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When other weight loss methods fail, gastric reduction surgery is a chance for recovery and a normal life.
Obesity has accompanied mankind since prehistoric times. The plentifully shaped Venus figurine of Willendorf has almost 30. years! For centuries, excess body was not only a sign of beauty and fertility, but also indicated prosperity and high social status, because only the rich could eat their fill. And although Hippocrates already noticed that obese people are more likely to suffer sudden death than slim ones, and overweight leads to many different diseases, only the English doctor Tobias Vanner in 1650 used the term “obesity”, which means Latin. obesus means “one made plump by eating”.
Today obesity has reached pandemic proportions worldwide. WHO is alarming that in the last 40 years the number of people suffering from obesity has increased from 105 million to 641 million! The diseases that accompany obesity, such as hypertension and diabetes, are one of the main causes of mortality. Complication of obesity are also degeneration of the joints or infertility.
– We have constant access to inexpensive food that is highly processed and high in calories. This is the greatest plague of our time – says Tomasz Jaworski, MD, a bariatric surgeon.
And he adds that Poland leads in this shameful ranking, because by choking on the West, we developed bad eating habits in the 90s, and they persist to this day. Eurostat data show that every second Pole is overweight, and every fourth is obese.
According to experts, as many as 1,5 million Poles qualify for the surgical treatment of obesity.
THE ARTICLE COMES FROM NEWSWEEK ZDROWIE 1/2020 MAGAZINE
Tendency to gain weight
Obesity does not hurt and therefore develops secretly. It is enough to eat two cubes of chocolate every day, which is 50 kcal more than what our body needs to maintain a stable body weight, in order to gain 2 kg in a year, which will give us an additional 10 kg in 20 years. Doctors believe that being overweight, i.e. a few kilograms above the established norm, is the beginning of obesity and an alarm signal to start counteracting it. Change your lifestyle to a healthy, rational diet and combine it with physical activity. With each additional kilogram it will be more and more difficult – the effectiveness of diet treatment in overweight or even obese patients is low.
– The effectiveness of conservative obesity treatment according to various sources is estimated at 1 to 5 percent, i.e. at most 5 obese people out of 100 who try to lose weight permanently – says Dr. Jaworski. A sustainable result is considered to be the maintenance of the reduced body weight for five years.
– I don’t think there is a person suffering from obesity who would not have tried to lose weight. Some patients are on a diet all the time. Only not on one, but on two, three, because one is not eaten … – says the bariatrist. Introducing physical activity into the life of an obese person is also ineffective. An obese person often suffers from diseases of the osteoarticular system, such as pain in the joints and spine, which make it difficult or impossible for him to move sufficiently.
– The movement of such a person cannot be too intense. He may feel thirsty after it, but not hunger, because then, after returning home, he will direct his first steps to the refrigerator. And she will eat more calories than she burned – says Dr. Jaworski. – It is such a vicious cycle that must be broken so that there is no tendency to gain weight.
Break the vicious circle
Our appetite is governed by two hormones: ghrelin – the hunger hormone and its opposite, leptin – the satiety hormone. Leptin, which signals the body to “I’m full and I don’t need food,” is mainly produced by body fat.
However, in obese people who have excess body fat, there is leptin resistance, i.e. a weakening of the effect of leptin, and this mechanism is inoperable. In an obese person, the feeling of hunger increases not only. The system responsible for feeling pleasure from eating is also not inhibited. Pleasure is continuous, so a person with obesity more readily and more often reaches for it.
Ghrelin, which signals the body to ‘I’m hungry’, is produced in the stomach. In some people the concentration of this hormone is too high, so the body gets a constant signal to replenish its nutritional reserves.
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Therefore, the key to effective bariatric treatment is to regulate the hormonal balance. – Thanks to gastric reduction surgery, we really influence hormones – explains Dr. Tomasz Jaworski. – One of the most popular is the so-called sleeve gastrectomy, which consists in removing the part of the stomach responsible for the secretion of the hunger hormone.
Metabolic reset
When there are no ghrelin-producing cells in the body, the patient no longer feels hungry and therefore loses weight. There are even people who have to remind themselves of the mealtimes by setting the alarm on the phone. This is how 60 percent reacts after surgery. patients.
– In the remaining 40 percent, the body “starts to figure out”. And it activates the hunger hormone-producing cells in those parts of the stomach or gastrointestinal tract that have not been removed, says Dr. Jaworski. – However, this does not happen until a year or a half after the operation. During this time, patients lose weight and have time to develop proper eating habits – emphasizes the doctor.
Why is it easier to do this after bariatric surgery? The moment of the operation is a great metabolic stress for the body. The body is dumbfounded by what happened. On the one hand, it cannot accept more calories, because a reduced stomach has 70-100 ml instead of 1,5-2 l and reacts with pain and nausea to excess food. On the other hand, it has to start using its own cells and its own fat to meet its energy needs. It all contributes to the fact that the metabolism suddenly returns to the correct path.
“You could say the surgery resets your metabolism to a baseline,” says the bariatrician. – By changing the hormonal balance, the body learns and remembers that less food is enough to feel full and satisfied.
Sweet? No thanks
What about people with a sweet tooth addiction? Another type of gastric reduction surgery, the so-called gastric reduction surgery, works best for them. gastric by-pass. It consists in creating a new stomach, reduced to 20-30 ml, and attaching the small intestine to it.
– Food literally passes through this tiny stomach and falls directly into the intestine, which unfortunately does not tolerate large amounts of sugar – explains Dr. Tomasz Jaworski.
Sugar irritates the intestinal mucosa. It secretes a lot of intestinal juice to dilute this sugar and neutralize it, so that its concentration drops. – Water for the production of intestinal juice is taken from the blood by the intestine, which makes the patient feel dehydrated and feel weaker. At the same time, the intestine, filled with sweetish fluid, tries to empty itself as quickly as possible, says the bariatrist.
The effect of eating sweets instead of endorphins and the feeling of pleasure are very unpleasant things – fainting and diarrhea. The patient begins to associate the effect with the cause and gives up eating sweets.
Cell memory under control
Bariatric surgery is performed laparoscopically, and the patient goes home within a day or two after the procedure. A liquid, mushy diet is recommended for 2-3 weeks, then you can return to normal nutrition. The greatest weight loss occurs in the first 6-8 months to a year.
You can lose from 30-40 up to 60-70 percent. excess body weight. Then comes stabilization.
However, the operation itself is not enough to maintain this condition. Obesity is a chronic and difficult disease to cure, surgery can lead to re-emission, but it must be under control throughout life.
Why is this happening? Fat cells do not disappear during weight loss, but their volume decreases. – From the point of view of the cell itself, it has been robbed of the prosperity of its fat store. And it will strive to supplement this warehouse – says Dr. Jaworski. – Cellular memory lasts for many years and therefore the tendency to gain weight in such a person will always be. This mechanism was genetically determined. Millions of years of evolution have prepared us for periods of hunger that were once part of the rhythm of life and nature. But in our civilization, hunger does not come.
– Therefore, we assume that the obese patient is obese from the end of his life. Internally, metabolically, says the doctor.
“He needs to be in constant control, but it is certainly easier for him after surgery. First of all, it often returns to normal life, and the diseases accompanying obesity also disappear or are alleviated.
– When he loses 20 kg in the first month after the surgery, it is as if someone suddenly took a bag of cement off his back. Not only is it slimmer, but it has more strength and energy. Begins to want more, it is easier to take up physical activity. This is how the next stage of breaking the vicious circle takes place, concludes the bariatrist.
Consultation: Tomasz Jaworski, MD, PhD, specialist in general surgery with extensive experience in the surgical treatment of obesity. Successively gets acquainted with the latest treatment techniques at courses, trainings and scientific conferences. Works at the Żagiel Med hospital in Lublin
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