The incidence of clinically
severe obesity --- or simply the state of exceeding the Ideal Body
Weight (IBW) by 100 lbs. for males, or 80 lbs. for females, is rising
among Filipinos. Severe obesity refers to a Body Mass Index (BMI)
of >40 kg/m^2, the normal BMI being 19-25. Commonly called morbid
obesity, it gives rise to a host of diseases such as high blood pressure,
diabetes, joint disease, high cholesterol, heart disease, pulmonary
problems, and reduced life expectancy.
Morbid obesity could develop to be one of the major
health problems in the Philippines unless serious steps are taken
to arrest the rise of its incidence or, better, prevent it altogether.
"There are an estimated 500,000 Filipinos suffering
from clinically significant obesity. It is especially alarming to
note that some of these patients are very young," says Dr. Hildegardes
C. Dineros, main proponent, Asian Bariatrics, an advocacy group committed
to create awareness on the problem of obesity.
Western experience in the past 30 years has established
a definite role of surgery in the treatment of morbidly obese patients.
The 1991 NIH Consensus states "dietary weight reduction with or without
behavioral modification or drug therapy had an unacceptably high incidence
of weight regain in the morbidly obese within 2 years after maximal
weight loss." Great effort is exerted to address this problem because
in the U.S. alone more than half of their adult population are obese
and presently around 12 million Americans need surgical intervention.
Very alarming is the rapid increase in the number of affected individuals,
even including children.
Is this obesity trend seen in the third world as
well? National statistics on malnutrition show undernutrition as a
major problem of developing countries like the Philippines. However,
this is fast changing. As Filipinos adopt more of the western lifestyle
and diet as reflected by the so-called "McDonald's index", a segment
of our population inevitably becomes subject to the consequence of
being overweight and finally obese. Based on the data gathered from
the NUTRISTAT Protocol at St. Luke's Medical Center (1999 - 2000),
34% of the total admitted patients are malnourished and yet surprisingly
about one-fourth of them are obese. There was more overweight (2/3)
than undernourished (1/3) patients. These data may give us an idea
of how serious the problem is even in our country. These data are
based on the WHO Classification of Obesity using Caucasian BMI level
guidelines. The incidence could go higher if the Asia-Pacific BMI
level guideline is utilized. The FNRI data in 1998 revealed an incidence
of overweight and obesity in the Philippines of 16.9%.
Bariatric surgery deals with the gastrointestinal
tract, specifically, the stomach and the small intestines. The procedure
may be purely Restrictive (Gastroplasty, Gastric Banding) so that
satiety is attained even with a small amount of food intake or Malabsorptive
(Biliopancreatic Diversion), which minimizes the chance of food nutrients
to get absorbed from the gut. There may be a combination of the above
techniques (Gastric Bypass, BPD with Duodenal Switch). Procedures
may be done as Open Surgery or Laparoscopic. The most commonly performed
technique in the US is Roux-en-y Gastric Bypass thus making this technique
the present gold standard. In Europe and Australia, Gastric Banding
is relatively popular. Surgery is the most effective means available
for successful long-term weight loss in the morbidly obese patient,
the lowest weight generally attained in 12-24 months.
The Philippines is the first in Southeast Asia to
provide the service of Bariatric Surgery, and the most active in creating
awareness for the global problem of Obesity.
The success of these surgical procedures for obesity
is measured by the Excess Weight Loss (EWL). This ranges from 50-100%
depending on the technique used. The clinical outcome of weight reduction
after surgery is most desirable, for the "shrunk" person will now
be able to live a healthy and full life.
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