Obesity assessment

N : You know that obesity is an adipose, or fattytissue, illness which results from long-term energetic imbalance that can be deleterious to health.

P : I know that in this case we take in more calories that we burn, don’t we ?

N : Exactly. Now tell me what measures have been taken with your primary care doctor and nutritionist ?

P : We considered diet therapy associated to physical activity, but this does not seem to work. I asked my doctor for an appetite suppressant, but he is against any drug.

N : He did well. The pharmacovigilance authorities warn against the use of the only medication we have for weight loss, as some serious hepatic disorders have been signaled.

P : I’m a bit nervous about the surgery anyhow, although I do want this operation !

N : This is what I’m here for. So, your case can be explained as an evolutive chronic condition with regular weight gain, in spite of all the measures that have been taken. And apart from genetic predisposition, some environmental factors are associated, like lifestyle and your socio-economic conditions, sleep disorders, improper nutrition, stress from work, alcohol intake and medications.

P : Are there any serious health problems that are related to all this ?

N : Yes. This is what we call comorbidity. We mostly notice diabetes, certain cancers, obstructive sleep apnea, cardiac conditions, high blood pressure, articulation problems and many other serious health conditions like respiratory problems which can be particularly worrisome in Covid cases.

P : But I mostly feel depressed and I have low selfesteem from the systematic stigmatization.

N : Here’s where bariatric surgery comes in, which helps you lose weight and improve health related problems and the quality of life. This procedure is often referred to as gastric sleeve or gastric bypass. The surgeon makes changes to the digestive system by making the stomach smaller or changing the small intestine so it can absorb fewer calories. As I can see, you have gone through all surgery pre-requisites, like changes in diet, adapted physical activity, psychiatric assessment, general health check-up, and benefited from the required 6-month preparatory path and patient education that will go on until the end of the long-term therapeutic procedure following the operation. I guess you have understood it’s not an overnight procedure.

P : I do understand that very well and am willing to go through it, whatever it takes. But just can you remind me of the side effects of all this ?

N : There are no serious side effects, just that you have to observe a long-term personal engagement in diet, have a vitaminic therapy, psychotherapy to accept all the changes, practice physical activity and mostly use a contraceptive for about 18 months following the surgery, and follow a coordinated, multidisciplinary care plan with nurses, occupational therapists and other professionals. Is that clear ?

P : Crystal clear. Thank you.