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Globally, it is estimated that there are currently 1.1 billion people who are overweight and this total is expected to rise to over 1.5 billion by 2015[3]. For the first time in history the number of overweight people is about to surpass the number of underweight people[4]. Moreover, the World Health Report 2002 indicates that - with 26,5 - Europe has one of the highest average Body Mass Indexes (BMI, a measure of body fat based on height and weight that applies to both adult men and women).
At the moment, nearly 400 million adults in the WHO region are estimated[5] to be overweight (BMI > 25) and around 130 million to be obese (BMI > 30). In children, the situation is even more dire with estimates ranging from 10-30% of European children (7 - 11 years old) being overweight or obese[6]. In Europe alone, the prevalence of obesity is probably in the order of 10-20% in men and 15-25% in adult women.
Click here for an overview of male and female obesity in a number of European countries.
According to Prof. Dr. Martin Fried, Professor of Surgery at the Charles University in Prague and Executive Director of IFSO-EU (International Federation for the Surgery of Obesity - European Chapter), 2005 saw the creation of a breakthrough initiative when the EASO (European Association for Study of Obesity) and IFSO-EU, the two leading European scientific societies, formed the BSCG (Bariatric Scientific Collaborative Group). The group is composed of representatives from Austria, Czech Republic, France, Germany, Greece, Italy, The Netherlands and Switzerland, with the UK and the US being involved as "consulting countries". Recently, the ECOG (European Childhood Obesity Group) joined the BSCG.
The primary aim of the BSCG is to draft and publish bariatric guidelines to improve pre- and post- operative patient care; update the criteria for bariatric surgery; and define the role of internists, surgeons and other experts during the post-operative stage. This process is currently in the final stage and the guidelines are planned to be presented at major scientific meetings in Europe and worldwide. Additionally, they will be published in major, obesity-focussed scientific journals in the course of 2007.
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Given the sensitivity of the topic, experts were reluctant to draw attention to the obesity problem in the developing world while so many people were confronted with hunger. As more and more startling reports are being released, however, the medical world is starting to challenge conventional wisdom.
Almost one in five people in Hungary is obese, three times the proportion in Norway, Italy, and France, says a new report. [7]
The study, which was based on data from 24 countries in Europe and published online before print publication on 14 June in the European Journal of Public Health (www.oxfordjournals.org), shows that Central and Eastern European nations have some of the highest rates, although the prevalence of obesity among men is higher in the United Kingdom than in Russia, where women are nearly twice as likely to be obese as men.
The results show that the prevalence of obesity varies with economic and other indicators. There was less obesity in countries with a higher gross domestic product and in nations with higher percentages of city dwellers.
In many overweight or obese people a rigid combination of physical exercise and healthy diet proves to be an effective measure to counter obesity. In some people however, these measures alone cannot revert the situation and their condition brings about other serious health risks. This group of people suffers from morbid obesity and in many cases only a surgical procedure yields positive, long-term results.
In bariatric surgery (i.e. the collective term for gastrointestinal operations that reduce the amount of food a person can eat and diminish caloric intake) there are three common procedures to treat obesity, all of them with their advantages and disadvantages.
Adjustable gastric banding is a procedure which restricts and decreases food intake without interfering with the normal digestive process. In this procedure, a hollow band is placed over the upper part of the stomach, thus creating a small bag. A narrow tunnel connects this "pouch" to the rest of the stomach. The small upper stomach delivers an immediate sense of satisfaction and by forcing food to pass through this tunnel, the feeling of fullness is prolonged. The procedure is reversible and adjustable. The main advantages of this procedure are:
Obesity is multi-factorial which means that there are multiple factors causing obesity. There is no one and single factor. It is not a patient failure, we should not blame the patient that he is obese because there are environmental factors and major genetic factors involved as each human body has a unique energy storage programme.
Gastric banding is a restrictive procedure which means that it decreases and restricts the volume of the stomach. The band is usually placed around the upper part of the stomach, creating a small upper pouch. This pouch creates an early feeling of satiety for the patient. The patient eats food which goes into the small upper pouch of the stomach and stretches the wall of the stomach. Then there are nerve fibres indicating to the brain that the stomach is full. The operation is done laparoscopically, which means through a so-called keyhole approach. This is a minimally invasive approach which causes much less pain for the patient than a normal procedure and it allows the patient to leave the hospital usually within 24 to 48 hours after the operation.
Obesity is a major problem in European countries and it currently affects more than one quarter of the European population. It represents a major burden to societies, not only from a social but also from an economical point of view and it badly affects the healthcare systems of European countries.
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Prof. Dr. Martin Friedman on obesity and gastric banding. Extract from "Metamorphosis - From disability to an active lifestyle".
When the surgeon opts for a vertical banded gastroplasty (VBG), a small stomach pouch is created by vertically stapling the upper stomach. Similar to adjustable gastric banding, a vertical banded gastroplasty limits the amount of food the stomach can hold at one time. To lower the risk of food passing from the pouch to the rest of the stomach via the staples, a variation of the standard VBG procedure is used whereby the stomach is cut around the series of staples.
The main advantages of this procedure are similar to those of gastric banding, except for the fact that this procedure is not reversible.
The gastric bypass procedure combines both restrictive and malabsorbent methods to achieve the desired weight loss. The operation is divided into two steps. During the first phase, an operation is carried out to reduce the size of the stomach by creating a pouch that will hold the food. In the second phase, the surgeon connects a section of the small intestine to the pouch. When food enters the digestive system, it travels from the pouch through the newly created connection and bypassing the lower, bigger stomach. The base of the connection is affixed to the bottom of the stomach. Part of the stomach and small intestines are thus literally "bypassed".
The main advantages of this procedure are:
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In the last few years however, numerous studies have been released that clearly demonstrate the immediate and long-term beneficial effects of bariatric surgery on obese patients. In the study "Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients"[9] Dr. Nicolas Christou and others test the hypothesis that bariatric surgery reduces long-term mortality in morbidly obese patients. They found that patients who had undergone bariatric surgery exhibited significant risk reductions for developing cardiovascular, cancer, endocrine, infectious, psychiatric and mental disorders compared with people not undergoing surgery with the exception of blood related and digestive diseases. Moreover, compared to morbidly obese patients who did not undergo surgery, the bariatric surgery patients needed fewer post-operative hospitalizations, the total hospital stay was significantly lower and the surgery group needed significantly less doctor's visits in the five year follow-up period.
About ten years ago I started gaining weight. During my puberty my weight increased rapidly. When I was 14 I started following different diets and taking pills. All these measures initially made me lose weight, but shortly after I gained even more weight.
This made me feel depressed, moreover because I did not know what was wrong with me. I experienced one anger attack after the other until I decided, back in 2001, to visit my physician. I weighed 123 kg... He confronted me with my obesity and suggested the possibility of gastric banding. Two years later, on 3 July 2003 I had my operation. In the weeks immediately following the operation I started losing weight. As I was losing weight, I felt more active, took up sports and went cycling with my children.
Before my operation, I weighed 123 kg, now I weigh 68 kg. 55 kg makes a world of difference. I can do household chores on my own, I feel like no mountain is too high, my no longer feel depressed and I look so much better.... Gastric banding has truly saved my life.
Anne-Marie, 32 years old, The Netherlands
Basically I was imprisoned at home because I weighed 70 kg more than I weigh now. I could only walk very short distances and I got tired very quickly, I could not participate in normal social activities, I was living a kind of partial life prior to the operation.
I couldn't go out, that was the first thing and the second thing was my inability to live a normal life because the pain in my back and in my knees was so bad that I was unable to move.
I was a little afraid prior to the operation about what was going to happen to me. On the other hand, I was looking forward because I wanted to get rid of my overweight. The operation went fine ; it took just one hour. Within a couple of hours, I was able to walk around my bed. I got something to eat in the evening and the next day I started with fluids and yoghurt and I felt really fine. I was discharged and within a couple of days I was perfectly ok and back to my normal life.
Tomas Osvald, Czech Republic. Extract from "Metamorphosis - From disability to an active lifestyle".
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[1] http://www.euro.who.int/obesity
[2] Gardner G. and Brian Halweil. Worldwatch Paper #150: Underfed and Overfed: The Global Epidemic of Malnutrition. March 2000
[3]http://www.euro.who.int/obesity
[4] Gardner G. and Brian Halweil. Worldwatch Paper #150: Underfed and Overfed: The Global Epidemic of Malnutrition. March 2000
[5] Seidell JC, Flegal KM: Assessing obesity: classification and epidemiology. Br Med Bull 53:238, 1997
[6] WHO Fact Sheet - The challenge of obesity in the WHO European Region, September 2005
[7] Dobson R. Obesity is less common in richer countries. BMJ 2006;333:12. 1 July.
[8]Chapman A, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery 2004; 135: 326-351
[9]Christou N.V., Sampalis J.S., Liberman M. et al. Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Annals of Surgery vol. 240 n°3. September 2004.
