Understand Differences Between Type 2 and Bariatric Surgery

The term morbid obesity is known to refer to Excessive body fat, which results in health. They are individuals with a body mass index (BMI = weight / height²) greater than 35 kg / m² with associated diseases or above 40 kg / m² (normal BMI between 19 and 24.9 kg / m², overweight 25, 1 to 29 , 9 kg / m².

Bariatric surgery, also known as obesity surgery or more popularly stomach reduction, brings together scientifically-backed techniques for the treatment of obesity and diseases associated with excess body fat or aggravated by it such as type 2 diabetes mellitus (T2DM), hypertension, arthrosis, infertility, sleep apnea and so on. Bariatric surgery has more than 40 years of safe use in Brazil, and the most effective forms of treatment for long-term weight loss when clinical treatments fail is undoubtedly

. However, a new concept has drawn the attention of physicians : malignant obesity. These individuals may have BMIs at or around 30 kg / m², characterizing mild obesity, but suffer from diseases aggravated by overweight, especially diabetes and hypertension. These are cases in which the severity of the associated diseases is not directly related to BMI.

Studies show that bariatric surgery may be a treatment option for those in this condition and can no longer control the problem with medication alone. This suggests that it is possible to be apparently thin, but with typical health problems of the obese. It is like being thin but physiologically fat.

DMT2, responsible for 90% of the 251 million cases of diabetes in the world, is one of the most serious diseases today. It is estimated that 11% of the Brazilian population is diabetic. It affects men and women, generally after the age of 30, who present among the risk factors, mainly overweight and obesity (non-morbid), since more than 55% of the cases are individuals of normal weight or overweight, and present other factors

After all, if more than half of diabetics are not morbidly obese and there are mechanisms of disease control initially independent of weight loss, bariatric surgery equals surgery for the development of the disease, such as heredity. the DMT2 or metabolic? The answer is no!

From identification in morbidly obese diabetics who had their blood glucose levels normalized after bariatric surgery (for obesity) without direct relation to weight loss, but through mechanisms that act directly on DMT2 , we started a series of clinical studies to evaluate the feasibility of performing this type of surgery in morbidly non-obese diabetics. The results indicated that patients who present clinical conditions of pancreatic function deficiency in producing insulin, tissue resistance to Insulin with difficulties in maintaining the drug treatment, can benefit from the surgical treatment, creating the definition of metabolic surgery.

It can be defined that the interventions on the digestive tract that has control of DMT2 almost immediately in the post several direct mechanisms against the disease, initially without relation as weight loss, are called metabolic operations, where long-term weight loss is an excellent side effect.

Bariatric surgeries are those indicated for those individuals who have complications due to high weight, such as joint diseases, disc hernias, acid reflux from the stomach into the esophagus, and so on. Metabolic interventions have the primary goal of controlling T2DM and its complications and have nothing to do with the patient's BMI, but rather with the severity and inadequate control of T2DM, regardless of BMI, whether above or below 35 kg / m² . Metabolic surgery primarily treats DMT2 and the conditions that come along, such as high blood pressure, cholesterol and triglycerides.In the cases of the morbidly obese, important studies prove the efficiency of bariatric surgery, which significantly reduces the risks of complications and development of diabetes over the years. Only 10% of the operated patients develop the disease during the 10 and 15 years postoperatively, against 95% of the non-operated patients who follow non-surgical disease control programs. In fact, several epidemiological studies showed a decrease of up to 92% in diabetes-related mortality in the operated group at a follow-up of up to 16.

Regarding surgery in morbidly non-obese diabetics, the results are also promising. Mortality in diabetics is predominantly secondary to cardiovascular complications, and in approximately one year post-operative there is evidence of control of vascular disease progression in the operated group, suggesting that correctly indicated surgery decreases mortality of type 2 diabetic subjects submitted to operative treatment. Research in our group is consistent with the consensus that preoperative BMI does not accurately reveal the severity of diabetes, its power to cause complications and the mechanisms of the disease. In addition, other factors such as age, gender, history of diabetes and postoperative weight loss have not been determinant in the remission of the disease.

Many researches carried out and in progress in Brazil and abroad reinforce the guideline of the International Diabetes Federation (IDF), which recommends surgery for patients with BMI from 30 kg / m², as long as they are diabetic or predisposed to the disease and present cardiovascular risks. The guideline, published in March 2011, was supported by more than 200 medical institutions in 160 countries.

The current national and international regulations restrict the indication of bariatric and metabolic surgery for patients with BMI from 35 kg / m² with associated diseases or above 40 kg / m², without the obligatory presence of other diseases. This criterion has been maintained for 20 years, based on the consensus of the US National Institutes of Health (NIH) and Brazil is established by the Federal Council of Medicine (CFM) through Resolution 1974, of 2010.

Indications for metabolic surgeries, free of BMI restrictions as the only parameter for indication have been amplified. The British Medical Practice Agency (NICE acronym) 2 months ago modified its criteria for indication of surgical treatment for patients with T2DM without adequate clinical control, reducing the BMI to 30 kg / m2.

The national CFM guidelines are based on international consensus in 1991, where there was no less invasive laparoscopic surgery, and the operation of the gastrointestinal tract was not known for the control of T2DM.

There is currently a joint effort of the National Societies of Bariatric and Metabolic Surgery and Endocrinology to seek a new guideline that may benefit patients with uncontrolled DMT2 with drugs to have access to surgical treatment. No doubt worth the effort.

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