Covid-19, the impact of the pandemic on obesity surgery

Covid-19, the impact of the pandemic on obesity surgery

Due to the pandemic in 2020 there was a drastic drop in operations. Yet obese patients are more at risk of becoming severely ill with Covid-19

Less than 30%, with peaks of 50% in some centers. For those who need to be helped by the "scalpel" to cope with extra pounds, or who need to undergo bariatric surgery, Covid-19 has had a really heavy impact. To sound the alarm, recalling the importance of paths that facilitate the challenge of overweight and obesity, is Diego Foschi, President of SICOB, Italian Society of Obesity Surgery and Metabolic Diseases at the National Congress.

Why action is needed

In recent months there has been a drastic decline in operations: from a census carried out at 48 SICOB centers out of 74 it emerged that in 2020 there were 4,727 interventions with a reduction of 2,286 compared to 2019 (equal to 28%), with a very low Covid positivity rate (0.38%) and a complication rate of 1.2%. Nonetheless, interventions continue to decline because in this moment of emergency the health organization cannot guarantee surgical assistance to bariatric patients.

If we consider, however, that according to the Ministry of Health 44% of cases of type 2 diabetes, 23% of cases of ischemic heart disease and up to 41% of some cancers are attributable to obesity and overweight, it is clear that , if obesity is fought or prevented, the prevention of other serious and often fatal diseases is automatically promoted.

Furthermore, the news and studies conducted all over the world reveal that people with obesity are hospitalized for Covid much more than "normal weight" patients: being obese involves a significant increase in the risk of getting seriously ill with COVID-19. This fact is now universally accepted, so much so that the algorithm for calculating the COVID risk developed and published in the British Medical Journal by the English working group coordinated by the University of Oxford includes the BMI (Body Mass Index, body mass index) as a variable. directly related: the higher the BMI, the higher the COVID risk.

And if we add to this that half of those hospitalized in intensive care are hypertensive, diabetic and cardiopathic and that with advanced age this situation is highly fatal, it also becomes clear that the patient suffering from obesity must be included in the Covid prevention programs reserved for more fragile and high-risk categories.

"In the light of all these evidences – explains Foschi – fighting against obesity and preventing its most serious consequences becomes not only a duty but a moral obligation. We are committed to fighting the deeply rooted stigma against patients with obesity, so that the prejudices that lead to blame them are eliminated and, unfortunately, in some cases, to treat them only when the complications have already occurred. This, in our opinion, is an evident unresolved short-circuit of the NHS which, by delaying therapies for bariatric patients, itself encounters management costs that are much more impacting ”.

"Tailor-made" operations

Obviously, bariatric surgery comes as part of a path aimed at reducing excess body weight that must be guided by the doctor and first of all passes through a tailored diet and an increase in physical activity. Even the interventions are not all the same and it is essential to rely on specialized centers to choose the most suitable way of the scalpel in the individual case.

In general terms, we can think of a bariatric surgery when a series of factors are combined, the main of which is the presence of the so-called severe obesity or in a patient who has a BMI (body mass index) greater than 35 BMI is defined as weight in kg divided by height squared. The normal value is between 18 and 25. On the technical front, the options are different. But there are two "principles" at the base: "the" restrictive "one, that is, reducing the stomach's ability to receive food, and the malabsorptive one, that is, inducing a change in the absorption of what the patient eats

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