Metabolic weight loss surgery saves severe obesity! Four key points of the new international guidelines are released

According to a 2016 study by the British medical journal Lancet, more than one in eight adults in the world were obese in 2014, and this number will increase to one in five by 2025, exceeding 1.1 billion. This will be the first time in the world that the number of obese people will exceed that of underweight people, and the obese population will also exceed the proportion of the population where one in nine people is malnourished and underweight. There are many health problems related to obesity, including high blood pressure, diabetes, high blood lipids, sleep apnea, etc. From the above problems, it can be seen that obesity has become a problem that everyone needs to pay great attention to.

Obesity has been regarded as a chronic disease that can cause many problems. In addition to the three highs (high blood pressure, high blood sugar, and high blood lipids) and cardiovascular diseases, it can also cause sleep apnea, fatty liver, and the incidence of cancer.

Obesity is a chronic disease. Poor control may lead to comorbidities.

Professor Li Weijie, former president of the Taiwan Society of Metabolic and Bariatric Surgery, pointed out that obesity has been regarded as a chronic disease and will cause many problems. In addition to the three highs (high blood pressure, high blood sugar, and high blood lipids) and cardiovascular diseases, it will also cause the incidence of sleep apnea, fatty liver and cancer. When one is fat to a certain extent, the bones and joints cannot bear the burden, which will cause chronic pain and compromise the quality of life.

Dr. Bo-jen Yang, clinical associate professor of surgery at the National Taiwan University School of Medicine and CEO of the Weight Loss and Metabolic Surgery Center at the National Taiwan University Hospital, said that Taiwan's National Health Insurance classifies people with a body mass index (BMI) ≥ 32.5 and obesity-related complications, or a BMI ≥ 37.5, as "morbidly obese" patients. If such patients use medical weight loss treatments such as drugs, diet, and exercise, they may lose weight quickly in a short period of time, but the long-term failure rate is as high as over 90%. The physiological structure of this type of patients has not changed. The physiological signals, including the brain's desire for food and the gastrointestinal tract's demand for nutrition, are the same. Once the patients relax a little, they will uncontrollably return to their previous eating habits, and eventually even exceed their original weight. This constant fluctuation in weight is called the "yo-yo effect." In addition to causing great psychological pressure on patients, it also has a huge negative impact on the body.

BMI is seriously over the limit, and renal failure makes it difficult to even undergo dialysis

Dr. Yang Boren once treated a 48-year-old Mr. Chen, who was too busy running his own business to take care of a balanced diet and often attended social gatherings and dinners. Over time, his weight increased rapidly and his BMI exceeded 40. His kidney failure was so serious that he had to undergo dialysis. However, due to morbid obesity, he had difficulty with hemodialysis or peritoneal dialysis. His wife hoped to donate a kidney to save him from dialysis, but he was too overweight and a kidney transplant would be quite risky. The doctor recommended weight loss first and then surgery, but he was still unable to achieve his weight loss goal through medication, so he had to undergo bariatric surgery. After the surgery, his BMI dropped to 28.3, and he was able to safely and successfully undergo a kidney transplant.

International metabolic weight loss surgery guidelines updated for the first time in 30 years

Professor Li Weijie shared that metabolic weight loss surgery is a very important medical procedure for severely obese people. Many obese people's complications such as diabetes, cardiovascular disease, kidney disease, etc. can be greatly alleviated after surgery. Recently, the American Society for Metabolic and Bariatric Surgery and the International Society for Bariatric and Metabolic Surgery jointly published the latest consensus on indications for metabolic bariatric surgery in 2022, which keeps pace with the times and replaces the old standards from 30 years ago. The key points include:

Recently, the American Society for Metabolic and Bariatric Surgery and the International Society for Bariatric and Metabolic Surgery jointly issued the latest consensus on the indications for metabolic bariatric surgery in 2022, which keeps pace with the times and replaces the old standards from 30 years ago. (Photo courtesy of the Society of Metabolic and Bariatric Surgeons)

1. For those with BMI ≥ 35kg/m2, bariatric surgery is recommended. For those with BMI between 30-34.9kg/m2 and metabolic diseases, if they cannot lose weight effectively through non-surgical weight loss methods, metabolic weight loss surgery should be considered.

2. Asians with a BMI ≥ 25kg/m2 should be considered obese, and those with a BMI ≥ 27.5kg/m2 are recommended to undergo metabolic weight loss surgery.

3. Metabolic weight loss surgery may also be considered for children and adolescents after careful evaluation of the impact of obesity.

4. Randomized clinical trials spanning 30 years and real-world patient outcome data have confirmed that metabolic weight loss surgery is safe, effective, and durable compared to non-surgical treatments.

"Bariatric surgery not only helps patients lose weight, but also improves complications. Many patients with type 2 diabetes meet the criteria for stopping medication after undergoing bariatric metabolic surgery." Dr. Yang Boren pointed out that bariatric surgery is very helpful in improving the long-term survival and quality of life of morbidly obese people.

The current NHI reimbursement standards for weight loss surgery are for those aged 20-65 years with a BMI ≥ 37.5, or those with a BMI ≥ 32.5 and obesity complications. Although international guidelines have been updated, considering that international guideline research is based on Western races, the recommendations for Asian groups are not clear. In the short term, Taiwan's medical community needs more consensus before it can follow up.

Surgery can effectively reduce weight, and gastric reduction surgery can reduce more than 25% of body weight

Dr. Yang Boren shared that metabolic weight loss surgery is mainly performed in two ways: gastric bypass surgery and gastric reduction surgery. Gastric bypass surgery involves separating most of the stomach and leaving it in the body, while only connecting a small part of the stomach directly to the small intestine, thereby reducing food intake and absorption, achieving the effect of weight loss. It is suitable for patients with metabolic diseases such as diabetes. Gastric reduction surgery involves removing most of the stomach, leaving only about a quarter of its capacity. Many patients can only eat a quarter of a lunch box after the operation, and it is expected to reduce more than 25% of their weight.

Professor Li Weijie pointed out that in fact many diabetic patients suffer from weight control, and research results have proved that bariatric surgery not only helps to reduce weight, but also can relieve patients' physical and mental relief, making it easier to fight the disease. He further explained that the issue of weight loss surgery improving and curing diabetes has sparked widespread discussion in the medical community in recent years. This is because weight loss surgery shortens the path of food from the stomach to the small intestine, guiding the pancreas to return to normal function, thereby inhibiting the rise in blood sugar and relieving diabetes symptoms. Postoperatively, the decrease in food intake and food absorption can also make diabetes treatment more effective.

Medical aesthetics has been on the rise in recent years, and many people still view weight loss at the level of external aesthetics. In fact, the reason why some patients are obese may be due to family genes, not themselves. The key to weight loss is maintenance. People who want to lose weight should adopt a balanced diet and exercise to avoid unexpected weight rebound. If necessary, they can seek medical assistance to achieve their weight loss goals. If they try diet control, exercise, etc. and still cannot effectively achieve their goals, they should seek medical evaluation and rely on internal medicine medications. If that doesn't work, they can consider metabolic weight loss surgery.