Metabolic Surgery Revolutionizes Obesity Treatment with Integrated Approach
The future indicates that, increasingly, the surgical treatment of obesity will focus on diseases associated with it, mainly type 2 diabetes mellitus , high blood pressure and dyslipidemia, diseases that make up the metabolic syndrome. “We are migrating from the concept of bariatric surgery to that of metabolic surgery and the ministerial ordinances, which govern bariatric and metabolic surgeries in Brazil, must undergo modifications for a more unified approach to these procedures”, says professor Wilson Salgado Junior, from the Faculty of Medicine of Ribeirão Preto (FMRP) at USP and specialist in digestive system surgery.
The term “bariatric”, of Greek origin, derived from “baros” (weight and density) and “iatros” (treatment, care), has its history related to the treatment of severe cases of obesity since the 1960s. Bariatric surgery has grown notably since the 1980s.
In 2013, the Ministry of Health established regulations for bariatric surgery, determining criteria such as Body Mass Index (BMI) greater than 40 kg/m², or BMI above 35 kg/m², when associated with diseases linked to obesity. “Attention to this procedure has increasingly focused on obesity-related diseases.”
According to the professor, studies indicate more effective results in the medium and long term in controlling these conditions, even in patients with a BMI below 35 kg/m², when undergoing surgery compared to clinical treatment. “Worldwide and in Brazil, metabolic surgery is being performed on patients with a BMI between 30 and 35 kg/m², among other criteria.”
Priority
Despite the conceptual differences, “the surgical techniques, in the bariatric and metabolic approaches, are the same”, according to Salgado Junior. “Given the growing demand for these surgeries, priority will be given to patients with associated diseases, even with a BMI below 35. The benefits, such as the remission or improvement of associated diseases, indicate for the future a closer integration between surgical care and the treatment of obesity.”
The professor also highlights post-surgical improvements in several conditions, such as high cholesterol and triglycerides, hepatic steatosis, sleep apnea, idiopathic intracranial hypertension and female infertility. Furthermore, he points out, “treating obesity reduces the risk of several types of cancer.” Even with the benefits, the professor warns of the risks of these surgeries, which require sacrifices and collaboration on the part of the patient, and are not free from complications. The need for lifelong monitoring is crucial to optimize the results obtained.
For the professor, the challenges faced by health services currently include managing the waiting list for this type of surgery, especially in public institutions, amid growing demand, worsened by the Covid-19 pandemic. The professor highlights the need for greater funding to expand the accreditation of new public hospitals and, in this way, make a greater number of these surgeries possible through the Unified Health System (SUS). “It is estimated that only 0.3% of possible candidates for surgery are operated on annually by the SUS, which demonstrates the urgency of this expansion.