Surgical treatments designed to restrict the absorption of food are in full swing. Because beyond weight loss, they can reverse the course of many chronic diseases.
Bariatric surgery is very popular. The number of interventions has been multiplied by twenty in France since 1997, reaching today 59 000 per year, 80% of which are women, according to the Ministry of Health.
This boom can be explained by the spectacular results achieved in terms of weight loss: an American study of the University of Duke showed that 72% of the operated patients lost durably one fifth of their initial mass and 40% shed a third their kilos!
The techniques have also changed a lot. The gastric band, widely used ten years ago to slow down the passage of food in the stomach, is less popular because of its low tolerance. Longitudinal gastrectomy (or sleeve), which consists of reducing the volume of the stomach by two-thirds, now accounts for nearly 60% of obesity surgeries. Finally the bypass, which bypasses part of the small intestine, now accounts for 25% of operations.
Finally, the youngest, the gastric balloon is an alternative to surgery. It allows to lose pounds without anesthesia or invasive action. Its principle is simple: just swallow a capsule in which a balloon - called Elipse - is compressed. Once in the stomach, it spreads and is filled with 550 ml of water using a thin tube that the doctor immediately withdraws. As the gastric balloon occupies space, it induces a feeling of satiety as soon as you swallow a few bites. As a result, meals are spontaneously less rich. After sixteen weeks, the balloon empties and is eliminated by the natural channels.
Although these interventions are not without risks, they are extremely beneficial for overall health. Hence the idea may be to limit them to adults with severe or massive obesity only, ie patients with a higher body mass index (BMI). or equal to 35.
Bariatric surgery improves type 2 diabetes in heavily overweight patients, but also in those with lower initial body weight. "The improvement in blood sugar occurs quickly after surgery, before weight loss is significant," says Professor Lawrence Serfaty, hepatologist at St. Antoine Hospital (Paris).
A large Swedish study has shown that 72% of diabetics are in remission two years after the operation and another 36% eight years later! They no longer need drugs. Of course, dietary restriction plays a role in the return to normal of blood glucose. But the surgical remodeling of the digestive tract also upsets the metabolism: it modifies the composition of the intestinal microbiota and the secretion of several hormones (ghrelin, peptide YY ...) involved in the regulation of blood glucose levels.
Recent studies carried out in Lille attest that this surgery restores the health of the damaged livers. "85% of patients with fatty liver - liver having accumulated too much fat - find an almost normal liver after a bypass or a sleeve," says Professor Philippe Mathurin, hepatologist at Lille University Hospital. There is also a decrease in inflammation and liver fibrosis not related to alcohol, which significantly reduces the risk of liver cancer. As for non-alcoholic cirrhosis, they decrease by 15 to 20%. On the other hand, "with the gastric band, the efficiency fades over time," says Professor Mathurin.
Surgical treatments for obesity reduce mortality from myocardial infarction and stroke. An Israeli study published in January 2018 suggests that the risk of cardiovascular disorders, all diseases combined, falls by about 30%. This improvement can be explained by the stabilization of lipid levels in the blood, the decrease in volume of the left ventricle and the reduction of hypertension. One year after surgery, nearly 60% of patients regain normal blood pressure (12-7 vs. more than 14-9).
After a bariatric intervention, people with obesity see the specter of cancer move away according to a US study of the University of Cincinnati published in September 2017. The impact is particularly significant in women: their risk of cancer breast postmenopausal drop of 42% and that of the wall of the uterus (endometrium) by 50%. "There is also a 41% decrease in the risk of colon cancer and 54% of pancreatic cancer," says Dr. Daniel Schauer, co-author of the study.
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