Obesity is considered a risk factor for several diseases, such as strokes, cancer, diabetes and high blood pressure. There is no ICD classification (a number that indicates worldwide recognized diseases) for obesity by the WHO (World Health Organization), but many doctors are looking for forms of treatment to reduce the risks of other comorbidities.
Among the main types of treatment is bariatric surgery, the only alternative for patients with obesity who are exclusively dependent on the SUS (Unified Health System) in Brazil. Other ways to treat obesity include dietary re-education, psychotherapy and adopting a healthier lifestyle.
In recent years, new therapeutic classes indicated for type 2 diabetes have also shown surprising results in weight loss. Some of these drugs are already labeled for obesity in Brazil and the United States. However, there is still no incorporation of them into the public health service.
See below which treatments are available for obesity in public and private services.
WHAT IS OBESITY?
Clinical obesity is characterized by the accumulation of adipose tissue (fat) that causes signs or symptoms of organ dysfunction or affects mobility. An important effect of obesity is chronic inflammation of the body, which also harms the immune system. For this reason, doctors consider obese patients to have an increased risk of developing other conditions, such as type 2 diabetes.
When there is adiposity but no organ damage or dysfunction, it is called preclinical obesity.
WHAT TREATMENTS ARE AVAILABLE FOR OBESITY IN THE SUS?
In the SUS, there is a lack of treatments against obesity, the only one available being nutritional counseling, although this itself depends on the availability of a qualified professional at health centers, and bariatric surgery.
Bariatric surgery is recommended for people with a BMI (body mass index, calculated by dividing weight by height squared) equal to or greater than 40 or for those with a BMI greater than 35 and with comorbidities, which pose a health risk, such as steatosis. liver disease, heart disease and high blood pressure.
To obtain treatment through the public system, patients undergo a pre-surgical evaluation and must meet certain criteria, such as not responding to other forms of treatment for obesity, such as diet and exercise, for at least two years. Patients, however, wait five to ten years in line to undergo surgery through the SUS.
WHAT ABOUT THE HEALTH PLAN?
Just like via SUS, health plans offer coverage for bariatric surgery, also associated with a prior health assessment and referral by a surgeon.
In addition to bariatrics, health plans also offer some medications that are already known and used to combat obesity, with benefits in weight reduction.
These medicines, to be incorporated into the SUS, also need to demonstrate a reduction in mortality and cost-effectiveness and, therefore, there is no medicine approved so far for use in the public network.
HOW IS BARIATRIC SURGERY PERFORMED?
Bariatric surgery is recommended for people with a BMI above 40 and who have lived with obesity for at least five years, without success with previous therapeutic methods.
It consists of surgically reducing the size of the stomach, which will lead to less food intake and, thus, weight loss.
Bariatric surgery also plays a role in the production of hormones known as GLP-1, which act on the feeling of satiety, which will also lead to endocrine changes in the patient and reduce their desire to eat and hunger.
WHAT IS THE DIFFERENCE BETWEEN BYPASS AND GASTRIC SLEEVE?
The two most common types of bariatric surgery are gastric bypass and gastric sleeve. The first uses staples or cuts to reduce the stomach and alter the intestine, connecting it to the functional part of the stomach (creating a “Y” shape, which is why it is also called “roux-en-Y” bypass). The stomach capacity goes from around 1.5 L to up to 200 ml.
The gastric sleeve or ring consists of placing a band that reduces the mouth of the stomach, reducing the content that can pass through. In this technique, there is no change in the intestine.
WHAT IS RECOVERY LIKE?
In general, patients who undergo bariatric surgery undergo 2 to 4 weeks of recovery.
For the first 14 days, food should only be based on liquids, switching to soft foods in the third week and semi-solid foods in the fourth. At the end of 30 days, the diet returns to similar to the pre-operative one.