Indications
What is severe obesity?
The term severe obesity (morbid obesity) is used to classify people with huge amount of overweight, usually due to accumulation of fat, and who, for this reason, are at high risk of diseases (comorbidities) and mortality, from 6 to 12 times more likely to die than a person of adequate weight.
The main risks associated with severe obesity are:
- Heart and circulation disorders (such as heart attack, stroke, thrombosis in the legs, pulmonary embolism, and arterial hypertension);
- Diabetes;
- Spinal and joint diseases;
- Digestive system´s diseases (such as gallstone and reflux disease);
- Hormonal and sexual changes;
- Difficulty to breath and to sleep;
- Increased incidence of some types of cancer;
- Depression and other psychological changes.
In addition, the person with severe obesity ends up having significant limitations in their life, having difficulty to perform tasks considered trivial, such as walking, running or tying their shoes.
How do I know if I have severe obesity and if my case is for surgical treatment?
The most commonly used method for determining whether a person is obese is by calculating their Body Mass Index (BMI), using the following formula: BMI = Weight (Kg) / Height x Height (m). If your BMI is above 35 in the presence of any of the described comorbidities or you have a BMI above 40 (even without comorbidities), you are suffering from severe obesity.
The current criteria for indicating the surgical treatment of obesity are regulated by the Conselho Federal de Medicina (Federal Medical Council):
Resolution of the Conselho Federal de Medicina (Federal Medical Council) nº 1942, of 2010
They are candidates for surgical treatment of obesity:
- Patients with BMI greater than or equal to 40;
- Patients with BMI over 35 with life-threatening obesity-related diseases such as diabetes mellitus, sleep apnea, hypertension, dyslipidemia, heart artery disease, joint diseases, among others;
- They must have undergone clinical treatment with unsatisfactory result for at least two years.
These are the criteria still used by most health insurance providers to authorize the operation, as determined by the ANS (agência Nacional de Saúde – National Health Agency) by normative resolution n ° 211/2010 and n ° 262/2011.
Resolution of the Conselho Federal de Medicina (Federal Medical Council) nº 2.131 / 15, of 2016
This new text changes the previous resolution, maintains the indication of surgery in patients with BMI above 40 and points out another 21 diseases associated with obesity that can lead to an indication of surgery in patients with BMI between 35 and 40.
They are: diabetes, sleep apnea, hypertension, dyslipidemia, cardiovascular diseases including coronary artery disease, myocardial infarction (MI), angina, congestive heart failure (CHF), stroke, hypertension and atrial fibrillation, dilated cardiomyopathy , cor pulmonale and hypoventilation syndrome, severe uncontrolled asthma, osteoarthrosis, disc´s hernia, gastroesophageal reflux with surgical indication, calculus cholecystopaenia, acute recurrent pancreatitis, hepatic steatosis, female urinary incontinence, male and female infertility, dysfunction erectile dysfunction, polycystic ovary syndrome, varicose veins, hemorrhoidal diseases, idiopathic intracarian hypertension, social stigma and depression.
Opinion of the Federal Medical Council nº 38, of 2017
It acknowledged the Metabolic Surgery for the treatment of patients with Type 2 Diabetes Mellitus with BMI between 30 and 35, with no response to conventional clinical treatment, aged between 30 and 70 years, with Gastric Bypass being the surgery of choice for this treatment and Vertical Gastrectomy an alternative.
Clinical and preoperative treatment
All people with severe obesity and those who wish to undergo bariatric surgery may already have tried previous medical treatment (diet, physical activity and / or medication), however, this type of treatment has a very low success rate.
When it is determined that the clinical treatment has obtained unsatisfactory result and the surgery is considered the next alternative, the patient should undergo a preoperative evaluation with a multidisciplinary team that includes an endocrinologist, cardiologist, anesthesiologist, nutritionist and psychologist. Some patients may need other specialists to assist in the preoperative preparation in order to reduce the risks of the procedure.