Am I Candidate for Obesity Surgery?
The management of the obese patient at present must be Multidisciplinary, with the main objective of offering our patients a safe and effective surgical procedure tailored to their needs. The initial evaluation is Clinical Nutrition and includes the classification of the patient according to the degree of Obesity through the Body Mass Index.
HOW IS OBESITY CLASSIFIED?
Obesity is classified in degrees according to the Body Mass Index (BMI), which is the Weight (in Lb) divided by the Size (in In²), established by L.A.J. Quetelet in Belgium in 1835, according to Kral (2001). The original publication of Quetelet, published in 1842, has been reproduced in Obesity Research (Quetelet 1994). The World Health Organization (WHO 1997) and the National Institutes of Health (NIH 1998) have adopted the BMI as a parameter of obesity.
Classification of Obesity according to the BMIObesity ClassBMI (lb / in²)
|Normal||–||18.5 – 24.9|
|Overweight||–||25 – 29.9|
|Obesity||I||30 – 34.9|
|Morbid obesity||II||35 – 39.5|
|Obesity||III||more than 40|
|Super Obesity||–||more than 50|
|Super Super Obesity||–||more than 60|
|Triple Obesity||–||more than 65|
The risks of comorbidity and mortality associated with these categories are classified as “increased” in the range of 25.0-29.9 lb/in², “moderate” in Class I, “severe” in Class II and “very severe” In Class III (Kral 2001).
• OBESITY SURGERY INDICATIONS:
The Consensus of the National Institutes of Health establishes that patients with a BMI greater than 40 lb/in² (Class IV) should be considered for surgery, and also those with less marked obesity, BMI 35-40 lb/in² (Class III), with concomitant pathologies (comorbidity) of high risk, such as cardiopulmonary disease, sleep apnea, uncontrollable diabetes and hypertension. However, cases with body mass indexes between 30 and 35 in the presence of comorbidity, and a history of nutritional medical management in obesity with poor response, could be analyzed and agreed to undergo Bariatric Surgery.
1. Age over 18 years old and under 60 years old.
2. BMI greater than 40.
3. BMI greater than 35 in the presence of comorbidity.
4. Morbid obesity maintained for more than 3 years.
5. BMI between 30 and 35 in the presence of comorbidities and poor response to nutritional medical management. (Previous consensus of the medical group).
6. Ages between 15 and 18 years, with a BMI greater than 40 in the presence of comorbidity or greater than 50 without comorbid. (Previous consensus of the medical group).
7. Ages between 60 and 70 years, with acceptable operational risk. (Previous consensus of the medical group).
1. Age under 15 years and over 70 years.
2. BMI less than 30.
3. High Operative Risk
4. Drug addiction and alcoholism.
5. Mental Retardation
6. Psychotic disorders without medical control.
7. Bulimia Nervosa.
The Selection of a Patient that is candidate for Obesity Surgery must apart from having these criteria, be submitted to an evaluation and consensus on the part of our medical group according to the following specialties.
• Clinical Nutrition
• Internal Medicine and Medical Sub-specialties such as Pulmonology, Cardiology and Critical Medicine in case of being a High Risk patient.
• Psychology and Behavioral Management
• Obesity surgery
• Plastic surgery
• Physical rehabilitation