“Lifestyle changes are often recommended as a way to prevent obesity, but for some people this advice comes too late or is not enough,” says surgeon Eric Hazebroek. “We need to recognise that obesity is a chronic disease and look for the most suitable treatment for each patient, including medication and surgery, in combination with those lifestyle changes.” On 23 November, he will talk about this at the conference ‘Accelerating cooperation to stop overweight and obesity’.
“We treat patients with lung cancer or cardiovascular diseases without judging the behaviour that may have caused the disease, such as smoking,” explains Eric Hazebroek, a bariatric surgeon at Rijnstate Hospital and Professor of ‘Nutrition & Obesity Treatment’ at Wageningen University & Research. “But in the treatment of obesity – a chronic disease according to the World Health Organisation – the focus is often more likely to be on losing weight through personal lifestyle changes. Unfortunately, this is not feasible for all patients, and there are many other causes of obesity outside of lifestyle factors. After doing everything possible to lose weight, surgery (i.e. a stomach reduction) may well be the last resort for some people. So, we should never stigmatise this treatment.”
Multidisciplinary guidance and assistance
People who are eligible for a stomach reduction have a BMI of 40 or more, or 35 or more in combination with obesity-related symptoms such as diabetes. They are first extensively screened by specialists including dieticians and psychologists. “When they get the green light, we can start the treatment process,” says Hazebroek. “Patients are provided multidisciplinary guidance and assistance by an obesity nurse, a dietician and a psychologist. They learn to eat healthily and in moderation, for example by eating only small portions five to six times a day. After one-and-a-half to two years, the visits to these specialists become less frequent, but we continue to check blood levels annually for any vitamin deficiencies. The total guidance and assistance process lasts five years.”
According to Hazebroek, the aim of the treatment is not to become super slim, but to achieve a healthy weight and thus reduce the risk of secondary conditions such as hypertension and diabetes. On average, patients lose 25% of their total weight and 50-80% of their excess weight following the surgery.
“After surgery, the patient is unable to eat as much as they used to, but the hormones produced by the stomach that regulate the feeling of hunger and satiety also change, making it easier for them to lose weight,” says Hazebroek. “People with type 2 diabetes can halve or stop their medication after just one day. This is an interesting finding, as they actually only start losing weight sometime later.”
Developing and sharing knowledge
“The prevention of obesity is essential, but at the same time we are dealing with a problem that is already there,” says Hazebroek. “I will be talking about this at the conference ‘Accelerating cooperation to stop overweight and obesity’. Healthcare providers should always seek the most appropriate treatment. For some patients that will be a lifestyle change, others will need surgery and the accompanying support.”
“Besides, there is still a lot we don’t know yet,” he continues. “We perform exactly the same operation time after time, and yet you see different effects, even when people carefully follow all the lifestyle recommendations after surgery. More factors play a role than we are currently aware of, which is why it is important to continue to conduct research and share knowledge. With its focus on strengthening cooperation between all professionals involved, this conference certainly contributes to that.”
Interested in the conference ‘Accelerating cooperation to stop overweight and obesity’? Read the full program here.