Surgical treatment of obesity

Written by Yang Li
Endocrinology
Updated on September 06, 2024
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Surgical treatment for obesity is applicable under certain conditions. This requires the obesity to reach a specific level, defined by indicators such as a BMI of over 35, and in the absence of severe diabetes or complications associated with diabetes. Considering surgical interventions for weight loss, these primarily involve bariatric surgeries like gastric bypass or gastroenterostomy which reduce food intake and absorption, thereby decreasing calorie absorption to achieve weight loss. While the effects of surgical weight loss are generally quite good, it can lead to some long-term postoperative complications, so careful consideration is required.

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Which department does obesity belong to?

Obesity is defined by calculating the Body Mass Index (BMI), where one's weight in kilograms is divided by their height in meters squared to obtain a numeric value. If the BMI is 28 or higher, it is defined as obesity. There are two types of obesity based on BMI excess: simple obesity and secondary obesity. Simple obesity occurs without any other internal medical conditions, purely due to weight gain. Secondary obesity may be due to other psychosomatic diseases that lead to an increase in BMI. Therefore, it is recommended to consult the endocrinology department for physical examinations and laboratory tests to determine whether the obesity is simple or secondary. Hence, a consultation in the endocrinology department is advised.

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What is obesity?

Obesity is a common group of metabolic syndromes, which occurs when the caloric intake of a human body exceeds its caloric expenditure. The excess calories are then stored in the body in the form of fat. When this amount exceeds normal physiological needs and reaches a certain value, it evolves into obesity. There are many methods for assessing obesity, including anthropometry, dual-energy X-ray absorptiometry, ultrasound, CT, infrared sensing valves, and others. Obesity without a clear pathological cause is referred to as simple obesity, while obesity with a defined pathological cause is referred to as secondary obesity. The causes of obesity are of two types: one is primarily due to excessive diet and insufficient activity, where caloric intake exceeds caloric expenditure; the other is obesity caused by disorders of fat metabolism.

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How is obesity treated?

Regarding the treatment of obesity, the cause of obesity must first be identified. For patients with simple obesity, the primary approach involves lifestyle interventions, including exercise and diet. The diet should involve a calculation of caloric intake based on activity levels, generally focusing on a low-calorie or very low-calorie intake. Additionally, it is recommended to engage in suitable aerobic exercises. Currently, there are products available such as fat enzyme inhibitors that reduce weight by inhibiting the absorption of fats in the intestines. Also, in the United States, GLP-1 agonists are available for the treatment of simple obesity. If obesity is caused by certain medical conditions, such as an endocrine disorder known as Cushing's syndrome, which can also lead to obesity, treatment should first address the primary disease, which would also resolve the obesity.

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What department should obesity be treated in?

Obesity should be considered based on the specific situation. If the patient has uniform obesity, meaning that the limbs and torso are equally fat, then they should visit the nutrition department for guidance on dietary control, diet adjustments, and increased exercise. However, if the patient's obesity appears different, for example, if they have a very thick back, a larger belly, a red face, and acne, then I suggest they consult the endocrinology department because it might be related to Cushing's syndrome, which involves centripetal obesity.

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What are the dietary restrictions for obesity?

If it's obesity, it means a body mass index (BMI) greater than 28. In terms of dietary restrictions for obesity, the general principles are low salt and low fat. First and foremost, intake of fats should be limited, including both the cooking oils and foods consumed. Preference should be given to vegetable oils, and consumption of animal fats should be minimized. Even with vegetable oils, there is a limit to how much should be used, as excessive amounts can also exceed health standards. Furthermore, one should eat less fast food and junk food, such as various fried foods or those containing excessive seasonings, and these foods should be consumed minimally. There are also "invisible" fats to consider, such as those found in nut snacks and various small packaged snacks like peanuts and fried beans, which are very high in calories and should be consumed less. Additionally, sugary drinks like iced tea and pear syrup drinks should be avoided. The overall principle is a low-calorie diet, avoiding high-calorie foods.