What is the Body Mass Index (BMI)?
According to the World Health Organization, excessive body weight and obesity are terms defined as the abnormal accumulation of fat posing a risk to a person’s health. The most commonly used assessment for these terms is the Body Mass Index (BMI), calculated as follows:
BMI = body weight (kg) / square of height (m2)
The interpretation of the BMI calculation is as follows:
| Index | Classification |
| <18.5 | Underweight |
| 18.5 – 24.9 | Normal weight |
| 25 – 29.9 | Overweight |
| 30 – 34.9 | Obesity (Class I) |
| 35 – 39.9 | Obesity (Class II) |
| >40 | Extreme obesity |
It should be noted that this index should not be used and interpreted in the same way for individuals with pronounced muscle mass.
Causes of Obesity
The causes of obesity are numerous. It is now known that risk factors include:
- Genetics: Some individuals may have an increased tendency to accumulate fat.
- Socioeconomic status: This affects the ability to access healthy lifestyles (fiber-rich diet, fresh fruits and vegetables, physical activity).
- Psychological factors: These manifest in various personality disorders related to emotional overeating, as well as well-known eating disorders.
The problem of obesity has grown to epidemic proportions in the past two decades. According to relevant data, approximately 4 million people worldwide die prematurely each year due to complications of obesity and associated diseases, with particular concern for this trend in children. From 1975 to 2016, the prevalence of obese children and adolescents aged 5 to 19 increased more than four times from 4% to 18% globally.
Risk Factors
Excessive body weight and obesity are major risk factors for various chronic diseases, including cardiovascular diseases (heart attack, stroke), diabetes with all its known complications, dyslipidemia, and others.
Obesity can also lead to musculoskeletal disorders, including osteoarthritis.
Furthermore, obesity is associated with certain types of cancer, including endometrium, breast, ovaries, prostate, liver, gallbladder, kidneys, and colon. The risk of these non-communicable diseases increases with an increase in the Body Mass Index (BMI) above 30 kg/m2, with an additional increase in morbidly obese individuals with an index above 40 kg/m2.
Preventing Obesity
Many causes of excessive body weight and obesity can be prevented. Although other factors are involved, the fundamental cause of obesity is the imbalance between calories consumed and calories expended. As global dietary habits have changed in recent decades, there has been an increased intake of high-fat and free sugar content foods. There has also been a trend of reduced physical activity due to changes in the nature of many types of work, increased availability of transportation, urbanization, and the adoption of sedentary work and leisure lifestyles.
Reducing the risk of overweight and obesity involves:
- Reducing calorie intake from fats and simple sugars,
- Increasing the daily intake of fruits, vegetables, legumes, whole grains, and nuts, and
- Engaging in regular physical activity (recommended 60 minutes a day for children and 150 minutes a week for adults).
For infants, studies have shown that exclusive breastfeeding from birth to 6 months of age reduces the risk of obesity in the first years of life.
Who Are Candidates for Bariatric Surgery?
Candidates for bariatric surgery are patients with a Body Mass Index (BMI) above 35 kg/m2 and the presence of diseases associated with obesity, as well as all patients with a Body Mass Index (BMI) above 40 kg/m2.
In addition to stating the index, leading global bariatric surgery associations recommend initiating conservative treatment for obesity for a minimum of 6 months. These methods primarily involve optimizing diet and implementing a recommended physical activity plan. After the initial 6 months, the success of the applied methods is evaluated, and the patient is referred for further surgical treatment.
What is the Success Rate of Bariatric Surgery?
With decades of accumulated experience in bariatric surgery worldwide, it is clear that surgery performed by an experienced surgeon is the most effective way to treat this disease. Global data indicate that acceptable mortality after a successfully performed operation is around 0.1%, with an acceptable overall complication rate of about 3-4%.
The success of bariatric surgery is not only measured by weight loss but also by improved control of diseases associated with obesity. Research indicates that surgery results in improved quality of life for patients, a significant extension of life expectancy, and a significant reduction in the need for medications in 90% of patients with diabetes mellitus. With the appropriate choice of the procedure, we can expect the cessation or reduction of medication for high blood pressure, high cholesterol, as well as significant relief from joint pain in patients with obesity.
How to Prepare for Bariatric Surgery?
Before surgery, proper preparation is necessary. Patients are advised to quit smoking at least one month before surgery and adhere to a low-calorie diet plan.
It is mandatory to examine patients for the presence of reflux disease and perform upper flexible endoscopy (gastroscopy) to exclude inflammatory processes in the lower esophagus and stomach. All bariatric surgeries, except in very rare and exceptional situations, are performed in a minimally invasive manner (laparoscopic).
What Are the Advantages of Minimally Invasive Laparoscopic Surgery?
Laparoscopy is an approach technique to the abdominal cavity through small incisions in the abdominal wall ranging from 5 to 12 mm. Through specially made working channels (ports), and with the help of elegant instruments and a camera with magnification of 5 to 10 times, we can access every part of the abdominal cavity and chest, adequately identify and resolve the problem. These small incisions, compared to traditional surgeries, provide the possibility of rapid recovery, reduce the risk of infection, allowing a return to regular activities in just a few days. The advantage of a camera with magnification reduces the possibility of error in experienced hands to a minimum and leads to the observation of the tiniest details during the procedure.
