Page 151 - When surgery alone won’t cut it - Valerie Maureen Monpellier
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SUMMARY - ENGLISH
Obesity is a chronic disease in which abnormal or excessive fat accumulation impair health. Wether a person is obese is classified with the body mass index (BMI). The BMI can be calculated by dividing a person’s weight in kilograms by the square of his height in meters: kg/m2. An adult with a BMI ≥ 30 kg/m2 is classified as obese. When the BMI ≥ 35 kg/m2 with obesity-related comorbidities or the BMI is ≥ 40 kg/m2 a per- son is classified as morbidly obese.
Obesity is a major public health issue in the Netherlands, 14.2% of the population old- er then 20 year is obese and 0.9% suffers from morbid obesity. Obesity is associated with several medical conditions, like diabetes mellitus, hypertension, sleep apnoea and cardiovascular disease. Obese persons also have higher rates of cancer, overall diseases and health related mortality. Currently the burden of healthcare expenditure on morbid obesity exceeds those of smoking.
Besides the negative effct on health, obesity is related to problems of social and psy- chological well-being. Obese persons generally have a lower health related quality of life (HRQoL), a more negative body image and higher rates of psychological problems.
The cause of obesity is complex, multiple factors play a role. It is assumed that cultur- al and environmental changes induce a higher energy intake and less physical activity leading to a positive energy balance. However, recent research is showing that other factors also play a role. Because the cause is not completely clear, treatment of obe- sity is difficult.
For persons with morbid obesity, a BMI ≥ 35 kg/m2 with comorbid conditions or BMI ≥ 40 kg/m2, bariatric surgery is the best treatment. Bariatric surgery includes a variety of surgical procedures in which the gastro-intestinal tract is altered, which results in weight loss. The weight loss is caused by lower intake and absorption of nutrients, and changes in gut hormones, bile acids and microbiota. The Roux-en-Y gastric by-e pass (RYGB) is the most performed type of bariatric surgery in the Netherlands.
Whether a patient qualifies for bariatric surgery is determined after a comprehen- sive multidisciplinary screening by a team experienced in bariatric surgery. This team assesses if the patient meets the IFSO-criteria: the criteria for bariatric surgery de- veloped by the International Federation for the Surgery of Obesity and Metabolic Disorders. In addition, pre-operative evaluation includes assessment of motivation, psychological disorders, willingness to life-long follow-up and acceptance of lifestyle modification. There is no guideline or consensus on how behaviour, motivation and
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