Obesity: Stigmas affect treatment and delay surgery – 01/18/2024 – Balance and Health

The stigma of obesity interferes with the search for bariatric surgery and leads some people to postpone treatment for the disease, indicates a survey carried out in the United States.

The study, carried out by the Ipsos Institute with 1,017 adults, indicates that 79% of Americans see bariatric surgery as a “last resort”, and for 60% the procedure is a shortcut to losing weight.

“Bariatric surgery is by no means an easy path”, recalls surgeon André Teixeira, medical director of the Institute of Bariatric Surgery at Orlando Health, a network of hospitals that financed the research.

The interviews also revealed that for 61% of Americans, practicing physical exercise and following a diet should be sufficient, a distortion that also finds supporters in Brazil.

“Most people perceive obesity as a matter of changing their lifestyle, eating less and doing more exercise, and not as a disease”, says endocrinologist Fábio Rogério Trujilho, vice-president of Abeso (Brazilian Association for Study of Obesity and Metabolic Syndrome).

“Often, you need to use medication and, when we talk about bariatric surgery, the feeling is the same, that it is the last option”, he adds. “Sometimes, the patient feels like a failure for not having achieved good results with other methodologies.”

For Trujilho, even health professionals who are not specialized in obesity may have this view, which contributes to increasing the waiting time until appropriate treatment.

President of SBCBM (Brazilian Society of Bariatric and Metabolic Surgery), Antônio Valezi believes that the media and medical societies have helped Brazilians understand that obesity is an illness and bariatric surgery is a treatment tool.

Still, it is necessary to emphasize the limitations of the surgical procedure and the importance of multidisciplinary monitoring, physical exercise and adequate nutrition after surgery.

“Just like a hypertensive person continues with their cardiologist and a diabetic, with their endocrinologist”, explains Valezi. “Obesity is a chronic disease that requires long-term treatment and offers several therapeutic modalities.”

In the case of surgery, resolution No. 2,131/2015 of the CFM (Federal Council of Medicine) stipulates some indications, including patients with BMI (body mass index) above 40 kg/m^two and patients with a BMI greater than 35kg/m^two who have comorbidities worsened by obesity, such as diabetes, sleep apnea, hypertension, cardiovascular diseases and depression.

The council also establishes criteria for metabolic surgery, in which the techniques used are the same as bariatric surgery, but the purpose is to treat diseases such as diabetes.

According to CFM resolution no. 2,172/2017, people with type 2 diabetes, with a BMI between 30 kg/m, are eligible for the procedure.^two and 34.9 kg/m^twounresponsive to conventional clinical treatment.

In addition to the indications, experts note the need to individualize cases, as two patients with the same BMI can be impacted differently by obesity.

“There are patients for whom clinical treatment is possible and others for whom the cardiologist, endocrinologist or orthopedist see that there is no point in insisting on methods other than surgical treatment”, says Valezi.

Regarding the clinical approach, Trujilho emphasizes the difference between “weight loss pills” and obesity treatment. While those are often used without prescription and guidance, this must be closely monitored by a multidisciplinary team. It is up to professionals to check whether the patient has a contraindication to the medication and what the appropriate dosage is.

“We are living in a time of new drugs for obesity, but I don’t think they will take over from surgery. There will be patients for both tools.”