한국 안산의 비즈니스 이벤트 및 컨퍼런스
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The objective of gastric bypass surgery is to make the patient lose weight and avoid the morbidities associated with obesity. Morbidly or severely obese patients are at increased risk of health problems, tend to have a shorter life expectancy, and are potentially at additional risk from continued weight gain. The risk of severe obesity, however, must be weighed against that of surgical treatment and the benefits derived from it. The logical question that comes to mind is: Are you eligible for a gastric bypass, just because you are overweight?
Meta-analysis of the reported studies indicates that patients lose, on average, about 70% of their excess weight in the first year after gastric bypass, and up to about 80% of their excess weight by the end of the second year. In general, more than half of the operated patients find an improvement in their high blood pressure, almost 80% of non-insulin dependent diabetics are controlled without medication after surgery. Obesity-related breathing problems, including sleep apnea and shortness of breath with minimal exercise, are known to improve or resolve completely. Arthritis, urinary incontinence, acid reflux, menstrual irregularity, and certain types of headaches also benefit from weight loss after surgery.
However, surgery can cause a variety of complications, including electrolyte abnormalities, nutrient deficiencies, infections, kidney stones, osteoporosis, and even death. The criteria for the selection of patients for the procedure, therefore, are very strict and exact. A risk-benefit analysis carried out by a multidisciplinary team, on a case-by-case basis, is imperative to obtain optimal results. This team consists of physicians, therapists, counselors, and dietitians, in addition to surgeons, to manage the patient’s associated comorbidities, nutrition, physical activity, behavior, and psychological needs.
The National Institutes of Health sponsored a consensus panel whose recommendations set the current standard for consideration of surgical treatment. They recommend that gastric bypass be recommended in people who have a BMI of 40 or more, or with a BMI of 35 or more with one or more related comorbid conditions.
Body mass index (BMI) is defined as body weight (in kilograms), divided by the square of height (in meters). A BMI below 18.5 is considered underweight, while a BMI between 18.5 and 24.9 is in the healthy category. A BMI between 25 and 29.9 indicates overweight, while between 30 and 39.9 is considered obese. Any BMI over 40 is morbidly obese.
To calculate your own BMI, multiply your weight in pounds by 703. Divide that answer by your height in inches, and divide this answer by your height in inches again.
The American Society for Bariatric Surgery (ASBS) revised these criteria and made them more comprehensive. They have recommended that you are eligible for gastric bypass if:
– You weigh twice your ideal body weight or are 100 pounds or more overweight
– You have a BMI (body mass index) greater than 40
– You have a BMI greater than 35 with comorbidities (diseases related to being overweight).
– You have been overweight for 5 years or more and have not been able to lose weight or maintain weight loss under supervision
– You are willing to comply with lifestyle and dietary changes that require you to eat several small meals. This implies that your dietary intake will be under the close supervision of a qualified nutritionist in consultation with your surgeon, along with regular monitoring of blood levels of essential nutrients and nutritional supplements.
– You realize that surgery is not a solution but only helps you train yourself to eat much less. To achieve long-term weight loss and avoid complications from the procedure, you must exercise, eat properly, and get proper follow-up care.
– Has a clear understanding of the principles of the surgical options available, the short- and long-term risks, complications, and the need for follow-up visits.
– In case you are planning to get pregnant, you should keep in mind that you will need to delay it for at least eighteen months until after the surgery, so that your body has time to recover from the surgical stress. You should also remember that weight loss usually results in increased fertility, so you should use birth control measures.
Surgery is not recommended for people with diagnosed alcoholism, overt psychosis, and severe cardiopulmonary disease, which may increase the risks of surgery.
You as a patient must understand that gastric bypass is not a panacea. Results vary from person to person, and very often the results are gradually apparent. Furthermore, in the absence of proper postoperative care and lifestyle modifications, the health risks are many. Therefore, it is essential that you make a decision about gastric bypass in consultation with a multidisciplinary bariatric team, only once you and your treating surgeon are absolutely convinced of the need for surgery.
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