Obesity increases the risk of cardiovascular disease! What are the types of weight loss surgeries? What are the conditions for health insurance to cover weight loss surgery?

In the outpatient clinic, I met a patient in his 30s who told me about the problems he was facing: he couldn't sleep well at night and often woke up. His roommates complained about his loud snoring. He also often had knee pain. These problems had lasted for a long time and tended to become more and more serious. Of course, as soon as he stepped into the clinic, I knew what was going on - he was a morbidly obese patient, and was classified as super obese. After understanding his problems and the causes of his illness, we began to conduct detailed inquiries regarding his eating and exercise habits.

The patient stated that the effects of medications she had taken at other weight loss clinics were not ideal. It was also relatively difficult for her to increase her exercise due to her daily work and current knee pain. After half a year of dietary adjustment and tracking in the outpatient clinic, the results were still low. After a detailed discussion with the patient, it was decided to perform surgical treatment. After the surgery, the patient's weight loss was quite obvious at the beginning. The patient's diet after the surgery can be said to have adapted well. His weight is currently decreasing steadily, and the symptoms that troubled him before the surgery are gradually alleviating.

The word obesity may have been seen as a sign of affluence in the past, but in today's medical concept it is a sign that needs to be actively controlled; morbid obesity is already considered a disease. In this era of calorie explosion, most people consume foods high in sugar and oil, but few are able to get enough exercise to burn off these calories. Due to the situation of "spending more than income", people's weight is rising sharply. According to the World Obesity Atlas 2023, in 2020, 38% of the world's population was overweight and 14% was obese; even among adolescents, the obesity rate was still as high as 8-10%. This is a very shocking number, considering that the global prevalence of diabetes is only 9.8% (2021). The proportion of obese people is even higher in advanced countries, even reaching over 40% in the United States. In Taiwan, surveys from 2017 to 2020 showed that the overweight and obese population reached 50.3%.

So what exactly is considered obesity? According to the definition of the World Health Organization (WHO), the distinction is made based on body mass index (BMI). BMI is an index obtained by dividing body weight (kg) by height squared (m2). Overweight is ≥25, and obesity is BMI ≥30. So-called morbid obesity varies slightly from region to region. The United States defines morbid obesity as a BMI ≥ 40 or ≥ 35 with one or more comorbidities caused by obesity; the Taiwanese standard is a BMI ≥ 37.5 or ≥ 32.5 with one or more comorbidities caused by obesity. Therefore, morbid obesity has been regarded as a disease that requires active medical assistance to control weight. The above-mentioned outpatients are extremely obese with a BMI ≥ 50, which results in more serious complications.

What problems does obesity itself bring? These include poor metabolism of blood sugar and blood lipids; increased risk of cerebrovascular and cardiovascular diseases and hypertension; excessive wear and tear on the knee joints due to excessive weight; acid reflux in the gastrointestinal tract due to excessive abdominal pressure; sleep apnea syndrome; increased risk of cancer; and many other problems including skin, immune system, and psychological issues. This will certainly not be reflected in young people immediately, but after 10 or 20 years, the physical damage caused will emerge one by one, causing irreversible symptoms.

Weight control initially focuses on diet control and changing lifestyle and exercise habits. There are many health foods and even drugs on the market to help people lose weight, but most of them require long-term use. There are many cases where weight regains immediately after stopping use. And for many obese patients with serious complications, it may be too late to save the day. Bariatric surgery has been shown to produce long-term and stable weight loss results. The weight loss mechanism of bariatric surgery can be divided into two parts: restricting intake and restricting nutrient absorption. Therefore, gastric reduction surgery and bypass surgery are the two core components of weight loss surgery.

The more common surgical operations currently include sleeve gastrectomy, Roux-en-Y gastric bypass, and the most popular single anastomosis gastric bypass. About 3/4 of weight loss surgeries worldwide are sleeve gastrectomy because of its good weight control effect and low side effects and complications. However, for patients with severe poor blood sugar control or patients who gain weight again after sleeve gastrectomy, they must consider combined bypass surgery to further lower blood sugar and weight, which will inevitably bring more risks of complications. Due to the advancement of technology and equipment, these operations are performed in a minimally invasive manner to achieve the effect of small wounds and quick recovery.

There will be a difficult adaptation period of several weeks after the surgery. The texture and quantity of diet must be adjusted, and some vitamins and minerals must be supplemented to avoid nutritional imbalance caused by the surgery. After that, you can slowly adjust to a normal diet, but you still need to understand that there is still a chance of gaining weight again after the operation, so you need to remind yourself to control the portion size and keep the ingredients balanced. Some reports show that the effectiveness of general surgical weight loss can reduce weight by more than 70% after 2 years of follow-up, and can maintain a reduction of about 60% after 10 years of follow-up. The rate of weight regain varies from 3.3% to 12.5% ​​depending on the surgical method chosen. Of course, these are approximate figures, and the actual condition and speed of weight loss will vary from person to person.

Currently, bariatric surgery is covered by National Health Insurance. Starting from May 1, 2020, National Health Insurance coverage for bariatric surgery treatment must meet certain conditions.

Currently, bariatric surgery is covered by the National Health Insurance. Starting from May 1, 2020, the National Health Insurance's payment for bariatric surgery treatment must meet the following conditions:

• BMI ≧ 37.5, or BMI ≧ 32.5 and combined with high-risk complications, such as: type 2 diabetes patients whose glycosylated hemoglobin remains 7.5% after medical treatment, hypertension, apnea syndrome, etc.

• Age range: 20 to 65 years old.

• The patient must have been in a weight loss clinic for at least six months (or have relevant supporting evidence from the clinic for at least six months) and have controlled his diet through exercise for more than six months.

• No endocrine system abnormalities or other diseases that may cause obesity.

• No substance abuse or mental illness.

• No major organ dysfunction and can accept the risks of surgery.

• The patient is mentally sound and has been confirmed to be normal by a psychiatric specialist.

Patients who need to lose weight can go to the Cathay General Hospital outpatient clinic for more detailed instructions and learn about weight loss methods that better suit their needs.