Prof. Michalik: Bariatric surgery is not a cosmetic procedure but a life-saving one

The team led by Prof. Maciej Michalik from the Department of General and Minimally Invasive Surgery of the University of Warmia and Mazury conducts 500 bariatric procedures per year in the city hospital in Olsztyn. They consist in reducing the stomach size in obese people. The procedure under full anaesthesia takes about 45 minutes, and the patient is discharged from the hospital on the first day after surgery. The procedure is financed by the National Health Fund. During the first 6 months, the patient loses 10 to 20 kilograms per month, then the weight loss is smaller (2-3 kg per month), and ultimately the weight stabilizes.

"According to the World Health Organization (WHO), obesity is the first epidemic of the 21st century: two-thirds of American population are overweight or obese people. Poland is one of four countries in Europe (together with the Czech Republic, Germany and the United Kingdom), where people gain weight the fastest. The worse news is that Polish children are the fastest in Europe when it comes to gaining weight, which is a bad prognosis" - emphasises Prof. Michalik.

He points out that "an obese person is treated as a village fool, a benevolent fatty with a weak will, a glutton who avoids any activity".

He adds that the common view is that you only have to move a lot and the effect of weight loss will come. "But I was operating on a sportswoman who trained for 8 hours a day and a man who works hard physically. Should I advise them to work out some more after a workout or a day of hard work?" - the specialist asks.

He emphasises that obesity is a disease of complex aetiology and its causes include genetic factors as well as thermoregulation disorders, lipid metabolism disorders, hormonal disorders, including ghrelin (the hunger hormone) level.

"A slim person is not a person who has a strong will, clenched teeth and watches the amount of eaten food. A slim person has a low level of hunger hormone, a person, for whom eating products worth 1800 kcal is enough to feel comfortable. An obese person feels hunger unless he or she eats 3.5 thousand kcal" - describes Prof. Michalik.

He points out that obesity is a mother disease that spawns other diseases - from the classical ones such as hypertension, type 2 diabetes, through endocrine disorders, such as hypothyroidism or polycystic ovary syndrome causing problems with pregnancy, to cancer. In obese people, the risk of cancer is up to 7 percent higher; ovarian and uterine cancer may occur in women. There is a greater risk of developing gallbladder cancer, colon cancer or pancreatic cancer. Men have a problem with erectile dysfunction. The quality of life of obese people is significantly reduced, starting from the problems with the purchase of clothes and footwear to limited social relations and exclusion.

Research suggests that obesity shortens life expectancy by 8 to 20 years. "An obese person is a patient who may die as a result of sudden cardiac death, but in the death certificate we will not show that the cause was obesity, but rather hypertension or diabetes, which is why experts propose to call this disease fatal obesity" - Prof. Michalik says.

"Treating bariatric surgery as a cosmetic surgery is a misunderstanding, and stating that obese people want to +take a shortcut+ when they decide to have a surgery, is false" - he adds. "This procedure saves lives. The point is not to change obese women into top models or obese men in Arnold Schwarzenegger look-alikes, but to restore patients` normal health" - he emphasises.

After surgery, the patient loses weight, and the accompanying diseases such as hypertension and diabetes disappear. Epilepsy, from which patients suffer, takes a milder form. Skin diseases such as psoriatic dermatitis or shin ulcer are also easier to treat.

The expert explains that conservative treatment of obesity is ineffective. Patients lose only 5 to 10 percent of their weight. On average, a person who has a stomach size reduction surgery has tried 18 weight-loss therapies. They do not bring the desired results and, due to the yo-yo effect, after temporary weight loss patients gain even more.

Patients come to bariatric surgery centres through support groups and associations of obese people. In Poland, such associations include the "Od-waga" foundation and the association "CHLO czyli chirurgiczne leczenie otyłości". They are also referred by family doctors, endocrinologists, diabetologists and orthopaedists. Surgeons in Olsztyn also operate on obese children. The condition is that the young person should reach sexual and bone maturity. The child`s treatment must also be preceded by work with parents and psychological support. (PAP)

author: Agnieszka Libudzka

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