Obesity: Conservative Treatment or Bariatric Surgery?

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The World Health Organization classifies obesity as a "noncommunicable epidemic of the 21st century". According to current statistics, more than 50% of Europeans cannot get rid of their excessive weight, while more than 20% of Europeans suffer from obesity. In economically developed countries, the treatment costs for obesity and its complications make up 8-10% of the total annual healthcare costs.

The modern range of therapeutic options available include lifestyle modification programs, dietary recommendations and individual sets of physical exercises, pharmacological support, and bariatric surgery. In each case, the doctor selects the most sparing and most effective scheme for the patient, which guarantees a long-term result.

Content

1. Obesity treatment goals
2. Selection of the best therapeutic tactics
3. Preliminary medical examination
4. What is included in the conservative obesity treatment program?
5. Eating behavior correction
6. Advanced physical activity
7. Lifestyle modification
8. Pharmaceutical support
9. Selection of a specialist and development of a comprehensive treatment program

Obesity treatment goals 

Excess body mass is primarily associated with aesthetic problems. As a rule, overweight people are less active in social terms, they are more likely to experience psychological disorders, including depression. However, the main danger of obesity is associated with a high risk of somatic diseases:

• Cardiovascular diseases. Excessive adipose tissue leads to increased levels of "harmful" cholesterol (low-density lipoproteins), coronary heart disease, arterial hypertension, heart attacks, and strokes.
• Type 2 diabetes mellitus develops due to impaired tissue sensitivity to insulin, as a result of excess body mass. Also, the pancreas depletes its hormonal reserves and cannot provide the obese patient with the required amount of insulin.
• Oncological diseases. Major studies show solid evidence of the association of obesity with colorectal, esophageal, liver, pancreatic, endometrial, and breast cancers.
• Joint pathologies. An increased load on the musculoskeletal system leads to premature joint degeneration and the development of arthrosis.
• Reproductive dysfunction. The excess hormones of adipose tissue (leptin, adiponectin, and resistin) adversely affect the quality of eggs and sperm.

Thus, comprehensive obesity therapy pursues three goals:

1. reduction of body mass by 5-7% per month until its normalization;
2. patient's lifestyle modification for long-term consolidation of results;
3. assessment of the patient’s general condition in dynamics and, if necessary, treatment of obesity complications.

Selection of the best therapeutic tactics

As a more advanced treatment method, bariatric surgery attracts the attention of patients, promising quick results without any significant efforts. However, when choosing treatment tactics, the doctors always take into account the advantages and risks of both approaches. 

Advantages and disadvantages of bariatric surgery:

1. An advantage is that weight loss can be achieved faster, due to a sharp decrease in the volume of food (restrictive operations) or the intensity of nutrient absorption (malabsorption operations).
2. An advantage is that the patient can directly regulate the amount of food they eat by changing the volume of the stomach (in case of gastric banding).
3. A disadvantage is the surgical risks. Any operation potentially carries a risk of complications. These can be bleeding, infection, pain syndrome, and functional disorders of the gastrointestinal tract.
4. A disadvantage is the long period of hospitalization and rehabilitation. The patient should be under the supervision of doctors in a hospital for 5-7 days after their surgery. This period is followed by the adaptation to a new diet and physical activity.
5. A disadvantage is that the cost of treatment, especially in cases using endoscopic and minimally invasive interventions, can be quite high. As a rule, bariatric interventions are not covered by insurance.

Advantages and disadvantages of conservative therapy:

1. An advantage is a safe and physiological decrease in body mass, not exceeding 5-7% of the current weight per month. The risks of conservative therapy are minimal, especially when compared to surgical treatment.
2. An advantage is a more stable and long-term result. To maintain weight after any type of treatment, it is important to adjust the diet and build a good body with exercise. Surgery alone will not allow the patient to achieve their desired goal.
3. An advantage is improved overall health. Along with weight loss, conservative therapy has a positive effect on the cardiovascular and nervous systems, all types of metabolism, as well as the patient’s mental state.
4. A disadvantage is that the process of losing weight takes longer. This is undesirable in the treatment of obesity complications, such as hip arthrosis or diabetes mellitus decompensation.
5. A disadvantage is that the patient usually requires a radical modification of their lifestyle. The patient should change his attitude to physical activity and eating habits.

In general, the conservative methods demonstrate the highest effectiveness and long-term results. Doctors only prefer a permanent or temporary bariatric surgery if conservative methods have failed to be effective.

 

 

Preliminary medical examination

Specialists from the leading world hospitals only elaborate on an individual obesity treatment program after a comprehensive examination of the patient. This approach is most effective, since excess weight can be the result of hypothyroidism, adrenal pathology, or other disorders. In this situation, the medical program includes the necessary treatment of the underlying disease.

The preliminary medical examination includes:

1. Physical examination: body mass index calculation; abdominal, thigh, and shoulder circumference measurement; blood pressure measurement.
2. Laboratory testing: complete blood count, blood glucose test, glucose tolerance test, lipid profile, biochemical profile with the determination of kidney and liver function, hormone blood test (TSH, free T4, LH, FSH, prolactin, estradiol, progesterone, cortisol).
3. Imaging: ECG at rest and during exercise and abdominal ultrasound. If indicated, echocardiography, Doppler ultrasound of the blood vessels, and CT/MRI scans of the joints.

If there are complaints of snoring and respiratory failure during sleep, the doctors carry out diagnostics of obstructive sleep apnea. A psychologist also works with the patients. This helps to set patients the right goals and find their motivation for active participation in the treatment process.

What is included in the conservative obesity treatment program?

The initial stage of the program is on an inpatient basis. This increases the patient’s commitment to therapy and makes it easier for them to switch to a healthy lifestyle and acquire the necessary life skills to maintain their weight (for example, following a diet and day regimen, changing their food shopping habits, and daily exercise).

 

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Eating behavior correction

During a hospital stay, the patient switches to split meals and receives 5-6 meals per day. This mode of eating makes it possible for patients to get enough food from a small volume of dishes and eliminates overeating and extra "snacks". When the patient has split meals, they do not feel any hunger or discomfort.

Once active training at the inpatient stage of treatment is completed, the patient can do the following things on his own: 

• assess the composition of a food product and eliminate potentially hazardous food additives (preservatives, dyes, stabilizers, etc.);
• calculate the daily calorie content of food;
• create a tasty and varied menu for a day and for a week;
• create a food basket and organize the purchase of products;
• cook several dishes (basic meals);
• organize proper nutrition in various life situations, namely in everyday life, during a trip, on vacation, and during intense sports training.

If necessary, when developing an individual diet, the doctors take into account concomitant diseases, such as peptic ulcers, food intolerances, or diabetes mellitus.

Advanced physical activity

Physical activity makes up 20% of the result in weight loss (the remaining 80% depends on nutrition) along with 100% result is the improvement of aesthetic parameters of the body. The specialized European hospitals include several types of necessary physical activity in their treatment programs:

• workouts to improve overall stamina for at least 2.5 hours a day – walking, swimming, cycling, and aqua gymnastics;
• training for the formation of the muscular corset of the back (prevention of spinal pathology);
• joint gymnastics, flexibility exercises (yoga and pilates);
• outdoor games and sports;
• breathing exercises.

In addition to practical training, a patient is offered theoretical classes on the biological and medical background of a physical activity. The patient also learns how to do special exercises to reduce the volume of the stomach. This helps them to control the size of their servings and stops them overeating. Once the inpatient treatment is completed, the patient will receive a set of exercises to perform at home.

Lifestyle modification

Forming new everyday habits guarantees that after their discharge from the hospital, the patient will continue to work on their weight loss and will do it with pleasure. A good helper in "restructuring" their usual way of life is communication with a psychologist. Such classes provide an opportunity to:

• understand the benefits of weight loss;
• set goals for the near future and long-term goals;
• appreciate the changes that occur within the body, and encourage yourself to continue working;
• work with stressful situations and level their impact on the process of losing weight;
• identify the causes that have led to the development of obesity in the past, and exclude them.

If desired, patients can attend self-help groups to share their successes and difficulties with other people in a similar situation. Both diaries and photo diaries are encouraged, since these help the doctor and patient to track the weight loss process more objectively.

 

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Pharmaceutical support

In some clinical cases, losing weight requires pharmaceutical support. Taking medications can be either temporary, at the initial stage of losing weight, or permanent, for the treatment of chronic diseases:

• levothyroxine drugs for hypothyroidism (underactive thyroid, which is one of the common causes of obesity);
• metformin drugs for insulin resistance (impaired tissue sensitivity to insulin, which stimulates the synthesis of adipose tissue);
• specific inhibitors of gastric lipases (for example, Xenical, Orlistat), which hamper the absorption of food fats;
• drugs that affect the center of hunger in the brain (for example, Cefamadar) and suppress appetite;
• glucagon-like peptide-1 analogues (for example, Victoza, Saxenda) that regulate the levels of hormones affecting body mass.

Patients can also receive vitamin preparations and trace substances. According to the results of a number of clinical trials (for example, the CODING study on the use of selenium), replenishment of micronutrient deficiencies stimulates the process of losing weight and helps to maintain weight at the desired level in the future.

Selection of a specialist and development of a comprehensive treatment program

The high standards of work of the leading European hospitals allow them to treat not only the citizens of their countries, but also international patients. The European hospitals, in particular inpatient Obesity Centers in Germany, offer a structured treatment concept that combines the work of nutritionists, psychologists, physiotherapists, and specialists in related fields.

If you do not have extensive experience of treatment in foreign hospitals, it will be more comfortable and safe for you to use the services of the Booking Health company. The Booking Health helps patients from 75 countries to get treatment abroad.

The specialists of the Booking Health company will help you with the following important issues:

• selection of the right hospital based on an annual qualification profile;
• direct communication with an attending physician;
• preliminary development of a treatment program, without repeating previous examinations;
• provision of a favorable cost of hospital services, without overpricing and coefficients for foreign patients (saving up to 50%);
• appointment with a doctor on your desired date;
• monitoring of the medical program at all its stages;
• assistance in buying and forwarding medicines;
• communication with the hospital after the treatment’s completion;
• control of invoices and return of unspent funds;
• organization of additional examinations;
• top-class service, including the booking of hotels, airline tickets, and transfers.

Please leave a request with your medical and contact information, on the Booking Health website, and a qualified medical advisor will contact you on the same day. You will receive care and support 24/7 throughout your stay in the foreign hospital.

 

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Choose treatment abroad and you will for sure get the best results!

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Authors:

The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

 

Sources:

National Center for Biotechnology

Healthline

Medical News Today

 

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