Diabetes, hypertension, Sleep Apnea, joint disorders … Obesity induces multiple pathologies and reduces life expectancy.
A BMI over 40
6.9 million French people are obese, including 550,000 considered to be suffering from so-called “morbid” obesity. When diets are no longer enough, surgery remains. Last year 30,000 patients underwent obesity surgery. Faced with the resurgence of this type of treatment, Health Insurance has carried out an in-depth study on bariatric surgery.
Obesity surgery is offered to patients whose BMI is greater than 40 or greater than 35 with an associated risk factor (hypertension, diabetes, cholesterol, asthma…) and this only in the event of failure after 6 months of well-conducted medical treatment.
According to their study, the Health Insurance finds that it is women who use this type of operation the most. “8 out of 10 patients are women, on average 39 years old. On average, women are operated on at a lower BMI and at a younger age than men.”
Preferred irreversible techniques
The type of intervention performed has evolved over the years. “The fitting of an adjustable gastric band, a reversible and reference technique in 2006, declined and in 2011 only corresponded to 25% of operations. The other (irreversible) techniques for reducing the stomach and / or bowel diversion (sleeve gastrectomy and bypass), rarely performed in 2006, now account for 75% of operations. “
The intervention rate and the type of operation offered vary greatly depending on the regions unrelated to a prevalence of obesity. This prompted the Health Insurance to request a framework for bariatric surgery by communicating more on prevention and hygiene-dietetic measures and by updating the guidelines for good practice in obesity surgery (indications, choice of technique used).
It also wishes to promote the labeling of centers capable of taking care of young patients and to set up a cohort to monitor operated patients (young people and adults) in order to assess the benefit-risk ratio of bariatric surgery over time.
Lifelong treatments
Because indeed, this type of surgery is not trivial. One in two operated patients has an associated risk factor and nearly one in five takes anti-anxiety or antidepressants.
New irreversible techniques are being perfected and allow a real improvement in the quality of life and a reduction or even a cure of related pathologies (in particular diabetes.) But these surgeries, in particular bypass, generate more significant side effects such as than malabsorption. “They often require for patients a treatment” for life “(vitamin supplements) to avoid severe deficiencies. This underlines that it is necessary to be relevant in the indication of this type of acts.”
