Bariatria

Bariatrics (Description)

Pathological obesity is a growing medical problem in highly developed countries. This results in many other health problems for society as a whole. Hand in hand with obesity is the increasing incidence of metabolic syndrome, leading to severe complications and disability. The health consequences of obesity are greater than those of smoking and drinking alcohol. It is believed that people with a high BMI (Body Mass Index - body mass index expressed in kg / m2) live on average 10 years shorter than people with a normal BMI. According to WHO obesity is the fifth most common cause of death depending on risk factors and wealth. Obesity is associated with an increased incidence of various disorders and diseases, such as hypertension, type 2 diabetes, hyperlipidemia, chronic hypoventilation and insomnia, hypertrophic cardiomyopathy and many others.
According to WOBASZ research from 2005 in Poland there are over 6,000,000 people with BMI -> 30 and almost 450,000 with BMI -> 40. As a result, obesity has become one of the most important public health problems. Conservative obesity treatment is ineffective and very burdensome for patients. The only effective method with documented long-term weight reduction in morbid obesity is bariatric surgery. In distant observations, it leads not only to weight loss but also to normalization of blood triglycerides in 65% of cases, HDL - 79% of cases, arterial hypertension - 69.9% of cases. and 90% recovery or improvement in diabetes control. Therefore, it leads to a reduction in the intake of anti-diabetic, high-pressure or lipid-lowering drugs.
The costs of treating patients with pathological obesity are also huge. It is believed that the number of obese Poles will increase to 33% of the population by 2035, and therefore the population of patients with type 2 diabetes will increase to 12%. Effective, i.e. surgical, obesity treatment can reduce the costs of treatment of complications, reduce the percentage of sickness absenteeism, disability pensions and minimize social damage resulting from seeking help by obese people in places offering unconventional or inconsistent with the current knowledge methods of obesity treatment.
An extremely important aspect is also changing the perception of obesity by society - obesity is not a defect in appearance, but a disease with specific complications and significantly shortening life.
The indications for surgical treatment are:
1. BMI -> 40
2. BMI -> 35 with at least one obesity-related disease (hypertension, type 2 diabetes, sleep apnea, dyslipidemia, musculoskeletal disorders limiting motor activity)
The most frequently performed bariatric surgeries:
1. Restrictive - limiting the volume of consumed food: Sleeve gastrectomy - one of the most frequently performed operations today
2.restrictive-exclusion - containing elements of both above: Gastrointestinal bypass (Roux-en-Y gastric bypass, MGB - mini gastric bypass
Properly performed operations are safe and give good long-term results. However, they should be performed in centers with properly trained staff.
Doctors working in our clinic have been dealing with the surgical treatment of obesity for many years. In addition, we provide support from a psychologist, dietitian and many years of postoperative control.

Laboratory tests

1st blood group
2. coagulation system
prothrombin time INR APTT
3. morphology
4. urine general examination
5. glucose
6. creatinine
7. total protein
8. albumin
9. glycated hemoglobin
10. sodium
11. potassium
12.Lipidogram
13. enzymes
1. AlAt
2. AspAt
14. TSH

IMAGE RESEARCH
1. abdominal ultrasound
2. chest X-ray

OTHER TESTS
1. gastroscopy
2nd ecg
3. ECHO of the heart
4.ECG using the Holter method (in the case of cardiological indications)

Price list

Prof. dr hab.med. Wiesław Tarnowski	first visit PLN 300.00; another PLN 270.00
Anna Gryz, M.Sc.	preoperative visit PLN 200.0, - other PLN 150.00
Dr. med. Artur Binda	200.00 PLN
Marcin Nowak, MD, PhD	200.00 PLN
Dr. med. Michał Wąsowski	bariatric qualification consultation 200.00 PLN, internist / endocrinologist consultation 1st visit 200.00 PLN, another 180.00 PLN
Dr. med. Ewa Czerwińska	PLN 180.00
Dr. med. Adam Ciesielski	PLN 180.00
Dr. Monika Krotki	PLN 120.00
Ostomy visit	PLN 80.00

The role of a dietitian

THE ROLE OF DIETETICS IN THE CARE OF PATIENTS SUBMITTED TO BARIATRIC SURGERY
THE ROLE OF DIETETITIAN IN THE CARE OF PATIENTS UNDERGOING BARIATRIC SURGERY

Monika Anna Krotki

summary
Obesity is a common problem in developed countries. It is a civilization disease that poses a threat to health and life. Due to its prevalence, it is considered an epidemic of the 21st century. It causes the development of many diseases, mainly cardiovascular and type 2 diabetes, and increases the risk of cancer. Conservative treatment of obesity, consisting in the application of a reduction diet and physical effort, is a difficult process due to the high risk of failure. Bariatric surgery has proven to be the most effective method of treating morbid obesity. The goal of preoperative treatment is to lose at least 5-10% of the initial body weight. Studies have shown that this loss significantly shortens the time of surgery, causes less blood loss during surgery and reduces the risk of postoperative complications. Dietary recommendations for the preoperative and postoperative period are based on the developed guidelines. In both periods, the patient should be looked after by an interdisciplinary team consisting of an internist, surgeon, fitness trainer, psychologist and dietitian. Bariatric surgeries, especially shutdown and mixed operations, carry a risk of complications in the form of nutritional deficiencies. It is therefore necessary to monitor the patient in this regard. The patient must be aware that a change in lifestyle consisting in the application of a low-energy diet, balanced with the correct supplementation of micronutrients and vitamins, and taking up physical activity, is valid for the rest of his life. Regular medical control and dietary modification under the supervision of a qualified dietitian will allow you to maintain weight reduction and prevent dangerous complications resulting from nutritional deficiencies.

Key words: obesity, bariatric surgery, reduction diet, nutritional deficiencies
Summary
Obesity is a common serious problem of the highly developed countries. It is the civilization disease that poses a threat to people's health and life. Because of its prevelance it is considered the epidemic of the XXI century. It is also the cause of development of many diseases, especially cardiovascular disease and type 2 diabetes. Conservative treatment of obesity, involving reduced diet and increased physical activity is a difficult process because of the high risk of failure. Bariatric surgery has proven to be the most effective treatment for morbid obesity. The purpose of preoperative treatment is the loss of at least 5-10% of the initial body weight. Studies have shown that such weight loss significantly reduces surgery time, the risk of postoperative complications and the loss of blood during surgery. The guidelines contain nutritional recommendations concerning preoperative and postoperative period. In both periods, patient should be placed in the care of interdisciplinary team consisting of: physician, surgeon, fitness trainer, psychologist and dietetitian. Bariatric operations, particularly malabsorptive and mixed procedures involve a high risk of complications such as nutritional deficiencies. Therefore, it is necessary to monitor the patient in this regard. Patient must be aware that lifestyle changes, featuring reduced and well-balanced diet, with proper supplementation of micronutrients and vitamins, as well as physical activity are valid for a lifetime. Regular medical monitoring and modification of nutrition under the supervision of a qualified dietitian will allow to preserve the weight reduction and prevent dangerous consequences of nutritional deficiencies.

Keywords: obesity, bariatric surgery, reduced diet, nutritional deficiencies.

Introduction
Obesity is defined as the excessive, pathological accumulation of body fat that leads to impaired body function and increases the risk of morbidity and mortality. Obese people are more likely to develop coronary artery disease, hypertension, diabetes, dyslipidemia, sleep apnea, osteoarthritis and neoplastic diseases. Patients' reduced mobility reduces their quality of life and increases the risk of injuries and accidents. According to the World Health Organization, obesity is a civilization disease that poses a threat to health and life. Due to its prevalence, it is considered an epidemic of the 21st century (1,2,3,4).
The main cause of obesity is a long-term positive energy balance associated with the excessive supply of food in relation to the body's energy expenditure. Excess energy is stored in adipose tissue. This phenomenon is favored by little or no physical activity, as well as hormonal disorders, metabolic abnormalities and genetic predisposition.
The goal of treating obese patients is not only to reduce body weight, but also to alleviate obesity-related complications.

Postoperative recommendations

POST-OPERATING RECOMMENDATIONS MGB / SG:

1. High-protein, low-fat diet with limited carbohydrates, liquid for 2 weeks, then mixed for 2 weeks, with good tolerance to home / solid diet after 4 weeks (dietary recommendations issued). Liquids between meals, please do not drink during meals. Still drinks. A minimum of 1.5 liters of fluids per day (drinking + meals)

2. Avoiding excessive physical exertion for 3 months - moderate exercise is recommended (eg walking, Nordic walking).

3. Control morphology, CRP, fasting glucose, in 14 days at the GP Outpatient Clinic

4. Arranging the date of a dietary consultation, inspection of wounds and removal of sutures in 10 days at the Surgical Clinic, periodic checks at the Surgical Clinic 30 days after the operation, and then once every 3 months during the first year after the operation.

5. Control of blood pressure and glycaemia at home, periodic control of blood chemistry, vitamin B12 levels, calcium and morphology in an outpatient setting.

6. Taking internal medicine as before hospitalization, modification of doses of hypoglycaemic drugs after consultation with a GP.

7. Low molecular weight heparin (prophylactic dose) 1 × 1 s.c. for 10 days, a multivitamin preparation 1 × 1 tablet, proton pump inhibitor 1 × 40 mg for 3 months, lactulose 3 × 15 ml for constipation, Metamizol 1x1g for pain (up to 3g daily)

8. In the event of nausea, vomiting, increased body temperature, pain complaints, urgent consultation at the Clinic.