The Bulgarian Society of Bariatric/Metabolic Surgery joins its efforts to fight obesity, which is one of the risk factors for a severe course of coronavirus infection, with an unfavorable outcome
The reason is that obesity is a chronic disease that is associated with the development of a number of socially significant complications such as type 2 diabetes, high blood pressure, high cholesterol and triglycerides, fatty liver, strokes, heart attacks, infertility, cancer and with higher overall human mortality.
We are talking about bariatric/metabolic surgery as a new direction in abdominal surgery for the treatment of obesity with the president of the society - Assoc. Dr. Konstantin Grozdev.
Assoc. Grozdev is part of the team of Second Surgery of UMBAL "Alexandrovska", which has a center for the treatment of obesity and bariatric surgery. He specialized in the European School of Laparoscopic Surgery and the Obesity Clinic at the Saint-Pierre University Hospital, Brussels, Belgium. In 2016, he defended his dissertation on "Modern minimally invasive techniques in laparoscopic surgery - advantages and disadvantages". There are more than 1,000 laparoscopic operations, some of which are performed through a single incision. He is a teacher at the Department of Surgery of Medical University - Sofia, and in 2020 he was elected associate professor.
Prof. Grozdev, in September of this year, the Bulgarian Society for Bariatric/Metabolic Surgery was established by leading specialists in this field, including you. What is the contribution of this surgery in the fight against COVID-19?
- Bariatric surgery is one of the main methods of treating obesity, and as a chronic disease leading to many accompanying socially significant diseases, it is risky in case of coronavirus infection. What's more, even - as a reason for a bad outcome of this infection. Studies in relation to the coronavirus infection, as well as the experience of colleagues who deal directly with these patients, report a greater morbidity among obese patients, a more severe course in them, with a greater mortality.
And this is one of the reasons why leading specialists from UMBAL "Alexandrovska", "Ajibadem City Clinic MBAL Tokuda" and UMBAL "Sofiamed" have united in a company whose main goal is to inform society about the problems that exist with obesity and for bariatric surgery in general.
We talk about Bulgaria's leading position in terms of mortality in Europe, but we ignore the problem of overweight - 60% of Bulgarians are precisely in this column…
- I wouldn't say we're neglecting this specifically more than other countries, as the problem as a whole is global and obesity has been a pandemic for quite a few years now. Despite the recommendations of the World He alth Organization and the policies that have been undertaken - mainly for prevention, because it is the basis of everything, the frequency of overweight and obese people has tripled. So the problem is very big and its solution is complex. Especially in Bulgaria, what is perhaps still sitting as an unresolved issue about bariatric surgery is that it is not reimbursed by the He alth Insurance Fund.
But we as a company in the future will work in collaboration with all government institutions and patient and class organizations to fight this problem. Bariatric/metabolic surgery has been proven to be the most effective method for treating morbid obesity, which not only leads to weight loss, but also remission of accompanying diseases, which is actually the very valuable and big news in this surgery.
Achieving remission of diabetes mellitus with a surgical method is a revolutionary moment in medicine in general. The current treatment of diabetes, which is known to everyone - with medication, insulin therapy, does not lead to complete remission. In addition, these operations are also associated with a reduction in the risk of developing malignant diseases and infertility. In general, bariatric surgery is associated with increasing life expectancy and dramatically improving its quality. Finally, drawing a line on the costs involved in this treatment, bariatric surgery actually saves the he alth care system quite a bit.
What is the cost of the operation?
- The price in Bulgaria is around BGN 10,000 - 11,000. The amount is really quite large and this is one of the reasons why a large contingent of Bulgarians with morbid obesity do not have access to this surgery, and thus do not have access to to the best for your he alth.
We usually associate overweight with too much food. Is gluttony alone at the root of obesity?
- Definitely not. Indeed, many of the patients have wrong eating habits - I would rather call it that, but the truth is that most of those whom I examine every day, and with a lot of weight, come to me during consultations and, accordingly, during examinations, which are done with nutritionists, with endocrinologists, with psychologists, in fact it turns out that they do not eat at all as is believed in society. On the contrary, many of them eat less than thin people.
So this about gluttony is not true. It's just a metabolic problem. If such a patient eats a chocolate bar and another person of normal weight eats the same bar, their body will process it differently. But the factors are many and different - there is a genetic predisposition, various factors from modern life are a prerequisite, such as stress, for example, the appearance of fast food restaurants, harmful foods. All this is the reason why there has been such a boom in obesity in the last 50-60 years.
All kinds of slimming preparations are available on the market. Are they not a way out of this state, so as not to reach the knife, as they say?
- There are different degrees of obesity and different ways of treatment. To make it clear, let's take another chronic disease - for example, cancer. There are different types of treatment for malignant diseases and it is applied depending on its stage. Let's say that with obesity in some initial stage, when it is not so advanced, maybe conservative methods of treatment, such as medication, physical activity, psychotherapy, will help. But when those don't help, comes surgery.
Here I want to say that with all these preparations being advertised and available everywhere, people should not think that they can self-medicate with them. Obesity is an extremely serious problem and help should be sought from professionals who understand. Multidisciplinary teams are needed to take a comprehensive look at the person and approach their treatment in an individualized manner. To take into account his taste preferences, his lifestyle, his eating habits - if possible, they should be changed so that the treatment can be complete and correct.
There is no universal diet and medicine that cures all people. So things are complex. But, categorically, whatever conservative methods are applied, only bariatric surgery is the method that gives long-term control of the disease. Diets and sports reduce weight for a certain period of time, but after a while people prone to morbid obesity gain weight again. With bariatric surgery, this is also possible, but to a much lesser extent.
And one more thing, you say: "so that they don't reach the knife". I assure you that in modern surgery a knife is hardly used. These operations are performed bloodlessly, laparoscopically. And it's an essential part of this surgery that it's now bloodless, which drastically reduces the risks of it and patients recover much faster.
Is body mass index the criterion for bariatric/metabolic surgery?
- Body mass index is a major criterion that enters into the indications for these operations. It is calculated by dividing the weight in kilograms by the height in meters squared. Indications for bariatric surgery are over 35 kg per square meter, with the presence of any accompanying disease and over 40 kg per square meter.meter, without necessarily having an accompanying disease. But in recent years, the trend is that the body mass index does not accurately reflect the degree of the obesity disease, because agree that with this ratio there can be a person who is, for example, over 100 kg, but he is all in muscles. Then there is no obesity.
So a much more accurate method is to measure the amount of fat tissue and its distribution in the body. Especially in Aleksandrovsk Hospital there are such tests that determine the amount of fat in the body.
What is bariatric/metabolic surgery?
- Bariatric/metabolic surgery is equal to laparoscopic surgery. There is no other alternative. Years ago, of course, these were "open" operations - with large incisions, but nowadays it is a mistake of the art if such an operation is done by opening the abdomen. Therefore, the specialists who perform these operations must be well prepared in this type of surgery. And here I hasten to say that these are not cosmetic operations, this is not liposuction - suction of fatty tissue. Here we are talking about a rearrangement of the gastrointestinal tract.
When a person eats, food passes from the mouth into the esophagus, then into the stomach, duodenum, intestines. During these operations, the path of food is changed, a rearrangement is made, because it turns out that the gastrointestinal tract is the main organ that secretes various enzymes and hormones in the body and regulates many metabolic processes in the body. When we rearrange the gastrointestinal tract, these regulatory mechanisms change and actually heal the metabolism. That is why it is also called metabolic surgery.
How do you determine if an operation is successful or not?
- An operation is considered successful when its goals are achieved, which is a 50% reduction in excess weight. If there is more than a 50% reduction in excess weight within two years, the surgery is a success. Also, its success is determined by the course of accompanying diseases.
If we do not have a reduction of more than 50% of excess weight, the operation can be said to be unsuccessful and there is a reason for this. But, for example, a patient may not lose those pounds, but have a remission of their severe diabetes and after two years stop all kinds of medication, the operation can again be said to be a success. That is, there are nuances that specialists must determine strictly individually. But overall, it's remission of comorbidities and more than 50% weight reduction.
You are a graduate of the Western European school of laparoscopic surgery and obesity treatment. Can Bulgarian laparoscopic surgery measure up to Western surgery?
- Oh sure. This is also one of the reasons why we came together under the common idea to create this company, because it is incomprehensible to me how it is spread everywhere that these operations are carried out in countries neighboring us without even knowing that this is happening and in Bulgaria.
I dare to say that we are at a fairly high level both in surgery in general and in laparoscopic surgery in particular. I have specifically been to the European School of Laparoscopic Surgery and specialized there and I can compare, so I say it first hand - we are at a pretty high level. In the last year, maybe also because of the pandemic, I have several patients with operations performed abroad who come to us with complications from those operations, and we have to deal with these problems. Yes, there are centers abroad as well, but not everywhere has the capacity to carry out such operations.