Dangerous obesity 
Dr. Chakraphan Siriwongmongkol
Dangerous Obesity
Obesity is a problem that affects patients’ physical and mental health, and it also has major social and economic impacts. According to WHO reports, in 2016 there were 1.9 billion people who were overweight or obese. It is projected that by 2035 there may be as many as 4 billion people who are overweight and obese, accounting for 50% of the world’s population.
In Thailand, data from the Ministry of Public Health found that the proportion of people who are overweight or obese was as high as 45.6% in 2020, increasing to 46.2% in 2021 and 46.6% in 2022.
Obesity affects health by increasing the risk of diabetes, high blood pressure, high blood lipids, fatty liver disease, obstructive sleep apnea, and knee osteoarthritis. It also increases the risk of several types of cancer, such as colorectal cancer, breast cancer, and endometrial cancer. There are various treatments for obesity, such as diet control and exercise, weight-loss medications, endoscopic intragastric balloon placement, endoscopic sleeve gastroplasty, and surgery.
Indications for bariatric surgery
BMI > 35 regardless of whether there are obesity-related comorbidities
BMI > 30 with obesity- and metabolism-related comorbidities
In populations of Asian descent, patients with BMI > 27.5 should be offered the option of surgical treatment. Long-term outcomes of bariatric surgery are safe and effective. Obese children and adolescents, if appropriately selected, can undergo surgical treatment.
Current surgical procedures are divided into 3 main groups.
Outcomes after surgery
Obesity is a problem that affects patients’ physical and mental health, and it also has major social and economic impacts. According to WHO reports, in 2016 there were 1.9 billion people who were overweight or obese. It is projected that by 2035 there may be as many as 4 billion people who are overweight and obese, accounting for 50% of the world’s population.
In Thailand, data from the Ministry of Public Health found that the proportion of people who are overweight or obese was as high as 45.6% in 2020, increasing to 46.2% in 2021 and 46.6% in 2022.
Obesity affects health by increasing the risk of diabetes, high blood pressure, high blood lipids, fatty liver disease, obstructive sleep apnea, and knee osteoarthritis. It also increases the risk of several types of cancer, such as colorectal cancer, breast cancer, and endometrial cancer. There are various treatments for obesity, such as diet control and exercise, weight-loss medications, endoscopic intragastric balloon placement, endoscopic sleeve gastroplasty, and surgery.
Indications for bariatric surgery
BMI > 35 regardless of whether there are obesity-related comorbidities
BMI > 30 with obesity- and metabolism-related comorbidities
In populations of Asian descent, patients with BMI > 27.5 should be offered the option of surgical treatment. Long-term outcomes of bariatric surgery are safe and effective. Obese children and adolescents, if appropriately selected, can undergo surgical treatment.
Current surgical procedures are divided into 3 main groups.
- Sleeve gastrectomy
- Sleeve gastrectomy combined with bypass (Roux-en-Y Gastric Bypass)
- Sleeve gastrectomy combined with intestinal bypass (Sleeve gastrectomy + gastric–small intestine anastomosis)
Outcomes after surgery
- Weight loss. The main goal is to reduce weight back to a normal level, or to a body mass index less than 25 kg/m² (BMI < 25). How much weight is lost depends mainly on the type of surgery and the patient’s changes in eating behavior and exercise. In most cases, weight loss is expressed as a percentage of total body weight lost, or as the percentage of excess weight lost compared with the ideal weight. In general, surgery can reduce body weight by an average of about 25–45%.
- Improved physical and mental health. After surgical treatment, in addition to losing weight, obesity-related comorbidities can improve or even be cured. Importantly, average life expectancy increases and quality of life improves.
26 December 2023
Dr. Chakraphan Siriwongmongkol
Specialties: Surgery, Bariatric (weight-loss) stomach surgery
