Patient­centered care and "people-first language" as tools to prevent stigmatization of patients with obesity.

Obesity is a global health problem with serious consequences, such as diabetes, dyslipidemia, cardiovascular disease, infertility, and certain cancers. Excess body weight, mainly due to its manifestation in an individual's appearance, also affects the psychological condition. Therefore, health care providers need to make an effort to diagnose and comprehensively treat obesity. The obesity treatment should be systemic and carried out by a multidisciplinary therapeutic team consisting of a doctor, nurse, dietitian, psychologist or physiotherapist, and surgeon. The first-line therapy of obesity includes lifestyle modification and increased physical activity. Pharmacological treatment is recommended in all adult patients with a body mass index (BMI) exceeding 30 kg/m2 or those with a BMI greater than or equal to 27 kg/m2 with at least 1 obesity­related comorbidity. Bariatric surgery should be considered in adults with a BMI of 40 kg/m2 or greater, or those with a BMI greater than or equal to 35 kg/m2 with at least 1 obesity­related disease. The holistic model of obesity treatment also includes psychological therapy. The European Association for the Study of Obesity recommends psychological assistance for all individuals with previous treatment failure. Adverse or harmful actions toward people with obesity, ascribing negative traits and behaviors to them, and their marginalization in the public space are referred to as stigmatization of obesity. This phenomenon is associated with reduced compassion and willingness to help, and a feeling of dislike or even anger toward this group of patients. The consequences of stigmatization are worse mental health, poorer physical health, avoidance of health care, and the maintenance or increase of excess body weight. Therefore, talking about obesity using the principles of "people-first language," as well as implementing a patient­centered care model are important.

The Influence of Obesity on Nutrition and Physical Activity during COVID-19 Pandemic: A Case-Control Study.

Obesity is one of the important risk factors for a severe course of COVID-19. Maintaining a healthy body weight through diet and physical activity is a reasonable approach to preventing a SARS-CoV-2 infection or in alleviating its course. The goal of the study was to determine the influence of obesity on nutrition and physical activity during the COVID-19 pandemic. A total of 964 respondents, including 227 individuals with a body mass index (BMI) ≥30 kg/m2 were evaluated in this study. In the case of 482 respondents, including 105 individuals (21.8%) with BMI ≥ 30 kg/m2, the data were collected during the pandemic period from 1 June to 31 August 2020. The remaining 482 individuals were the "pre-pandemic" group, selected via propensity score matching (PSM) out of the 723 National Health Program study participants whose data was collected in 2017−2019. The evaluated dietary health factors were quantitatively similar in patients with BMI of either <30 kg/m2 or ≥30 kg/m2 and showed no significant changes during the pandemic. The diets of those who suffered from obesity prior to the pandemic showed the evaluated unhealthy nutritional factors to be less pronounced in comparison with those of individuals with BMI < 30 kg/m2. During the pandemic, the BMI ≥ 30 kg/m2 group showed a significant increase in the overall calorie intake (by 319 kcal; p = 0.001) and an increased consumption of total carbohydrates 299.3 ± 83.8 vs. 252.0 ± 101.5; p = 0.000), sucrose (51.7 ± 30.0 vs. 71.6 ± 49.9; p = 0.000), plant protein (26.3 ± 12.1 vs. 29.3 ± 8.3; p = 0.040), total fat (73.1 ± 42.6 vs. 84.9 ± 29.6; p = 0.011) and saturated fatty acids (29.5 ± 16.4 vs. 34.3 ± 13.9; p = 0.014) in comparison with the pre-pandemic period. The energy and nutritional value of the diets of BMI < 30 kg/m2 individuals did not change between the pre-pandemic and pandemic period. Before the pandemic, the level of leisure physical activity of the BMI ≥ 30 kg/m2 group was significantly lower than of those with BMI < 30 kg/m2. Such differences were not observed in the levels of physical activity at work or school. The pandemic did not alter the amount of physical activity either during leisure time or at work/school in individuals with BMI ≥ 30 kg/m2. However, respondents without obesity exercised significantly less during the pandemic than before. In conclusion, the pandemic altered the diets and levels of physical activity in the Polish population, with dietary changes observed in individuals with BMI ≥ 30 kg/m2 and changes in physical activity observed in those with BMI < 30 kg/m2.

Management of obesity in the times of climate change and COVID-19: an interdisciplinary expert consensus report.

Obesity is a chronic disease associated with increased metabolic and cardiovascular risk, excessive morbidity and mortality worldwide. The authors of the present consensus, clinicians representing medical specialties related to the treatment of obesity and its complications, reviewed a number of European and American guidelines, published mostly in 2019-2021, and summarized the principles of obesity management to provide a practical guidance considering the impact that increased adiposity poses to health. From a clinical perspective, the primary goal of obesity treatment is to prevent or slow down the progression of diseases associated with obesity, reduce metabolic and cardiovascular risk, and improve the quality of life by achieving adequate and stable weight reduction. However, obesity should be not only considered a disease requiring treatment in an individual patient, but also a civilization disease requiring preventive measures at the populational level. Despite the evident benefits, obesity management within the health care system-whether through pharmacotherapy or bariatric surgery-is only a symptomatic treatment, with all its limitations, and will not ultimately solve the problem of obesity. The important message is that available treatment options fail to correct the true drivers of the obesity pandemic. To this end, new solutions and efforts to prevent obesity in the populations are needed.

Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons. Bariatric and metabolic surgery care standards.

The Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons (Polish acronym: SCMiB TCHP) is a Polish specialist scientific society representing bariatric surgeons as well as specialists from other disciplines and professions cooperating with them during the provision of services in the field of bariatric and metabolic surgery, as well as the entire care process before and after surgery. The following standards constitute the minimum requirements set by the SCMiB TCHP for good practice of the basic process of bariatric care throughout its entire period, which ensure satisfactory safety and effectiveness of the obesity treatment and its metabolic complications.

Diagnosis and treatment of thyroid disorders in obese patients - what do we know?

Obesity-related changes in the composition of the body interfere with the proper functioning of the thyrotropic axis, leading to its disturbances and changes in the structure of the thyroid gland. Distinguishing what is related to obesity and what constitutes pathological changes is crucial for the proper treatment of patients. In this paper authors present a case of a patient with a diet-induced obesity, whose only abnormalities in thyroid assessment included an elevated level of thyroid stimulating hormone (TSH) and hypoechoic thyroid gland on ultrasound. Based on this clinical situation, we reviewed literature in order to establish rules regarding management of thyroid disorders in obese individuals. The most common obesity-related thyroid abnormality is an isolated increase of TSH, without clinical symptoms of hypothyroidism, defined as hyperthyrotropinaemia. In obese adults, autoimmune thyroid disease is found equally often as in the normal-weight population. Thyroid enlargement, increased risk of nodules, and decreased echogenicity, not related to autoimmunity, is frequent among obese individuals. Weight loss leads to the normalisation of TSH levels and thyroid echogenicity. Excessive weight can influence both the TSH level and ultrasound image of the thyroid gland; however, these findings can be reversed by weight reduction. Therefore, in asymptomatic obese patients elevated TSH should not be treated with thyroid hormone replacement.

Gastric Ulcer Hemorrhage - a Potential Life-Threatening Complication of Intragastric Balloon Treatment of Obesity.

BACKGROUND: Some morbidly obese patients do not qualify for bariatric surgery due to general health contraindications. Intragastric balloon treatment might be a therapeutic option in the above-mentioned cases. It can prime super-obese patients with end-stage disease for bariatric surgery. As a neoadjuvant therapy before surgery, it leads to a downstage of the disease by preliminary weight reduction, to an improvement in general health and, in summary, to a reduction of the perioperative risk. It is generally considered to be a safe method. However, due to the wide range of possible complications and unusual symptoms after intragastric balloon treatment, an interdisciplinary, instead of only a surgical or endoscopic, treatment and follow-up might be recommended in these patients. CASE REPORT: We here describe a potential life-threatening complication in the form of gastric bleeding as a consequence of intragastric balloon treatment and simultaneous aspirin taking and Helicobacter pylori infection. CONCLUSION: There have been reports of some complications of intragastric balloon treatment. However, to the best of our knowledge there were no reports concerning life-threatening hemorrhage from gastric ulcer.

[The prevalence of overweight and obesity vs. the level of physical activity of aviation military academy students]. / Czestosc wystepowania nadwagi i otylosci u studentów lotniczej uczelni wojskowej a poziom ich aktywnosci fizycznej.

BACKGROUND: The aim of the study was to evaluate overweight, obesity and the level of physical activity in the study group of 100 cadets of the Air Force Military Academy in Deblin (WSOSP). MATERIAL AND METHODS: Evaluation of overweight and obesity was based on body mass index (BMI) and body fat content. An accelerometer AiperMotion 500TM was used to measure the level of physical activity. There were marked such parameters as the average daily energy consumption, the average distance covered during the day and the whole week and the indicator of physical activity level (PAL). RESULTS: Based on BMI indicators, 71.3% of the cadets had normal body weight, 25.3% were overweight and 3.4% were obese. Assessment of nutritional status showed significant differences between the 1st and 2nd vs. the 4th and 5th years of study. Normal BMI values showed 88% of the 1st and 2nd year students, while of the 4th and 5th years - only 48.6% (p < 0.05). Based on the body fat content, obesity was found only in a group of older students (16.2%) and overweight was 10 times higher in the 4th and 5th years (21.6%) in comparison to younger students (2%). The average distance covered during the day or during the whole week was significantly higher in the 1st and 2nd year students. CONCLUSIONS: It is necessary to implement appropriate measures in the field of nutrition and physical activity to prevent the development of excessive body weight during studies among the military cadets of the Air Force Military Academy in Deblin.

[Type 2 diabetes prevention. Experts' Group position paper endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy]. / Zapobieganie rozwojowi cukrzycy typu 2. Stanowisko grupy ekspertów wsparte przez Sekcje Farmakoterapii Sercowo-Naczyniowej Polskiego Towarzystwa Kardiologicznego.

Type 2 diabetes is responsible for approximately 90% of all diabetes worldwide and it is a global public health problem. This is a chronic, progressive, metabolic disease characterised by hyperglycaemia, which leads to microangiopathic and macroangiopathic complications. Subjects with type 2 diabetes have increased mortality and a reduced life expectancy compared with those without diabetes. Strong evidence supports the fact that identification of type 2 diabetes risk factors and early intervention influencing the modifiable ones can reduce incidence rate of diabetes and prevalence of its complications. There are many advantages of such interventions for patients (prolonged life expectancy, improvement of life quality) and for the whole society (reduction of the costs). Therefore the guidelines for the prevention of type 2 diabetes are needed. Experts of the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy reviewed recently published clinical studies regarding the prevention of type 2 diabetes and prepared their recommendations. The guidelines are designed to assist clinicians and other healthcare workers to make evidence based management decisions. The strategies are grouped broadly into interventions that aim to change lifestyle through physical activity and diet, interventions based on drug administration (pharmacotherapy) and surgical interventions.

Nutrition management of the post-bariatric surgery patient.

Bariatric surgery is considered one of the most effective methods of achieving long-term weight loss when all other medical treatments have failed. The number of bariatric procedures increases each year. Nevertheless, bariatric procedures are associated with a number of complications that require careful multidisciplinary management. Nutrition supervision is of substantial value, as malnutrition, vitamin, and micro- and macronutrient deficiencies may lead to deleterious consequences. In this review, we provide essential information on nutrition management, both before and after bariatric surgical procedures.

Small bowel necrosis as a consequence of spontaneous deflation and migration of an air-filled intragastric balloon - a potentially life-threatening complication.

Intragastric balloon placement is a common method of treatment of obesity and is often used by non-surgical teams in endoscopy departments. The likelihood of spontaneous intragastric balloon damage is a well-known phenomenon. We describe a patient who was disqualified from surgical obesity treatment and in whom intragastric fluid-filled balloons had already been inserted twice and removed due to their intolerance. Therefore we qualified this patient for placement of the air-filled balloon Heliosphere BAG. Two months after the planned check-up, he arrived at the surgery department complaining of nausea and vomiting and due to symptoms of ileus diagnosed with an X-ray and ultrasound examination we qualified him for emergency surgery. We would like to emphasise the following issues: the necessity of air-filled balloon removal according to the producer's instructions and multidisciplinary specialist team care along with appropriate diagnostic tools in every case of intragastric balloon insertion.

An evaluation of the knowledge of the surgical treatment of obesity among surgeons.

INTRODUCTION: Surgical treatment of obesity is currently the only effective treatment option for patients with excess body weight, especially morbid obesity and diseases caused by it. There are no studies evaluating the knowledge of surgeons in the field of bariatric surgery. AIM: To assess the knowledge of surgeons regarding bariatric surgery. MATERIAL AND METHODS: An anonymous questionnaire was conducted among 143 surgeons in 2010-2011 during local educational conferences. The survey consisted of 10 questions dedicated to the fundamental problems of the surgical treatment of obesity. RESULTS: Theoretical and practical knowledge connected to the so-called "epidemiological awareness" in the surgical treatment of obesity was possessed by 25% of the respondents. Knowledge of surgical techniques is known to most surgeons. Reducing the "oncological risk" after bariatric surgery is known to only 27% of surgeons. Almost 80% of surgeons indicated a necessity of their further education regarding the surgical treatment of obesity. CONCLUSIONS: Knowledge of Polish general surgeons in the surgical treatment of obesity is not high, with a high number of surgeons who possess knowledge of the operating technique, whereas only a quarter have a basic knowledge of the indication for surgical treatment. Most surgeons who participated in our study are awaiting educational programmes focused on this issue.

Hepatic angiogenesis and fibrosis are common features in morbidly obese patients.

BACKGROUND: A mass of visceral adipose tissue is one of the most important determinants of progressive liver injury in nonalcoholic fatty liver disease (NAFLD). In accordance, nonalcoholic steatohepatitis (NASH) and fibrosis are believed to occur more commonly in morbidly obese patients compared with nonobese NAFLD patients. AIM OF THE STUDY: Comparative analysis of NAFLD histopathologic features and angiogenesis activity in morbidly obese and nonobese subjects. MATERIALS AND METHODS: Biopsy samples from 40 severely obese (BMI ≥40 kg m(-2)) and 30 nonobese (BMI ≤30 kg m(-2)) NAFLD patients were examined. Kleiner's classification was used to diagnose NASH by grading steatosis, cytoplasmatic ballooning of hepatocytes, and lobular inflammation. The severity of fibrosis was evaluated according to the liver fibrosis staging system. Qualitative and quantitative immunohistochemical analyses of VEGF A, Flk-1, and CD34 were performed to study angiogenesis and the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) method was used to study hepatocyte apoptosis. RESULTS: Severely obese patients did not differ from nonobese patients with respect to age and sex distribution. NASH was diagnosed in nine (22.5%) severely obese patients and in seven (23.3%) nonobese patients. Fibrosis was more common in morbidly obese patients (82.5 vs. 43.5%, χ(²) = 11.71, p = 0.003) and was not associated with NASH. Moreover, the severity of fibrosis was greater in obese patients, as advanced fibrosis (bridging fibrosis and cirrhosis) occurred in six (15%) severely obese patients and in two (6.7%) nonobese patients. In morbidly obese individuals, angiogenesis was independent of NASH and was activated at the stage of simple steatosis. In severe obesity, there was a positive relationship between the stage of fibrosis and angiogenic activity. CONCLUSION: In severely obese patients, fibrosis is probably promoted by mechanisms independent of NASH. In these patients, angiogenesis is activated early in the natural history of NAFLD and correlates with the severity of fibrosis.

Assessment of the knowledge of GPS considering the surgical treatment of obesity.

UNLABELLED: Bariatric surgery is currently the only effective treatment option for morbidly obese patients. There has been observed a considerable disproportion between the number of procedures conducted in Poland and the number of patients requiring such treatment. There are no studies assessing bariatric knowledge among general practitioners who play crucial role in polish health care system. The aim of the study was to assess the knowledge of general practitioners regarding bariatric surgery. MATERIAL AND METHODS: An anonymous questionnaire conducted among 282 general practitioners in 2010-2011 during local educational conferences. The questionnaire consisted of 10 questions relating to fundamental issues of bariatric surgery. RESULTS: Only one twelfth (8.1%) of the general practitioners questioned knows the indications for bariatric surgery, can apply them, and has epidemiological awareness. 61.5% of general practitioners know the surgical procedures used for the treatment of obesity, whereas 58% of them show the knowledge of surgical technique in which they are performed. Only 23% of general practitioners were aware that bariatric surgery decreases cancer risk. 92% of the participants noticed a necessity of education regarding the surgical treatment of obesity. CONCLUSIONS: Bariatric knowledge among general practitioners is not adequate to scientific research results published during the last years. Most general practitioners who participated in our study are aware of that and are awaiting for educational programmes focused on this issue.

Liver visfatin expression in morbidly obese patients with nonalcoholic fatty liver disease undergoing bariatric surgery.

BACKGROUND: Visfatin has been identified as a new adipokine with proinflammatory and immunomodulating properties. It seems to interfere with immune and fibrogenic process in nonalcoholic fatty liver disease (NAFLD). The aim was to assess visfatin expression in the liver tissue and its association with biochemical parameters and morphological features in NAFLD patients. MATERIAL AND METHODS: The study included 40 severely obese patients with NAFLD who underwent intraoperative wedge liver biopsy during a bariatric operation. Immunohistochemical assay was carried out with the use of a visfatin mice monoclonal antibody. RESULTS: Visfatin expression in the liver was observed in all patients. The expression was significantly higher in patients with fibrosis (p = 0.036) and was positively correlated with the fibrosis stage (r = 0.52, p = 0.03). There was no difference between patient with nonalcoholic steatohepatitis (NASH) and simple steatosis (p = 0.54). Inflammatory activity and NAS (NAFLD Activity Score) score were not associated with visfatin expression. There was a tendency of more evident visfatin liver expression in morbidly obese patients with diabetes mellitus. CONCLUSION: Our study showed a positive association between visfatin and the fibrosis stage in NAFLD. This observation suggests a potential role of this adipokine in the pathogenesis and progression of NAFLD. Visfatin expression does not seem to be associated with liver steatosis and inflammation.

Postoperative analgesia in a morbidly obese patient with chronic renal failure.

BACKGROUND: The number of surgical interventions performed in obese patients has recently been increasing. Anaesthesia in a morbidly obese patient may be difficult, due to many pathophysiologic changes and co-morbidities, together with altered pharmacokinetics and pharmacodynamics of anaesthestic agents. We present a case of multimodal preventive analgesia in a bariatric patient with chronic renal failure. CASE REPORT: A 36-year-old, morbidly obese man (BMI 47.8 kg m-2) was scheduled for a laparoscopic adjustable gastric banding (LAGB). The anaesthetic risk was increased because of hypertension, chronic renal failure, steatohepatitis and obstructive sleep apnoea syndrome. 30 minutes before anaesthesia, the patient received 2 g iv paracetamol. After induction, he was given 8 mg dexamethasone and 100 mg tramadol. All port-sites were infiltrated with 0.5% bupivacaine and adrenaline, both before skin incision, and before wound closure. Since NSAIDs and opioids were contraindicated because of the patient's co-morbidities, postoperative analgesia consisted of tramadol and paracetamol, given alternately, every 3 hours. The patient was discharged home 28 hours after surgery. DISCUSSION AND CONCLUSION: According to the Polish Postoperative Pain Management Recommendations 2008, the pain after LAGB is multifactorial and rated as category 2. The pre-emptive analgesia and postoperative regimen presented in this case can be recommended in similar cases.

Red blood cell aggregation and deformability among patients qualified for bariatric surgery.

BACKGROUND: The study presents red blood cell (RBC) aggregability and deformability among obese patients qualified for bariatric surgery and its correlation with plasma lipid concentration. METHODS: We studied 40 morbidly obese patients who were qualified for bariatric surgery: mean age was 43.5 +/- 11.3 years, and mean body mass index (BMI) was 48.9 +/- 7.7 kg/m2. The RBC deformability and aggregation parameters: aggregation index (AI), syllectogram amplitude (AMP) and aggregation half-time (t1/2) were measured by Laser-assisted Optical Rotational Cell Analyser - LORCA. RESULTS: Elongation index of RBC was significantly lower in obese patients than in the control group (P<0.001) in 3.16-60.03 Pa shear stresses. Correlations between elongation index and triglyceride levels ranged between 0.42 to 0.44 (P<0.05). AI was significantly higher in the obese patients (P<0.001), t1/2 and the AMP were decreased (P<0.001) compared to the control group. The RBC aggregation index correlated positively with total cholesterol level (r = 0.61, P<0.05), non-HDL cholesterol level (r = 0.54, P<0.05) and BMI (r = 0.48, P<0.05). Negative correlation presented t1/2 with total cholesterol (r = -0.64, P<0.05), non-HDL cholesterol (r = - 0.51, P<0.05) and BMI (r= -0.59, P<0.05). CONCLUSION: Obesity is associated with RBC rheological disturbances expressed by a decrease in RBC deformability, increased total aggregation extent and the alteration of kinetics of RBC aggregation. These results may suggest the necessity of introducing treatment forms to correct erythrocyte rheological properties, which may improve the blood-flow condition in the microcirculation and prevent postoperative complications after bariatric surgery.

Rheological properties of erythrocytes in patients suffering from morbid obesity. Examination with LORCA device.

UNLABELLED: Obesity is associated with many comorbid pathologies that lead to increased morbidity and increased mortality. Hemorheological changes in obesity are currently investigated as one of the risk factors for many comorbid pathologies. It has been found that erythrocyte hyperaggregation and a decrease in erythrocyte filterability have also been well documented in obesity patients. The aim of this study is to present preliminary results of the influence of weight reduction after vertical banded gastroplasty (VBG) on aggregation of red cells and red blood cells deformability. We studied seven patients who underwent VBG, median age 46 years (range 35-52), median BMI 52.1 kg/m(2) (range 36.6-66). Blood rheology changes and selected biochemical parameters were examinated before and 6 months after VBG. Erythrocyte elongation and red blood cells (RBC) aggregation were measured using the Laser-assisted Optical Rotational Cell Analyser (LORCA). The RBC aggregation index was significantly decreased, while the aggregation half-time (t(1/2)) significantly elongated after surgery. The syllectogram amplitude did not change. No differences in RBC deformability were observed in the postoperative period. CONCLUSION: We could conclude that among morbidly obese patients six months after VBG some beneficial changes of erythrocyte rheological parameters are observed. Further studies are necessary to confirm our preliminary results.