Overweight in Russia has about 60% of the population, according to official statistics, every fifth inhabitant of the country is obese. In addition, among people over the age of 30, there is already 30% of the population and the larger the group we get, the higher the percentage of people with obesity.
A person can not always deal with this problem alone. When you are over 30 kg, it is almost impossible to do this without outside help – eventually, physical activity becomes impossible and without movement it is not easy to stop gaining weight simply with the help of a diet. In such cases, bariatric surgery or “obesity surgery” comes to the rescue.
What kind of surgeries are they, who can help, said an experienced doctor – candidate of medical sciences, surgeon of the highest category Arshak Arutyunovich Asatryan.
– In which cases are weight loss surgeries recommended and which ones?
– Many patients do not have the ability to treat obesity conservatively (diet, exercise, medication), because they already have a number of contraindications. For example, if a person has third-degree osteoarthritis of the hip joint, no matter how much you tell them to exercise, they simply will not be able to do it physically.
You can not just be hungry. We live in a certain society, in certain climatic conditions, we have winter for six or seven months, and if you do not eat certain foods during this period, your health will not increase. In addition, there are habits in which it is difficult for such people to sit at home and fight with themselves, not to eat without providing physical activity and to lose weight. For these patients, bariatric surgery is the best way.
The essence of such operations is the removal of part of the stomach, when instead of the stomach a gastric tube is formed, due to which a person begins to eat less and lose weight. It is important to note that with this measure we do not achieve some kind of aesthetic result, although this happens, whether you like it or not. The main goal is to fight obesity, which causes so many chronic diseases: diabetes, hypertension, osteoarthritis, joint problems, etc.
These operations are performed according to strict indications, one of which is diabetes mellitus.
For our country, this is a conditionally new direction – the experience of performing such operations amounts to a total of 20-30 years, but they have been actively practiced in our country for the last five or six years. If in different countries of Europe and America about 40-60 thousand such surgeries are performed annually, then we have a tendency to increase, but so far they do not exceed five thousand per year. This is due to several factors, mainly due to the fact that we have a conservative society.
– But we love the “magic pill”!
“They do, but someone has to recommend this pill. If therapists, endocrinologists are not used to it, they just do not know or have heard of it, but for them it is something new and incomprehensible, in which they have not delved, they will not tell the patient about this possibility. This is what hinders the spread and development of this therapeutic tactic.
What are you trying to achieve with these surgeries?
– Continuous weight loss. You can often observe a picture: a person starts exercising, with a desire to get some food, begins to lose weight, loses 5% of weight within a year. Then, for some reason, it crashed. And he starts gaining weight. After bariatric surgery, this becomes impossible.
– And if someone is accustomed to eating a lot, his stomach is reduced, he will not be able to stretch it later and gain weight again?
– This is the most common myth. The stomach really has endless possibilities for stretching. However, during the operation, we remove exactly that part of the stomach that is stretched. It remains the so-called smaller curvature of the stomach, which is not subject to stretching. After such operations, the stomach is stretched only when the operation was technically incorrect.
– And if someone is used to eating a lot, if he likes to eat a lot, how to deal with it?
– Our emotions and desires do not just arise – everything happens under the influence of the central nervous and hormonal system. In the so-called bottom of the stomach, there are endocrine cells that produce a special hormone that provides the person with a feeling of hunger and appetite. During the operation, this part of the stomach is removed and patients note not only that they can not eat much, because their stomach is narrow and does not fit much food. But the fact that they do not want to eat much, due to the fact that this part is removed and there is no hormonal effect on the formation of a “terrible” appetite.
– How fast does the weight start to fall after the operation?
– The process starts immediately. About 15-20% of the excess weight is lost in the first three months after surgery. This is a pretty good result, as conservative methods of combating obesity provide a loss of no more than 5% of excess weight during the year. And then this loss is most of the time unstable, unfortunately, there is always the risk of damage and overturning.
Is stomach reduction the only surgical solution?
There are several types of surgery in bariatric surgery. There are restrictive surgeries that aim only at reducing the stomach. And there are combined bariatric bypass surgeries that not only reduce the stomach, but also affect part of the small intestine (where all the nutrients of the body are absorbed). This is another operation. It ensures that a person eats little, and that what he eats is only partially absorbed – this further reduces the person’s weight and affects the process of treating diabetes and other problems.
These surgeries are not performed as often as simply reducing the volume of the stomach. And after that, patients may experience some discomfort because there are problems with the amount of vitamins and minerals – they need to be taken extra. In any case, which method of treatment to choose is always determined individually and strictly according to the indications.
In addition, we have an interdisciplinary team working with such patients in our clinic, which includes a cardiologist, a gastroenterologist, a nutritionist, an endocrinologist and a bariatric surgeon. We do not take anyone for immediate surgery – under no circumstances should this be done. Treatment should always be started with conservative methods, monitoring by an endocrinologist-nutritionist, diets and medications. And only if the result is not achieved, the question of surgery arises.
And in the postoperative period, the patient continues to be monitored and, if necessary, treated under the supervision of the team. This is a very important occasion, because in our city there is an unhealthy trend: come, have surgery and leave, live as you wish – this is wrong. Our task is not just to operate on an obese patient, but to help him face his problem, solve it and learn how to live with this result, to maintain it for many years.
You can make an appointment with Arshak Harutyunovich Asatryan or other obesity specialists at the Pasman Clinic by calling: 8 (383) 285–60–59.
ag. Karamzin, 92
Tel. +7 (383) 285–60–59
License LO-54-01-006086 dated 11 November 2020.