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Obesity: a serious chronic disease


Obesity is the most commonnutritional disorder in the Western world and is considered a true pathology, since it reduces life expectancy and is associated with high comorbidity, causing the occurrence of serious diseases such as diabetes, cardiovascular disease,high blood pressure, respiratory diseases such assleep apnea, joint disease, and many cancers. TheWorld Health Organization (WHO) recognizes obesity as the most serious chronic epidemic disease of our time and as a very serious public health problem, which over time has taken the place of conditions such as malnutrition or infectious diseases.

There are an estimated 250 million obese people in the world, and a much larger number of overweight people. Data from the 1999 National Health and Nutrition Examination Survey (NHANES III) indicate that about 61% of U.S. adults are overweight or obese(NIH 2001). In Europe, about 15% of the population is reported to be obese (14% of the male population, 16% of the female population).

The first approach to the treatment of obesity cannot and should not be surgical. The obese patient should first see theendocrinologist, to find out whether he or she is carrying any disease that is responsible for his or her excess weight, and the dietician/nutritionist, to have an appropriate diet to help him or her lose weight, while at the same time planning to carry out an appropriate program of physical activity. However, sometimes diet, medication and exercise are not enough; this is especially true in cases of severe obesity, which is defined by a simple value: the BMI, Body Mass Index

It has now been proven by countless scientific studies conducted over the past 20 years that with a BMI greater than or equal to 40-or greater than or equal to 35 in the presence of associated diseases, such as those mentioned earlier-the only effective therapy with permanent results for obesity is surgery: bariatric surgery with the gastric sleeve resection, gastric bypass, minibypass and other lesser used techniques.

As mentioned above, the simplest and most widely used way to "measure"obesity, that is, to assess whether and how obese a person is and what the risks associated with his or her condition are, is to calculate theBody Mass Index (BMI). The BMI is nothing more than a ratio of height, body surface area and weight; it is expressed in kilograms per square meter, and is given by the formula

BMI = kg / m^2


There is a very close relationship between obesity and the occurrence of type 2 diabetes mellitus. The following data summarize it:

  • 4.9% of the population served by the NHS is diabetic (3,000,000 Italians); 650,000 are residents of the Northwest (ISTAT 2010). Of them, 91.9 percent have type 2 diabetes(Annals of Diabetology AMD 2010).
  • 1,000,000 Italians are diabetic without knowing it(AMD-Associazione Medici Diabetologi and SID-Società Italiana di Diabetologia). By 2025, about 1 in 10 Italians will be diabetic (World Health Organization, IDF-International Diabetes Federation). 20% are younger than 55 years old(Annals of Diabetology AMD 2010).
  • A person with diabetes costs the NHS an average of 2,589 euros annually; the resources absorbed by the treatment of this condition account for about 15 percent of total health care costs (Arno Diabetes Observatory; Cineca Interuniversity Consortium, 2007). 
  • In 2009, 26,760 deaths had diabetes as the main cause. According to the United Nations, diabetes kills one person every 10 seconds worldwide.
  • Two-thirds of people with type 2 diabetes are obese, and only less than 20 percent are normal weight.


Obesity and diabetes mellitus in Piedmont

In Piedmont, about 40% of the population is reported to be overweight/obese. 6% are diabetic (twice as many as the normal population), and 13% of diabetics are obese. There are about 180,000 patients enrolled in the Regional Diabetes Registry; of these, more than 23,000 are obese.

Obesity, obesity-associated diseases, metabolic syndrome, complications of diabetesAmong the main pathologies associated with obesity, are to be remembered:

  • Cardiovascular disease: 2-4 times higher risk
  • Stroke - cerebral hemorrhage: 2-4 times higher risk
  • Amputations: more than 60% of non-trauma-related amputations occur in diabetic patients
  • Renal damage: 20 to 30 percent of patients with type II diabetes will develop kidney disease
  • Blindness: Diabetes is the most frequent cause of blindness among 20- to 74-year-olds

obesity, metabolic syndromeLa metabolic syndrome is a Pathological condition affecting many organs and systems of the body, and which manifests itself In obese patients, causing cardiological dysfunction, of blood glucose and the Cholesterol and triglyceride metabolismIt is an aggravating and dangerous condition that ultimately leads to deterioration of the body that causes the development of chronic diseases and reduces life expectancy.

Therefore, in recent years the concept of bariatric surgery has been joined and partly replaced by that of metabolic surgery. Today, gastric bypass and gastric sleeve resection are considered the most effective therapies available for metabolic syndrome in obese patients.

The indications for obesity surgery

Typical indications for bariatric surgery, which are always confirmed by a multispecialty team including, in addition to the surgeon,endocrinologist, psychologist , and nutritionist, are:

  • Patients with BMI greater than or equal to 40
  • Patients with BMI greater than or equal to 35, in the presence ofcomorbidities
  • Failure of other slimming methods (diets, exercise, medical therapies)
  • Psychological and endocrinological criteria met

However, in 2014 a new guideline published by the UK's National Institute of Health and Care Excellence (NICE) UK suggested that patients with a BMI of 30 and a diagnosis of type II diabetes mellitus made within the past decade should be considered as candidates for bariatric surgery. This is based on the evidence that about 60 to 80 percent of diabetic patients with BMI of 40 and above can recover from diabetes if they undergo bariatric surgery. The cost of surgery is largely repaid in less than 2 years, in terms of savings on the cost of therapies and procedures related to diabetes complications, ultimately resulting in savings of about £4,000 (over €5,000) per year per patient operated on.

Obesity, losing weight is only the beginning
Losing weight is only the beginning...

The Dr. Salvatore Cuccomarino has been involved in bariatric surgery since 2008, when, upon his arrival at the Gipuzkoa Polyclinic in San Sebastian, Spain, he was put in charge of theUnit of Esophagogastric Surgery within the General Surgery Service, and received the mandate, together with Dr. Javier Perez Diez and later with Dr. Rodolfo Romero Vece, to organize aBariatric Surgery Unit .Thus was born the first Bariatric Surgery Unit in the Basque Country, within which Dr. Cuccomarino performed many dozens of obesity surgeries.



In the Pinna Pintor Nursing Home, Dr. Cuccomarino continues to collaborate with Dr. Rodolfo Romero Vece, of theDelafontaineHospital in Saint-Denis, just outside Paris, a major French referral center for bariatric and metabolic surgery, where, each year, more than 400 obesity surgeries are performed -





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