Bariatric surgery is now recommended for individuals with a body mass index equal to or greater than 35 kg/m², regardless of the presence, absence or severity of comorbidities. These are the new guidelines released by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) and the American Society for Metabolic and Bariatric Surgeries, reference institutions in the area, updating indications that were in force for more than 30 years. “I fully agree with these changes”, says António Albuquerque, vice-president of the Portuguese Society for the Study of Obesity (SPEO). “It is extremely positive that IFSO has updated its guidelines, because it will allow greater access to surgery for patients who, in our clinical practice, we already felt that they could not have effective treatment in any other way”, he emphasizes.
Previously, for a person with grade II obesity (BMI ≥ 35 Kg/m2) to be considered eligible, they had to have at least one comorbidity, such as type 2 diabetes, arterial hypertension, obstructive sleep apnea, among other complaints. “Do we have to wait for people to worsen their health problems before we can act? It makes no sense!”, believes the surgeon. In Portugal, it is not known exactly how many people become eligible, but there will certainly be many thousands. According to the National Health Survey, released by the INE, more than half of the population aged 18 and over (4.6 million) continued to be overweight (36.6%) or obese (16.9%, 1.9 million people) in 2019.
Another significant change in the IFSO guidelines is that bariatric surgery is now considered for individuals with type 2 diabetes and a BMI equal to or greater than 30 kg/m2. “In type 2 diabetic patients with obesity, there was evidence that performing surgery substantially improved their condition and, in some cases, the diabetes even disappeared. SPEO and other entities had already reached this understanding, which is now reinforced by this international orientation”, points out António Albuquerque.
It remains to be seen when the Directorate-General for Health will validate these new guidelines and update the eligibility criteria for bariatric surgery. “Even if the DGS takes time to make this change, hospital units will not stop operating if they understand that this is the best treatment”, believes the vice-president of SPEO. Remember that, in this intervention, the digestive system is altered in order to reduce the amount of food tolerated by the stomach or to modify the natural process of digestion, in order to drastically reduce the amount of calories absorbed, facilitating weight loss. . Generally speaking, bariatric surgery reduces appetite and the amount of food a person can comfortably eat at one time. It also produces metabolic and hormonal changes, which play an important role in weight regulation.
In Portugal, obese people wait an average of 16 months between consultation and surgery, but there are waiting times of more than three years in public hospitals, according to data from the Health Regulatory Entity. “Patients despair, but they do not give up, because they know that this is the only solution and that, after the surgery, they gain a great quality of life. I have operated on more and more patients with severe obesity, which is not ideal. Everything that is done so that the intervention takes place sooner is seen with good eyes”, defends António Albuquerque.
