Interdisciplinary treatment of obesity under the supervision of specialists

Interdisciplinary treatment of obesity under the supervision of specialists

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More than half of all adults and one in five children in Poland suffer from obesity. Behind hypertension and smoking, it is the third risk factor for chronic diseases [1] - diabetes, back issues or cardiovascular problems. Overweightness and obesity, despite being serious health problems, are not always properly treated, and are often neglected. What is the reason for this? As experts point out, there is still belief that we can manage losing weight on our own, meanwhile treating obesity requires a comprehensive approach, understanding the causes of the illness, and individual treatment under the guidance of specialists.

Excessive weight gain is often attributed to lifestyle changes, poor eating habits, high calorie diets, or reduced physical activity. It is also a frequent result of stress, as well as emotional and mental disorders.

However, according to experts, leading an unhealthy lifestyle may not necessarily be the sole reason behind weight problems. Often the underlying problem is more complex. It may include genetic factors, which affect as much as 70% of people suffering from obesity, or the side effects of medications, or possibly the symptoms associated with many chronic diseases, such as hormonal disorders, including Cushing's syndrome. Hence, a proper diagnosis of the problem plays a key role in the treatment of obesity.

Without treating the primary cause of most overweight problems, losing weight will not bring the desired effects. In treating overweightness, a comprehensive approach to the patient is essential, taking into account all diagnostic tests, providing us with the cause of the problem, as well as allowing the detection of coexisting diseases. We must remember that excessive weight is often the cause of many other disorders - diabetes, hypertension, heart problems, which we also take into consideration when treating overweightness.

Dr Maciej Kielar, professor at the Jan Kochanowski University in Kielce, surgeon and Director of the Medicover Hospital Surgery Department.

Comprehensive and interdisciplinary treatment of obesity under the supervision of specialists

Treating obesity and overweightness is not a simple matter. Weight problems cannot always be solved with diets or lifestyle changes without the guidance of a doctor or dietitian. Proper treatment should take place in several stages and under the watchful eye of an interdisciplinary team of specialists, including a dietitian, psychologist, physiotherapist, internist, gastroenterologist and, if need be, a surgeon.

Comprehensive and interdisciplinary treatment of obesity is very important for achieving good results. Based on diagnostic tests, patient interviews, and joint consultations, a team of specialists chooses the appropriate method  to shed unnecessary kilograms, and provides support to the patient at every stage of treatment. Often the support of a psychologist is of paramount importance to the treatment, so a multi-faceted approach to treating obesity is fundamental.

There are many ways of treating obesity. The right method is chosen based on the underlying cause of the disease, the stage of disease determined by the BMI (weight divided by height in metres squared), or the risk assessment of accompanying diseases. A person who is slightly overweight will require a different method of treatment, such as lifestyle modifications, proper diet, physical activity and psychological support, which play an important role. While an obese person who needs to lose several kilos in a relatively short time, will require a completely different approach.

When diet is not enough

In cases where unnecessary kilograms are still a significant burden on the body, minimally invasive surgical methods are an option. One of them, recommended by experts, is a medically supervised obesity treatment called the "Orbera Balloon".

This is a method designed for people whose BMI exceeds 28 – first and second degree of overweight. It consists of a minimally invasive procedure of inserting an Orbera balloon - a soft balloon placed inside the stomach filled with saline, which reduces the capacity of the stomach, causing less food to be consumed, and the feeling of satiety after eating a much smaller meal than before. 

Dr Maciej Kielar, professor at the Jan Kochanowski University in Kielce,  surgeon and Director of the Medicover Hospital Surgery Department.

The procedure is performed under short intravenous anaesthesia. The patient remains under constant supervision of the doctor and undergoes regular consultations with a dietitian and psychologist. After six months the balloon is removed during a short procedure, and the treatment results in a loss of about 15-20 kilos, he adds. The constant supervision of a dietitian and psychologist is very important when undergoing this  treatment: the patient must develop a new, appropriate diet, which, even after removing the balloon, he or she will be able to maintain permanently, as well as learn and understand the mechanisms of emotional disorders, which increase the risk of recurrence of inappropriate eating habits. The ability to retain the results in the long run is also what makes this method effective. In most patients, this obesity treatment is successful – after using the Orbera balloon only about 40% of patients experience the yo-yo effect. In comparison, when the treatment involves solely dieting, nearly 90% of patients gain the weight back

Dr Maciej Kielar, professor at the Jan Kochanowski University in Kielce,  surgeon and Director of the Medicover Hospital Surgery Department.

This method is used as an independent treatment for patients with moderate obesity. In severely obese patients it may be a prelude to surgical treatment, because the loss of 10-20 kg in a patient with body weight of more than 160kg, reduces the risk of complications during bariatric surgery.

In morbidly obese patients (BMI >42), the method of choice is laparoscopic surgery, which allows to change the anatomy and function of the digestive tract without the traditional abdominal opening, leading to rapid and lasting weight loss. The most common metabolic procedures include sleeve gastric resection and gastric by-pass, which enable to limit food intake and decrease the absorption and assimilation of nutrients.
As experts point out, the key to success in battling overweightness is adapting long-term lifestyle changes by patients - healthy eating and physical activity, which are recommended for everyone, including after the surgery.

[1] M.H. Forouzanfar et al., Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013, Lancet 2015, vol. 386, No. 10010, p. 2287–2323.

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