Surgical Treatments for Obesity: Are They Effective?

Almost a third of the world’s population is obese. This problem concerns both the rich and the poor. An additional problem for obese people is the attitude of society in the form of condemnation. Advertising the services of plastic surgeons and popular shows about weight loss often form a simplified attitude to the problem. We will talk about what surgeries are really used to treat obesity as a confirmed diagnosis.


Obesity is an extremely important and growing public health problem in both economically developed and developing regions of the world. In 2008, more than 1.4 billion adults worldwide were overweight and more than 200 million men and almost 300 million women were obese. This number has doubled since the 1980s.

According to current estimates, 33% of the world’s population of 7.08 billion people, namely the staggering 2.36 billion people, are overweight or obese. Every second, 2.5 people are added to the world’s population, and one of them will be obese or overweight. According to statistics, 35.7% of adults in the United States are obese.

What is dangerous obesity

Obesity is associated with a markedly reduced life expectancy, which makes it the main cause of preventable death. Obesity is known to be associated with hypertension, hyperlipidemia, coronary artery disease, increased glucose tolerance or diabetes, sleep apnea, non-alcoholic fatty liver disease, and some types of cancer, including the esophagus, pancreas, kidney cells, mammary gland, endometrium, neck, and prostate cancer. Even more disturbing is the fact that at least 2.8 million people in the world die each year directly due to overweight or obesity.

Causes of Mass Obesity

The World Health Organization (WHO) defines obesity as a condition for excessive accumulation of body fat to the extent that it adversely affects health and well-being.

Our bodies are designed to work best in the conditions when food is unstable, and a high level of physical activity is required to provide oneself with food and shelter, as well as for transportation. Previously, this was enough to allow most people to maintain a healthy weight without conscious effort. But today everything is different. Providing food and shelter and movement in the environment does not require high levels of physical activity needed previously. Now you can be productive and have a sedentary lifestyle.

Technological advance in the workplace and reduced manual labor have led to a reduction in energy costs. Life in the city with infrastructure is characterized by the availability of public and personal transportation, the density and location of grocery stores and restaurants. All of these contribute to an unhealthy lifestyle. Significant changes have occurred in the food environment with the increased availability of inexpensive food. The prices of high-calorie foods and drinks have decreased significantly in contrast to the rise in prices for fresh fruits, vegetables, meat, and dairy products, which contributes to an increase in the consumption of unhealthy foods with an increase in portion sizes.

In such conditions, weight gain can only be prevented by consciously trying to eat less or be physically active.

Rich and poor: who is at higher risk of obesity

Obesity rates are rising among people with any level of income and level of education, but absolute figures are lower for people with higher income and level of education. The most inexpensive foods are those that are high in fat and sugar. Biological preference for these foods, combined with easy accessibility, contributes to overeating. In addition, low-income people may engage in less physical activity than other segments of the population. One of the reasons for this discrepancy may be that security problems in low-income areas may prevent adults and children from exercising outdoors.

Add to this the fatigue from work and a multitude of everyday problems that leave no effort to play sports. People who have more financial resources find it easier to cope with these circumstances and, therefore, are more physically active and less obese than those who have fewer resources.

Surgical Obesity Treatment

In the most severe cases, when other methods no longer help in the treatment of obesity, surgeries are offered.

What are the current indications for surgery?

  • With a body mass index of more than 40, regardless of the presence of concomitant diseases;
  • When the body mass index is more than 35 and there are concomitant obesity diseases;
  • If previous conservative treatment proved ineffective;
  • If the patient with severe obesity had managed to reduce body weight, but it began to increase again later.

Body mass index is calculated as follows: weight (in kilograms) should be divided by the square of height (in meters). For example, with a weight of 60 kg and a height of 170 cm, the calculation is as follows: 60 / (1.7 × 1.7) = 20.8. This result means normal body weight. An indicator below 18.5 means underweight, the presence of excess weight is diagnosed when the body mass index is more than 25, and obesity is registered in case of more than 30.

Modern surgeries in case of obesity:

The installation of an intragastric balloon is a minimally invasive method of reducing body weight, comparable in complexity to conventional gastroscopy (insertion of a probe through the mouth into the stomach – ed.). Filling a part of the stomach volume, the balloon promotes early saturation, and due to the quantitative restriction of the food consumed, the patient loses weight. The technique is used in individuals with a body mass index of 30 to 40, when surgical treatment is still premature, and also as a stage of preparation for surgery in patients with morbid obesity.

Longitudinal stomach resection is when the lateral part of the stomach is removed, while the most important physiological valves of the stomach are preserved. The stomach turns from a huge sack into a narrow tube, where food does not stay long and quickly goes into the intestine. In the case of LSR, the part of the stomach that secretes the hunger hormone, ghrelin, is removed, and therefore, patients reduce the need for food significantly after such a surgery. In 70% of cases, the effects of type 2 diabetes are compensated or even leveled out. Longitudinal resection can be considered as surgery of choice in patients with moderate excess body mass up to 35 to 45, as well as in those cases when performing more complex surgeries is unacceptable or impossible.

Gastric bypass surgery is a complex combined procedure, which combines a decrease in the volume of the stomach and a reconstruction of the small intestine, aimed at limiting the absorption of food components. As a result of the surgery, the amount of food consumed decreases several times. In this case, the early entry of food into the small intestine causes a steady and rapid feeling of satiety. The advantages of the surgery are a marked reduction in body weight and a significant impact on the course of type 2 diabetes and blood lipid composition. The main drawback is the need for life-long intake of vitamin and mineral complexes.

Biliopancreatic shunting is used to treat severe forms of obesity and refers to combined methods involving a reduction in the volume of the stomach and a shunting component, that is, reconstruction of the small intestine, aimed at reducing the absorption of food. The BPS surgery is by far the most difficult, but at the same time, the most effective for the treatment of morbid obesity. Its advantages are significant and the most sustainable in the long term: weight loss, effective therapeutic effects on type 2 diabetes, as well as compensation for concomitant diseases. However, it is necessary to take vitamin and mineral supplements systematically and throughout life after the BPS surgery, just like after gastric bypass.

In conclusion, it must be said that there is a clear need to raise awareness and educate the public about the complex etiology of obesity and about the significant obstacles in terms of sustainable weight loss. Predominant messages in society and the media that exacerbate the guilt of obese people should be replaced with reports that obesity is a chronic disease with a complex etiology.

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