World Obesity Day: who can benefit from it, what are the techniques… everything you need to know about bariatric surgery

Une chirurgie bariatrique n’est pas toujours possible. Trois critères doivent être remplis pour qu’elle soit envisageable.

On the occasion of World Obesity Day on March 4, the High Authority for Health published its latest recommendations concerning the management and care pathway for people who are overweight and overweight. rsquo;obesity. Focus on bariatric surgery, a possible therapeutic option for adults, under strict conditions.

Obesity is a chronic disease that can cause daily difficulties but also have deleterious effects on health. It can in fact cause other pathologies such as diabetes, high blood pressure, hypercholesterolemia, and sleep apnea syndrome. 17% of adults are obese in France, 49% overweight. While the prevalence of overweight remains stable, around 30%, the prevalence of obesity has been increasing at a rapid pace in recent years. It increased from 8.5% in 1997 to 15% in 2012 and 17% in 2020. Several therapeutic options exist to treat obesity, including bariatric surgery.

What is bariatric surgery ?

The High Authority for Health recently published, in the run-up to World Obesity Day on March 4, a guide to the care pathway for adults who are overweight and of obesity. One of the chapters is devoted to bariatric surgery. Also called obesity surgery, it "modifies the anatomy of the digestive system.It is a mechanical and metabolic aid which makes it possible to reduce the quantity of food consumed (Principle of restriction) and/or the assimilation of food by the body (principle of malabsorption)’ quot;.

Who can benefit from it ?

Bariatric surgery is not always possible. Three criteria must be met for it to be possible:

Suffering from massive obesity (BMI ≥ 40 kg/m²) or severe obesity (BMI ≥ 35 kg/m²) when it is associated with at least one complication that can be improved through surgery (diabetes, high blood pressure, sleep apnea syndrome, joint disorders…); Have already tried unsuccessfully to lose weight thanks to specialized medical care lasting several months with dietary monitoring, physical activity and psychological care; Do not have contraindications to surgery (e.g.: alcohol dependence) and general anesthesia.

Thus, in its report, the HAS insists on the fact that "bariatric surgery is a therapeutic option considered when a care and amp; rsquo;personalized support was implemented for 6 to 12 months by professionals with the support and participation of the person being treated, without sufficient benefits to his overall health. It cannot therefore be immediately offered to the patient.

Who to contact ?

You should talk to your doctor or a doctor specializing in obesity in advance. The patient will then be referred to a multidisciplinary team who will be able to tell them if an operation is possible. If this is the case, a preparation phase begins and it is at the end of this phase that the multidisciplinary team will deliver its final opinion.

How much preparation time before the intervention ?

"Its duration is at least 6 months from the planning of the personalized preparation for bariatric surgery and provided that the objectives of the preparation are achieved",continues the HAS. However, longer preparation is often necessary to fully understand the issues of the operation, acquire the necessary skills after bariatric surgery (self-care), treat other conditions, remove contraindications…

What are the techniques?

Restrictive techniques consist of reducing the size of the patient's stomach including gastric banding or gastrectomy ( practice which consists of removing part of the stomach).

Another technique, mixed (restrictive and malabsorptive), is gastric bypass. According to the specialized obesity center in Marseille, it "allows you to reduce both the quantity of food ingested (the size of the stomach is reduced to a small pocket) and the assimilation of these foods by the body, thanks to a short circuit of part of the stomach and intestine. Food arrives directly in the middle part of the small intestine and is therefore assimilated in smaller quantities.

And after the surgery ?

During his journey, the patient must be well informed that surgery alone is not enough. "Bariatric surgery is only one step in patient care", explains Dr. Séverine Ledoux , specialist in overweight and obesity, in a video posted online by the APHP. She points out that obesity is multifactorial and that these factors vary from one patient to another. "Surgery will only act on one of the determinants of obesity , which is the food volume. The patient will have to work on the determinants, that is to say eating disorders, l’ physical activity, stress, sleep, etc.", continues the specialist.

In addition to these new habits to put in place, psychological difficulties can arise linked to the modification of body image and relationships with others. Psychological help is offered to patients to overcome these problems.