BARIATRIC SURGERY
- Restrictive: a reversible restriction of the stomach is established, which induces a rapid sense of satiety. Type of surgery: adjustable gastric band surgery.
- Restrictive and functional: a restriction of the stomach is established, which may be connected to bypassed sections of the stomach based on the type of surgery, resulting in hormonal changes that cause a sense of early satiety. Type of surgery: sleeve gastrectomy, gastric bypass.
- Malabsorptive: an irreversible reduction in the size of the stomach is established thus reducing the absorption of calories and nutrients. Type of surgery: mini-gastric bypass (also known as single anastomosis gastric bypass).