Prevalence and management of dysphagia in nursing home residents in Europe and Israel: the SHELTER Project.

BACKGROUND: Dysphagia is a frequent condition in older nursing home residents (NHRs) which may cause malnutrition and death. Nevertheless, its prevalence is still underestimated and there is still debate about the appropriateness and efficacy of artificial nutrition (AN) in subjects with severe dysphagia. The aim is to assess the prevalence of dysphagia in European and Israeli NHRs, its association with mortality, and the relationship of different nutritional interventions, i.e. texture modified diets and AN-with weight loss and mortality. METHODS: A prospective observational study of 3451 European and Israeli NHRs older than 65 years, participating in the SHELTER study from 2009 to 2011, at baseline and after 12 months. All residents underwent a standardized comprehensive evaluation using the interRAI Long Term Care Facility (LTCF). Cognitive status was assessed using the Cognitive Performance Scale (CPS), functional status using Activities of Daily Living (ADL) Hierarchy scale. Trained staff assessed dysphagia at baseline by clinical observation. Data on weight loss were collected for all participants at baseline and after 12 months. Deaths were registered by NH staff. RESULTS: The prevalence of dysphagia was 30.3%. During the one-year follow-up, the mortality rate in subjects with dysphagia was significantly higher compared with that of non-dysphagic subjects (31.3% vs 17.0%,p = 0,001). The multivariate analysis showed that NHRs with dysphagia had 58.0% higher risk of death within 1 year compared with non-dysphagic subjects (OR 1.58, 95% CI, 1.31-1.91). The majority of NHRs with dysphagia were prescribed texture modified diets (90.6%), while AN was used in less than 10% of subjects. No statistically significant difference was found concerning weight loss and mortality after 12 months following the two different nutritional treatments. CONCLUSIONS: Dysphagia is prevalent among NHRs and it is associated with increased mortality, independent of the nutritional intervention used. Noticeably, after 12 months of nutritional intervention, NHRs treated with AN had similar mortality and weight loss compared to those who were treated with texture modified diets, despite the clinical conditions of patients on AN were more compromised.

Quantifying the relationship between dapagliflozin and loss of weight in type 1 diabetes mellitus patients.

WHAT IS KNOWN AND OBJECTIVES: Dapagliflozin was the first oral treatment approved in type 1 diabetes mellitus (T1DM) patients, simultaneously improving body weight. However, the time course and dose effect of dapagliflozin on loss of weight in T1DM patients was still unknown. The present study aimed to investigate quantitative relationship between dapagliflozin and loss of weight in T1DM patients based on Model-based Meta-analysis. METHODS: Five dapagliflozin dosage groups, two of them were 5 mg/day and three of them were 10 mg/day, 1612 T1DM patients were analysed with maximal effect (Emax ) model, and evaluation index was change rate of body weight from baseline value. RESULTS: In these T1DM patients, dosages were not incorporated into model, indicating no significant dose-response relationship between 5 and 10 mg/day affecting loss of weight. Emax and the treatment duration to reach half of the maximal effects (ET50 ) of dapagliflozin influencing loss of weight in T1DM patients were -4.9% and 10.4 weeks, and the duration to achieve 25%, 50%, 75%, and 80% (plateau) of Emax were 3.5, 10.4, 31.2, and 41.6 weeks. WHAT IS NEW AND CONCLUSIONS: It was the first time to explore quantitative relationship between dapagliflozin and loss of weight in T1DM patients. To achieve the plateau period in loss of weight, 5 mg/day dapagliflozin was required for at least 41.6 weeks.

Nutritional alterations after very low-calorie diet before bariatric surgery.

INTRODUCTION: There has been an alarming worldwide increase of obese people in recent years. Currently, there is no consensus on whether patients that are scheduled to undergo bariatric surgery should lose weight before the intervention. The objective of this research is to analyse the influence of pre-surgery loss of weight in the nutritional parameters of patients. METHODS: Fifty patients that were scheduled to undergo bariatric surgery followed a very low caloric diet during 4 weeks prior to the surgery. The nutritional parameters were analysed at 3 specific moments: before starting the diet, at the moment of surgery (when the diet was concluded) and one month after the surgery. RESULTS: Average values for hemoglobin, albumina and lymphocytes were kept within the range of normal values at all moments, even though the decrease of those parameters was statistically significant throughout the study (P<.05). By following the very low caloric diet, less than 9.5% of the sample suffered anaemia. CONCLUSIONS: Loss of weight prior to surgery does not have a significant influence in the nutritional parameters of the patient. These results would support the indication of losing weight for patients that are considered candidates for bariatric surgery.

The Prevalence of Hearing Symptoms Associated With Patulous Eustachian Tube Dysfunction Following Bariatric Surgery at King Khalid University Hospital, Saudi Arabia.

Background A patulous Eustachian tube (PET) is defined as a persistent tubal opening, which affects 0.3-6.6% of the population, with a female preponderance. PET is caused by the loss of subcutaneous adipose tissue enclosing the cartilaginous portion of the Eustachian tube (Ostmann's pad) as a result of acute, rapid, and substantial loss of weight which occurs during bariatric surgery. The most common complaint of PET is autophony, in which patients hear their own voices or breaths, with additional symptoms including crackling sounds, tinnitus, and aural congestion. In this study, we aimed to determine the prevalence of symptoms associated with PET dysfunction subsequent to bariatric surgery at King Khalid University Hospital (KKUH). Methodology A cross-sectional study was conducted at KKUH, Saudi Arabia. The presence of symptoms consistent with the diagnosis of PET dysfunction was assessed through in-person and telephonic interviews of bariatric surgery patients using a standardized questionnaire. Results A total of 450 patients were evaluated. The preoperative body mass index (BMI) of evaluated patients ranged from 28 to 117 kg/m2 (mean = 46.07 kg/m2), with no significant difference between symptomatic and asymptomatic groups (p = 0.303). The postoperative BMI ranged from 16 to 100 kg/m2 (mean = 29.37 kg/m2), with no significant difference between symptomatic and asymptomatic groups (p = 0.263). Hypertension was the most prevalent comorbid condition (12.2%), followed by diabetes (9.3%). In total, 91 (20.22%) patients exhibited symptoms (aural fullness and autophony) compatible with patent auditory tube dysfunction. Conclusions Overall, 20.22% of the bariatric surgery patients in our study sample displayed symptoms consistent with patulous auditory tubal dysfunction. The preoperative and postoperative BMI of symptomatic and asymptomatic patients did not differ significantly. To improve patient outcomes and satisfaction following bariatric surgery hearing symptoms associated with PET need to be included in postoperative follow-ups after bariatric surgery.

Fecal Metabolome and Bacterial Composition in Severe Obesity: Impact of Diet and Bariatric Surgery.

The aim of this study was to monitor the impact of a preoperative low-calorie diet and bariatric surgery on the bacterial gut microbiota composition and functionality in severe obesity and to compare sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). The study also aimed to incorporate big data analysis for the omics results and machine learning by a Lasso-based analysis to detect the potential markers for excess weight loss. Forty patients who underwent bariatric surgery were recruited (14 underwent SG, and 26 underwent RYGB). Each participant contributed 4 fecal samples (baseline, post-diet, 1 month after surgery and 3 months after surgery). The bacterial composition was determined by 16S rDNA massive sequencing using MiSeq (Illumina). Metabolic signatures associated to fecal concentrations of short-chain fatty acids, amino acids, biogenic amines, gamma-aminobutyric acid and ammonium were determined by gas and liquid chromatography. Orange 3 software was employed to correlate the variables, and a Lasso analysis was employed to predict the weight loss at the baseline samples. A correlation between Bacillota (formerly Firmicutes) abundance and excess weight was observed only for the highest body mass indexes. The low-calorie diet had little impact on composition and targeted metabolic activity. RYGB had a deeper impact on bacterial composition and putrefactive metabolism than SG, although the excess weight loss was comparable in the two groups. Significantly higher ammonium concentrations were detected in the feces of the RYGB group. We detected individual signatures of composition and functionality, rather than a gut microbiota characteristic of severe obesity, with opposing tendencies for almost all measured variables in the two surgical approaches. The gut microbiota of the baseline samples was not useful for predicting excess weight loss after the bariatric process.

Nutritional Considerations of Cardiovascular Diseases and Treatments.

Nutritional considerations of many chronic diseases are not fully understood or taken into consideration in everyday clinical practice. Therefore, it is not surprising that high proportion of hospitalized patients with cardiovascular diseases remains underdiagnosed with malnutrition. Malnourished patients have increased risk of poor clinical outcomes, complications rate, prolonged hospital stay, more frequent rehospitalizations, and lower quality of life. The purpose of this review is to recapitulate recent data on nutritional considerations in cardiovascular medicine.

Quality of life of obese patients after treatment with the insertion of intra-gastric balloon versus Atkins diet in Sulaimani Governorate, Kurdistan Region, Iraq.

BACKGROUND: Health-related quality of life of obese patients, before and after weight loss by insertion of BioEnterics Intra-gastric Balloon is studied widely. But the quality of life not related to comorbidity of the obese patients like mood, satisfaction with relationships, achieved goals, self-concepts, and self-perceived ability to cope with one's daily life is not studied on a wide scale. AIM: To evaluates the effect of the obesity on different aspects of life, and to evaluate the influence of weight loss after BIB insertion or Atkins diet on the quality of life regarding mood, satisfaction with relationships, achieved goals, self-concepts, and self-perceived ability to cope with one's daily life. PATIENTS MATERIALS AND METHODS: A prospective randomized study, from a total of 180 patients, 80 patients were selected to enroll in the work, over a period of 4 years from 2008 to 2012 in Hatwan private hospital and the private clinic, the closing date was 1st January 2013.Approval for the current work was obtained from the Ethics Committee of University, College of Medicine. The work has been reported in line with the STROCSS criteria. The study was designed as a descriptive longitudinal study conducted on 40 patients who underwent intra-gastric balloon insertion compared to a matched group (for age, BMI) of 40 patients on Atkin's diet. RESULTS: Two comparable groups of obese patients were studied, each group consists of 40 female patients, mean age in group A was 27 years (20-39 years) with mean body weight 90 kg (80-100) and mean body mass index 36 (31-39.9) who were treated with insertion of BIB. While mean age in group B was 29 years (20-39 years) with mean body weight 91 kg (80-102) and mean body mass index 36.5 (31-39.9). Statistically important changes occurred in the quality of life of the patients after either method of treatments to different degrees (p-value 0.005917). CONCLUSION: The patients lost more weight after insertion of intra-gastric balloon up to 35 kg of body weight, while the patients on Atkins diet lost up to 20 kg body weight. This results in statistically significant improvement of most aspects of QOL. Especially in Feeling happier, more satisfaction with the new body image, Improvement of self-esteem, encouraged for more regular exercises, less nervous, embarrassed less by unimportant matters, have less negative thoughts, and the craving of foods decreased remarkably.

Loss and Regain of Weight After Laparoscopic Sleeve Gastrectomy According to Preoperative BMI : Late Results of a Prospective Study (78-138 months) with 93% of Follow-Up.

INTRODUCTION: The long-term results in sleeve gastrectomy (SG) have been reported in few publications. None of them has evaluated the importance of preoperative BMI (kg/m2) in the final results. OBJECTIVE: To determine the loss and regain of weight after SG, determining the influence of preoperative BMI in final results. MATERIAL AND METHODS: This prospective study included all patients operated between 2006 and 2010. Exclusion criteria corresponded to patients with Barrett's esophagus, type 2 diabetes, and hiatal hernia greater than 3 cm. Patients were followed and controlled "face to face" by the main author. RESULTS: From 109 original patients included in this study, 102 (93.5%) completed the late follow-up. Patients were divided into four groups: (a) I-29 patients with BMI 32.1-34.9; (b) II-56 patients with BMI 35-39.9; (c) III-20 patients with BMI 40-49.9; and (d) IV-4 patients with BMI > 50. There was a significant decrease in the BMI 12 to 24 months after surgery. At the late control, patients in groups III and IV regained weight in 85 and 100%, respectively. Patients in groups I and II had 3.6 and 38% of weight regain. CONCLUSION: The changes in weight after SG are directly related to preoperative BMI: the higher this value, the higher the percentage of failure and weight regain late after surgery. Besides, laparoscopic SG seems to be an adequate operation at late control in terms of loose of weight after surgery in patients with a BMI less than 40 kg/m2 before surgery.

[Mesenteric panniculitis associated with acute pancreatitis: about a case]. / Panniculite mésentérique associée à une pancréatite aiguë: à propos d'une observation.

Mesenteric panniculitis is a nonspecific inflammation involving the mesentery. Its clinical presentation is variable depending on the stage of the disease. Clinical signs are usually pain but half of the patients remain asymptomatic. Palpable abdominal mass, weight loss, nausea and vomiting. There may be an inflammatory syndrome of variable intensity. Panniculitis is suspected based on scan showing hyperdense mesentery with adhesions to adjacent organs. Histologically there is adipocyte degeneration causing foreign body reaction and appear lymphoplasmacytic inflammatory lesions. We report a new case of mesenteric panniculitis associated with acute pancreatitis.

[Assessment of recent weight history before instituting continuous positive airways pressure in a cohort of patients with severe obstructive sleep apnoea/hypopnea syndrome]. / Histoire pondérale récente, avant l'institution de la pression positive continue, dans une cohorte de patients ayant un syndrome d'apnées-hypopnées obstructives du sommeil sévère.

OBJECTIVES: The aim of this study is to evaluate the recent weight history in patients with the obstructive sleep apnoea/hypopnoea syndrome (OSAHS) needing treatment with continuous positive airways pressure (CPAP). PATIENTS AND METHODS: Over a period of 18 months, a self-administered questionnaire concerning recent weight history was given to patients during the installation of CPAP. RESULTS: The study population consisted of 1337 patients. An increase in weight of at least 5% over the 5 years preceding the institution of CPAP was found in 44% of patients. This increase was moderate (5-10%), important (10-20%) and very important (>20%) in respectively 12.3%, 16.1% and 15.6% of patients. The patients with important or very important weight gain differed from those whose weight remained steady in a higher percentage of women, young people, and patients with a higher prevalence of obesity, persistent smoking, a history of venous thromboembolism and treatment with anti-depressants. CONCLUSION: A recent increase in weight is frequently seen in severe OSAHS and is associated with some clinical characteristics.

Algunos aspectos de interés sobre la cirugía bariátrica en la infancia y la adolescencia / Some aspects of interest about bariatric surgery applied in childhood and adolescence

Antecedentes: un porcentaje significativo de los niños y adolescentes afectados por la obesidad desarrollarán obesidad mórbida en algún momento de su vida adulta. Actualmente, el empleo de la cirugía bariátrica en estos pacientes es un tema polémico, por lo que resulta de interés conocer sus aspectos más relevantes, así como sus resultados en esta etapa de la vida. Objetivo: describir algunos aspectos de interés sobre la cirugía bariátrica en la infancia y la adolescencia. Desarrollo: se exponen y comentan los principales riesgos asociados a la obesidad en la niñez y adolescencia, los objetivos del tratamiento y los criterios de inclusión en un programa de cirugía bariátrica. Se enfatiza en el tiempo de tratamiento previo para valorar la necesidad de la intervención, la edad, el índice de masa corporal, la madurez sexual, ósea y psicológica del paciente, entre otros criterios, para autorizarla. También, se describen las contraindicaciones y medidas preoperatorias, ya que su conocimiento y cumplimiento posibilitarían la obtención de los resultados esperados. Se hace mención de las vías y técnicas quirúrgicas empleadas, así como algunos de sus resultados y complicaciones. Consideraciones finales: se exponen algunos aspectos de interés sobre cirugía bariátrica en la infancia y la adolescencia, con hincapié en los elementos más controversiales, lo que permite seleccionar a los pacientes que mejor evolución puedan tener con este tipo de intervención(AU)

Background: a significant percentage of obese children and adolescents develop morbid obesity at some time of their adulthood. The use of bariatric surgery in these patients is a controversial issue at present, so it is interesting to find out its most relevant aspects and results in this stage of life. Objective: to describe some aspects of interest on bariatric surgery applied in childhood and adolescence.Development: this review sets forth and comments on the main risks associated to obesity in childhood and adolescence, the objectives of the treatment and the inclusion criteria to be met in a bariatric surgery program. Emphasis was made on length of previous treatment to assess the need for intervention, age, body mass index, sexual, bone and psychological maturity of the patient, among other criteria, for giving authorization. Counterindications and preoperative measures were also described since knowing and complying with them would facilitate the expected results. Mention was made to the surgical paths and techniques as well as some results and complications of the bariatric surgery.Final thoughts: some aspects of interest on bariatric surgery in childhood and adolescence were explained, with emphasis on the most controversial elements, which will allow selecting the patients that could present better evolution with this type of intervention(AU)

Algunos aspectos de interés sobre la cirugía bariátrica en la infancia y la adolescencia / Some aspects of interest about bariatric surgery applied in childhood and adolescence

Antecedentes: un porcentaje significativo de los niños y adolescentes afectados por la obesidad desarrollarán obesidad mórbida en algún momento de su vida adulta. Actualmente, el empleo de la cirugía bariátrica en estos pacientes es un tema polémico, por lo que resulta de interés conocer sus aspectos más relevantes, así como sus resultados en esta etapa de la vida. Objetivo: describir algunos aspectos de interés sobre la cirugía bariátrica en la infancia y la adolescencia. Desarrollo: se exponen y comentan los principales riesgos asociados a la obesidad en la niñez y adolescencia, los objetivos del tratamiento y los criterios de inclusión en un programa de cirugía bariátrica. Se enfatiza en el tiempo de tratamiento previo para valorar la necesidad de la intervención, la edad, el índice de masa corporal, la madurez sexual, ósea y psicológica del paciente, entre otros criterios, para autorizarla. También, se describen las contraindicaciones y medidas preoperatorias, ya que su conocimiento y cumplimiento posibilitarían la obtención de los resultados esperados. Se hace mención de las vías y técnicas quirúrgicas empleadas, así como algunos de sus resultados y complicaciones. Consideraciones finales: se exponen algunos aspectos de interés sobre cirugía bariátrica en la infancia y la adolescencia, con hincapié en los elementos más controversiales, lo que permite seleccionar a los pacientes que mejor evolución puedan tener con este tipo de intervención(AU)

Background: a significant percentage of obese children and adolescents develop morbid obesity at some time of their adulthood. The use of bariatric surgery in these patients is a controversial issue at present, so it is interesting to find out its most relevant aspects and results in this stage of life. Objective: to describe some aspects of interest on bariatric surgery applied in childhood and adolescence. Development: this review sets forth and comments on the main risks associated to obesity in childhood and adolescence, the objectives of the treatment and the inclusion criteria to be met in a bariatric surgery program. Emphasis was made on length of previous treatment to assess the need for intervention, age, body mass index, sexual, bone and psychological maturity of the patient, among other criteria, for giving authorization. Counterindications and preoperative measures were also described since knowing and complying with them would facilitate the expected results. Mention was made to the surgical paths and techniques as well as some results and complications of the bariatric surgery. Final thoughts: some aspects of interest on bariatric surgery in childhood and adolescence were explained, with emphasis on the most controversial elements, which will allow selecting the patients that could present better evolution with this type of intervention(AU)

Medicamentos que favorecen la pérdida de peso y el control metabólico en las personas obesas con diabetes mellitus tipo 2 / Drugs for loss of weight and metabolic control in obese persons with type 2 diabetes mellitus

Introducción: la obesidad es una enfermedad compleja y multifactorial, frecuente, creciente, que afecta a casi todos los países, independientemente de su desarrollo económico, a ambos sexos, a todas las edades y grupos sociales. Genera importantes costos al sistema de salud, en particular cuando se vincula con la diabetes mellitus tipo 2. En tal sentido se hace necesario optimizar el tratamiento en estos pacientes. Objetivos: describir los medicamentos que deben ser usados en personas con diabetes mellitus tipo 2 que presentan sobrepeso u obesidad, con el objetivo de obtener un buen control metabólico y favorecer la pérdida de peso, o al menos, evitar su aumento. Desarrollo: la relación entre la diabetes mellitus tipo 2 y el exceso de peso está bien establecida. El tratamiento con hipoglucemiantes como sulfonilureas, meglitinidas, tiazolidinedionas, e incluso insulina, pueden ocasionar un aumento de peso como efecto secundario potencial; por tanto, es necesario el empleo en estas personas de fármacos que atenúen la ganancia de peso. Conclusiones: el uso de metformina y el análogo de insulina detemir en pacientes con diabetes mellitus tipo 2 y sobrepeso corporal, se asocia a un efecto neutral o a una modesta pérdida de peso corporal. Los inhibidores de la dipeptidil peptidasa-4, sitagliptina y vildagliptina tienen un efecto neutro sobre el peso, mientras que los agonistas del receptor de glucagon-like peptide 1, exenatide y liraglutide, así como el análogo de amilina, pramlintide, promueven la pérdida de peso(AU)

Introduction: obesity is a growing complex and multifactoral disease that frequently affects people from sexes, age groups and social segments in almost all the countries regardless of their economic development. It brings about substantial costs for the health care system, particularly when it is linked to type 2 diabetes mellitus. In this regard, it is necessary to optimize the medical treatment for these patients. Objectives: to describe the drugs that should be used in persons with type 2 diabetes mellitus, who present with overweight or obesity, in order to keep good metabolic control and encourage loss of weight or at least to avoid weight gain. Development: the association of type 2 diabetes mellitus and excessive weight is well-established. The treatment with hypoglycemic such as sulphonylureas, meglitinides, thiazolidonediones and even insulin, may cause weight gain as a potential secondary effect and therefore, it is necessary to use drugs diminishing the weight gain in these persons. Conclusions: the use of metformine and insulin analogue called detemir in patients with type 2 diabetes mellitus and body overweight is associated to neutral effect or to modest loss of body weight. The dipeptidyl peptidase-4, sitagliptin and vildagliptin inhibitors have neutral effect on weight whereas the glucagon-like peptide 1 receptor agonists called exenatide and liraglutide as well as amiline analogue called pramlintide encourage loss of weight(AU)

Respuestas para algunas preguntas sobre obesidad y cirugía bariátrica / Responses to some questions about obesity and bariatric surgery

La cirugía bariátrica en pacientes con obesidad mórbida y la obtención con este proceder de pérdidas de peso mayores y más rápidas que las reportadas por las vías convencionales de tratamiento, constituye, sin duda, una alternativa objetiva para disminuir la morbilidad y la mortalidad observadas en estas personas. Se pretende dar respuesta a las interrogantes que existen sobre algunos aspectos relacionados con la cirugía bariátrica como método más efectivo para tratar la obesidad mórbida. Esta se caracteriza por ser crónica, multifactorial, y asociada a importantes complicaciones físicas y psicológicas, que contribuyen a disminuir la calidad y la esperanza de vida de todo aquel que la padece. La cirugía bariátrica se basa en la reducción de la cámara gástrica, combinada o no con técnicas de mala absorción. Hasta ahora, prácticamente es el único tratamiento que consigue alcanzar las expectativas a largo plazo relacionadas con pérdidas de peso suficientes para controlar adecuadamente las comorbilidades. Este procedimiento se acompaña de importantes cambios, no solo en el peso, sino también en el perfil metabólico de los tratados con este método. Resulta imprescindible realizar un seguimiento médico a largo plazo de los sometidos a este tratamiento, una vez realizada la cirugía, por parte de un grupo multidisciplinario especializado en estos procedimientos, para detectar y tratar los trastornos que posteriormente puedan presentarse. Queda demostrado que existe una alternativa terapéutica para el tratamiento de las comorbilidades de la obesidad grave y mórbida, así como para la obesidad misma(AU)

The bariatric surgery aimed at patients with morbid obesity and the quicker major weight loss through this procedure when compared to the reports of weight loss in the conventional treatments is, beyond any doubt, an objective alternative to reduce morbidity and mortality rates in these persons. This paper was intended to answer the questions about some aspects of the bariatric surgery as a more effective method to treat morbid obesity. This disease is chronic, multifactorial, and related to important physical and psychological complications that contribute to reduced life quality and expectancies of every person who suffer it. The bariatric surgery is based on the reduction of the gastric chamber, either combined or not with malabsorption techniques. As far as it is known, this treatment is practically the only one that reaches the long-term expectations about enough loss of weight to adequately control comorbidities. This procedure brings about important changes not only in bodyweight but also in the metabolic profile of the treated persons. A long-term follow-up of the patients is indispensable after the surgery, which should be in charge of a multidisciplinary specialized team, in order to detect and treat any disorder that might occur. It has been proved that there is a therapeutic alternative for the treatment of comorbidities from severe morbid obesity as well as for the obesity as such(AU)

Respuestas para algunas preguntas sobre obesidad y cirugía bariátrica / Responses to some questions about obesity and bariatric surgery

La cirugía bariátrica en pacientes con obesidad mórbida y la obtención con este proceder de pérdidas de peso mayores y más rápidas que las reportadas por las vías convencionales de tratamiento, constituye, sin duda, una alternativa objetiva para disminuir la morbilidad y la mortalidad observadas en estas personas. Se pretende dar respuesta a las interrogantes que existen sobre algunos aspectos relacionados con la cirugía bariátrica como método más efectivo para tratar la obesidad mórbida. Esta se caracteriza por ser crónica, multifactorial, y asociada a importantes complicaciones físicas y psicológicas, que contribuyen a disminuir la calidad y la esperanza de vida de todo aquel que la padece. La cirugía bariátrica se basa en la reducción de la cámara gástrica, combinada o no con técnicas de mala absorción. Hasta ahora, prácticamente es el único tratamiento que consigue alcanzar las expectativas a largo plazo relacionadas con pérdidas de peso suficientes para controlar adecuadamente las comorbilidades. Este procedimiento se acompaña de importantes cambios, no solo en el peso, sino también en el perfil metabólico de los tratados con este método. Resulta imprescindible realizar un seguimiento médico a largo plazo de los sometidos a este tratamiento, una vez realizada la cirugía, por parte de un grupo multidisciplinario especializado en estos procedimientos, para detectar y tratar los trastornos que posteriormente puedan presentarse. Queda demostrado que existe una alternativa terapéutica para el tratamiento de las comorbilidades de la obesidad grave y mórbida, así como para la obesidad misma(AU)

The bariatric surgery aimed at patients with morbid obesity and the quicker major weight loss through this procedure when compared to the reports of weight loss in the conventional treatments is, beyond any doubt, an objective alternative to reduce morbidity and mortality rates in these persons. This paper was intended to answer the questions about some aspects of the bariatric surgery as a more effective method to treat morbid obesity. This disease is chronic, multifactorial, and related to important physical and psychological complications that contribute to reduced life quality and expectancies of every person who suffer it. The bariatric surgery is based on the reduction of the gastric chamber, either combined or not with malabsorption techniques. As far as it is known, this treatment is practically the only one that reaches the long-term expectations about enough loss of weight to adequately control comorbidities. This procedure brings about important changes not only in bodyweight but also in the metabolic profile of the treated persons. A long-term follow-up of the patients is indispensable after the surgery, which should be in charge of a multidisciplinary specialized team, in order to detect and treat any disorder that might occur. It has been proved that there is a therapeutic alternative for the treatment of comorbidities from severe morbid obesity as well as for the obesity as such(AU)