MORBID OBESITY AS MEDICAL AND SOCIAL PROBLEM AND WAYS OF ITS SOLUTIONS

Kryvopustov M. S.

LITERATURE REVIEWS

Scentific article

In the world according to WHO (October 2017) 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese. According to the Global Health Observatory (2017) 58.4% of the population (61.4% of men and 55.5% of women) have overweight in Ukraine, obesity is 24.1% of the population (22% of men and 25.7% of women). The International Federation of Surgery for Obesity and Metabolic Diseases (IFSO) pays special attention to the problem of morbid obesity (MO), in view of the known risks to the patient’s health, that is, obesity with a BMI > 40 kg/m2, separately underlining the superobesity (BMI > 50 kg/m 2 ). As you know, obesity is the cause of increased morbidity, disability, mortality and low quality of life (evidence level 1 according to the Scottish Intercollegiate Guidelines Network, 2010). The causes of obesity are multifactorial, therefore solution of this problem should be multidisciplinary. At the same time the modification of the lifestyle, diet, physical activity, behavioral counseling, etc. are considered. Insufficient effectiveness of conservative methods of treatment of obesity necessitated the introduction of bariatric operations into clinical practice. The AACE / TOS / ASMBS Guidelines 2013 emphasizes that indications for bariatric interventions are a BMI ≥ 40 kg/m 2 without comorbid medical problems, a BMI ≥35 kg/m 2 with one or more severe, obesity-associated comorbidities. In 2015 the 2nd Diabetes Surgery Summit (DSS-II) was held, where many recommendations for bariatric surgery were adopted in patients with type 2 diabetes based on evidence-based medicine. An algorithm for treating patients with MO and type 2 diabetes mellitus has been developed. Bariatric interventions are divided into restrictive, based on the principle of reducing the volume of the stomach; shunting, which is based on the exclusion from digestion of a significant portion of the small intestine; combined, combining both components. Laparoscopic technique should be considered as a method of choice in modern bariatric surgery. Currently, laparoscopic gastric bypass “Roux-en-Y Gastric Bypass” (RYGB) is recognized by the American Society for Metabolic and Bariatric Surgery as the “gold standard” in the surgery of morbid obesity. However, there is a problem of surgical and anesthesiologic risk in patients with morbid obesity, especially in the case of superobesity (IMT> 50 kg/m 2 ). A suitable strategy is the use of an intragastric balloon (IGB) to reduce this risk and prepare the patient for a bariatric surgery. Thus, the presence of morbid obesity according to modern standards is a direct indication for bariatric surgical interventions.

obesity, morbid obesity, surgical treatment

1. Egiev V, Rudakova M, Belkov D. Restriktivnye vmeshatelʹstva na zheludke v lechenii bolʹnykh ozhireniem. Moskva: Medpraktika-M; 2004. 100 s. [in Russiаn].
2. Ioffe OYu, Stetsenko OP, Kryvopustov MS, Tarasyuk TV, Tsyura YuP, Molnar IM, vynakhidnyky; Natsional’nyy medychnyy universytet imeni O.O. Bohomol’tsya, patentovlasnyk. Sposib likuvannya morbidnoho superozhyrinnya. Patent Ukrayiny № 90819. 2014 Cher [in Ukrainian].
3. Ozhirenie i izbyitochnyiy ves [Internet]. Vsemirnaya organizatsiya zdravoohraneniya. 2017 [cited 2 February 2018]. Available from: http://www.who.int/mediacentre/factsheets/fs311/ru/[in Russiаn]. 
4. Sedov V, Fishman M. Laparoskopicheskaya hirurgiya ozhireniya: Prakticheskoe rukovodstvo. Sankt Peterburg; 2009. 192 s. [in Russiаn]. 
5. Abdelaal M, le Roux C, Docherty N. Morbidity and mortality associated with obesity. Annals of Translational Medicine. 2017;5(7):161. 
6. Adjustable Gastric Banding | Weight Loss Surgery [Internet]. International Federation for the Surgery of Obesity and Metabolic Disorders. 2018 [cited 2 February 2018]. Available from: http://www.ifso.com/adjustable-gastric-banding/
7. Angrisani L, Santonicola A, Iovino P, Vitiello A, Zundel N, Buchwald H,et al. Erratum to: Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obesity Surgery. 2017;27(9):2290-2.
8. Bariatric Surgery Procedures – ASMBS | American Society for Metabolic and Bariatric Surgery [Internet]. American Society for Metabolic and Bariatric Surgery. 2018 [cited 2 February 2018]. Available from: https://asmbs.org/patients/bariatric-surgery-procedures#bypass
9. BilioPancreatic Diversion | International Federation for the Surgery of Obesity and Metabolic Disorders [Internet]. International Federation for the Surgery of Obesity and Metabolic Disorders. 2018 [cited 2 February 2018]. Available from: http://www.ifso.com/bilio-pancreaticdiversion-2/
10. Body Mass Index | BMI Calculator – Severe Obesity Treatment [Internet]. International Federation for the Surgery of Obesity and Metabolic Disorders. 2018 [cited 2 February 2018]. Available from: http://www.ifso.com/body-mass-index/
11. Bray G, Ryan D. Medical Therapy for the Patient With Obesity. Circulation. 2012;125(13):1695-1703. 
12. Burke L, Wang J, Sevick M. Self-Monitoring in Weight Loss: A Systematic Review of the Literature. Journal of the American Dietetic Association. 2011;111(1):92-102. 
13. Busetto L, Segato G, De Luca M, Bortolozzi E, MacCari T, Magon A,et al. Preoperative Weight Loss by Intragastric Balloon in Super-Obese PatientsTreated with Laparoscopic Gastric Banding: A Case-Control Study. Obesity Surgery. 2004;14(5):671-6. 
14. De Luca M, Himpens J, Weiner R, Angrisani L. IFSO Statement: Credentials for Bariatric Surgeons 2015. Obesity Surgery. 2015;25(3):394-6. 
15. Dumonceau J. Evidence-based Review of the Bioenterics Intragastric Balloon for Weight Loss. Obesity Surgery. 2008;18(12):1611-7. 
16. Fitz-Henry J. The ASA classification and peri-operative risk. The Annals of The Royal College of Surgeons of England. 2011;93(3):185-7. 
17. Flegal K, Kit B, Orpana H, Graubard B. Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories. JAMA. 2013;309(1):71. 
18. Gastric Bypass Surgery Naples | Morbid Obesity Naples [Internet]. International Federation for the Surgery of Obesity and Metabolic Disorders. 2018 [cited 2 February 2018]. Available from: http://www.ifso.com/roux-en-y-gastric-bypass/
19. Hamdy O, Uwaifo G, Oral E. Obesity: Practice Essentials, Background, Pathophysiology [Internet]. Emedicine.medscape.com. 2017 [cited 2 February 2018]. Available from: https://emedicine.medscape.com/article/123702-overview
20. Heymsfield SB, Harp JB, Reitman ML, Beetsch JW, Schoeller DA, Erondu N,et al. Why do obese patients not lose more weight when treated with low-calorie diets? A mechanistic perspective. Am J Clin Nutr. 2007 Feb;85(2):346-54. 
21. Inabnet W, DeMaria E, Ikramuddin S. Laparoscopic bariatric surgery. Philadelphia: Lippincott Williams and Wilkins; 2005. 
22. Jakicic (Chair) J, Clark K, Coleman E, Donnelly J, Foreyt J, Melanson E,et al. Appropriate Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults. Medicine & Science in Sports & Exercise. 2001;33(12):2145-56. 
23. Jakicic J. Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women. Archives of Internal Medicine. 2008;168(14):1550. 
24. Jensen M, Ryan D, Apovian C, Ard J, Comuzzie A, Donato K,et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults. Circulation. 2013;129(25 suppl 2):102-38. 
25. Johnston B, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk R,et al. Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults. JAMA. 2014;312(9):923. 
26. Logue J, Thompson L, Romanes F, Wilson D, Thompson J, Sattar N. Management of obesity: summary of SIGN guideline. BMJ. 2010;340(feb24 2):154. 
27. Mechanick J, Youdim A, Jones D, Garvey W, Hurley D, McMahon M,et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update. Obesity. 2013;21(S1):1-27. 
28. Miller W, Koceja D, Hamilton E. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. International Journal of Obesity. 1997;21(10):941-7. 
29. ORBERA™ Intragastric Balloon System (ORBERA™) Patient Information Booklet [Internet]. 2015 [cited 2 February 2018]. Available from: http://www.accessdata.fda.gov/cdrh_docs/pdf14/P140008a.pdf
30. Overweight and obesity [Internet]. World Health Organization. 2017 [cited 2 February 2018]. Available from: http://www.who.int/gho/ncd/risk_factors/overweight_obesity/obesity_adults/en/
31. Peterson N, Middleton K, Nackers L, Medina K, Milsom V, Perri M. Dietary self-monitoring and long-term success with weight management. Obesity. 2014;22(9):1962-7. 
32. Pischon T, Boeing H, Hoffmann K. General and Abdominal Adiposity and Risk of Death in Europe. Journal of Vascular Surgery. 2009;49(3):811-2. 
33. Rooney K, Werrett G. Obesity and Anaesthesia [Internet]. 2006 [cited 2 February 2018]. Available from: http://www.anaesthesiauk.com/documents/obesity.pdf
34. Rubino F, Nathan D, Eckel R, Schauer P, Alberti K, Zimmet P,et al. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care. 2016;39(6):861-77. 
35. Sallet J, Marchesini J, Paiva D, Komoto K, Pizani C, Ribeiro M,et al. Brazilian Multicenter Study of the Intragastric Balloon. Obesity Surgery. 2004;14(7):991-8. 
36. Sharma A, Kushner R. A proposed clinical staging system for obesity. International Journal of Obesity. 2009;33(3):289-295. 
37. Shaw K, Gennat H, O’Rourke P, Del Mar C. Exercise for overweight or obesity. Cochrane Database of Systematic Reviews. 2006;4. 
38. Sleeve Gastrectomy | International Federation for the Surgery of Obesity and Metabolic Disorders [Internet]. International Federation for the Surgery of Obesity and Metabolic Disorders. 2018 [cited 2 February 2018]. Available from: http://www.ifso.com/sleeve-gastrectomy/
39. Stroh C, Birk D, Flade-Kuthe R, Frenken M, Herbig B, Höhne S,et al. Studie zur Qualitätskontrolle der operativen Therapie der Adipositas – Ergebnisse der Jahre 2005 und 2006. Zentralblatt für Chirurgie. 2008;133(05):473-8. 
40. Thorogood A, Mottillo S, Shimony A, Filion K, Joseph L, Genest J,et al. Isolated Aerobic Exercise and Weight Loss: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The American Journal of Medicine. 2011;124(8):747-55. 
41. Tooze JA, Schoeller DA, Subar AF, Kipnis V, Schatzkin A, Troiano RP. Total daily energy expenditure among middle-aged men and women: the OPEN Study. Am J Clin Nutr. 2007 Aug;86(2):382-7. 
42. U.S. Department of Health and Human Services Public Health Service National Institutes of Health National Heart, Lung, and Blood Institute. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. [Internet]. NIH Publication No. 00-4084; 2000 [cited 2 February 2018]. Available from: https://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdf
43. Wing R, Tate D, Gorin A, Raynor H, Fava J. A Self-Regulation Program for Maintenance of Weight Loss. New England Journal of Medicine. 2006;355(15):1563-71. 
44. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005 Jul;82(1 Suppl):222-5. Review. 
45. Yanovski S, Yanovski J. Long-term Drug Treatment for Obesity. JAMA. 2014;311(1):74. 
46. Yumuk V, Frühbeck G, Oppert J, Woodward E, Toplak H. An EASO Position Statement on Multidisciplinary Obesity Management in Adults. Obesity Facts. 2014;7(2):96-101.

«Bulletin of problems biology and medicine» Issue 1 Part 1 (142), 2018 year, 34-39 pages, index UDK 616-056.52

10.29254/2077–4214–2018-1-1-142-34-39