▶ Park Young-seok, professor of surgery at Seoul National University Bundang Hospital
Obesity refers to when the body mass index (BMI), which is body weight divided by the square of height, is greater than 25 kg/㎡ (Korean Obesity Society). Specifically, if your BMI is above 35 kg/㎡, you are considered “severely obese.”
If you are “severely obese,” “obesity metabolic surgery” is the most effective treatment (National Institutes of Health). Fortunately, as of 2019, bariatric metabolic surgery to treat severe obesity is covered by health insurance.
-What is obesity metabolic surgery?
The goal is to substantially improve obesity by reducing food intake and absorption and reducing the risk of developing underlying diseases. As it is a surgery to treat diseases, it can be covered by national health insurance if it meets certain standards, so it is different from cosmetic treatments such as liposuction.
Obesity metabolic surgery is basically a method of cutting the stomach (sleeve gastrectomy) or bypassing it (Roo-Y gastric bypass), which reduces the capacity of the stomach and lowers the absorption rate, making it easier for obese patients to eat more less. Some patients fear feeling sad or in pain because they can’t eat much, but in reality they feel full even if they eat less, so very few patients have difficulty with this.
-Will the size of the stomach return over time?
About 2 to 3 years after surgery, the average amount of food consumed per meal is 70 to 80% of a serving. If you can eat more than 1-2 servings, it means something is wrong and you need to get tested. In other words, it’s actually difficult to gain weight back due to overeating.
However, bariatric surgery doesn’t mean you’ll never gain weight again. Even if you eat less, if you consume a lot of high-calorie foods, sweet snacks, drinks or alcohol, you will gain weight.
Of course, most people maintain good eating habits and the weight loss effect lasts a long time, so there is no reason to have vague resistance to surgery because of the worry of “not being able to control my eating habits adequately.” even if I had to undergo surgery.” As a result of a long-term follow-up study 10 to 20 years after metabolic surgery for obesity, cardiovascular disease complications and mortality rates of surgical patients were significantly lower.
-Is it possible to perform surgery on patients with obesity-related complications?
Since obesity metabolic surgery is also effective for obese patients suffering from diabetes, the surgery can be performed with national health insurance. This applies to patients with type 2 diabetes whose blood sugar level is not well controlled and whose body mass index (BMI) is 27.5 kg/㎡ or more. If you are not a lean diabetic and have difficulty controlling your blood sugar levels with medications or insulin alone, you may consider this surgery.
In particular, diabetic patients between 30 and 40 years of age have good results because they adapt well to changes in eating habits and can lose weight easily. The younger the patient, the more likely it is that pancreatic function is well preserved, so the higher the the effect of improving diabetes. .
Obese women of childbearing age who have difficulty conceiving due to PCOS can also benefit greatly from this surgery. Even before you lose enough weight after surgery, your hormones change, your menstrual cycle returns, and your fertility improves. One thing to note is that for the first year after bariatric surgery you eat less and lose a lot of weight, so for the health of the fetus it is best to try to get pregnant at least a year after surgery.
Daeik Kwon, medical journalist>
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