Extra kilograms accumulate gradually, and the human body adapts to this, so their harmful effects do not appear immediately. Even those who are overweight don’t always take steps to manage their weight, even though obesity is a risk factor for over 200 diseases. And those who have tried to do it on their own or with the help of a dietitian are often disappointed, because after losing 10 kg, they gain back 15 kg.
The 2023 health status overview of Lithuania states that in 2019, the proportion of obese adults increased to 18% and was higher than the European Union (EU) average. However, it’s not just the fact that nearly one in five adults in our country is obese that should alarm us, but also the fact that obesity contributes to preventable deaths. Lithuania has one of the highest mortality rates in the EU when considering deaths that could have been prevented through prevention and healthcare measures. In 2020, preventable mortality increased to 340 deaths per 100,000 population. For comparison, the EU average is 180 cases per 100,000 population. The same review also states that approximately 44% of all deaths registered in Lithuania in 2019 could be linked to behavioral and environmental risk factors. And about 25% of all deaths (9500 deaths) were caused by diet-related risk factors (including low consumption of fruits and vegetables, high sugar and salt intake). This indicator is significantly higher than the EU average, where diet-related risk factors caused 17% of deaths.
Why is obesity so dangerous? Obesity promotes cardiovascular problems (arterial hypertension, coronary heart disease), diabetes, atherosclerosis, gallstones, fatty liver, osteoarthritis (joint diseases), deep vein thrombosis, sleep apnea, and infertility. Obesity increases the risk of stroke and can cause the same brain neurodegeneration as Alzheimer’s disease.
Obese individuals have a higher risk of over 18 types of cancer (breast, uterine, colon, gallbladder, stomach, esophageal, liver, pancreatic, ovarian, kidney, prostate, etc.), and if they develop cancer, the prognosis and risk of death are worse. Obese people usually suffer from not one, but several chronic diseases. The most common ones are arterial hypertension, diabetes, joint and spinal diseases, and depression.
The prospect of being confined to four walls was unacceptable.” Jūratė believes her weight loss journey is similar to many women’s: “Probably, like everyone else, when I was young, being curvy didn’t bother me. Over the years, the kilograms kept piling on. After each childbirth, I gained 10 or more kilograms. But I didn’t feel any pain or limitations due to my weight: I attended line dancing, spent weekends at our country house, and tended to my flower beds. The illnesses came gradually: first, high blood pressure and medication to control it, then diabetes – and more medication. Of course, I tried to lose at least a few kilograms: I tested various diets, intermittent fasting, but the weight kept increasing. The realization that I needed to seek specialists and definitely lose weight came when my knee joints started to hurt severely. Medications were practically useless, every step caused pain. Traveling to our country house became torture, not to mention dancing. The doctor explained that due to my body weight and mechanical overload, the cartilage in my knee joint had worn out and needed surgery. At the same time, he warned me that I needed to lose weight, as other joints would also wear out, and even the replaced joint would wear out faster due to excessive weight. At that time, I weighed 105 kg (height 162 cm). I chose knee arthroplasty and at the same time started looking for ways to effectively lose weight. I realized that only surgery could help. I searched for information about which institutions perform which operations. I found information that today obesity can be treated endoscopically, that is, even without the tiny incisions that are made during laparoscopy. I signed up for a consultation with a surgeon, a medical board assessed my health, motivation, and readiness to make drastic lifestyle changes after the surgery. In fact, I was already quite motivated at that time, because the prospect of suffering from pain, living within four walls and being dependent on others, did not suit me at all. Today, more than 1.5 years after the surgery and having celebrated my 50th birthday, I realized that the decision to radically treat obesity was the best gift to myself. I weigh 82 kg and have no intention of stopping, because my motivation, seeing the results, has only strengthened. In addition, I don’t take medication for hypertension, and I also take less medication to treat diabetes.”
What makes endoscopic gastric reduction attractive? One of the pioneers of endoscopic gastric reduction in Lithuania, Olegas Deduchovas, a general surgeon at the Klaipėda University Hospital branch “Jūrininkų ligoninė,” notes that it is important to explain to the patient both the procedure and what to expect after the procedure, how they will feel, how they will have to eat, and how quickly and how much weight loss they can expect. Therefore, patients are first consulted by a team of medical professionals: a family doctor, a dietitian, a surgeon, an endocrinologist, and a psychologist. “The expected effect of endoscopic gastric reduction is about a 20% loss of total body mass. We are happy that our patients report losing 30-60 kg. A big advantage of this operation is that endoscopic gastric reduction is focused on a long-term effect and greater weight loss,” notes the surgeon. Patients are most often interested in the procedure and the risk of complications. “During the endoscopic procedure, the stomach is folded and compressed from the inside, forming a “tube” using a special, disposable device mounted on an endoscope. This reduces the volume of the stomach, which can hold about 150 ml of food/liquid. This prevents you from eating a lot. However, this is not the only important thing. The main mechanisms of action are not only that less food fits, but also that its emptying is slowed down, so the feeling of fullness lasts a long time. This innovative method has a lower risk of complications, there are no postoperative surgical wounds. Endoscopic gastric reduction, due to its specifics, has the least side effects compared to other surgical methods of gastric reduction, which are invasive. It is 10 times safer than surgical operations,” the expert shares scientifically proven information.
By reducing weight, comorbidities also improve. For many people, blood pressure normalizes or less medication is needed to control it. In people with diabetes, glycemic control improves, some patients recover completely, while others need lower doses of medication to maintain blood sugar levels. Sleep quality improves, joints experience less stress, and accordingly, pain is less bothersome, and the patient moves more. “Everything is interconnected. The goal of the procedure is not only to reduce weight but also to improve the control of diseases associated with overweight or obesity,” emphasizes O. Deduchovas.
What kind of follow-up is there after the surgery? According to O. Deduchovas, patients are planned to be monitored for 2 years. Today, about 2/3 of them follow this plan: they visit dietitians, have blood tests done, and are monitored for any nutrient deficiencies. The diet is adjusted as needed. “Our patients are motivated and this leads to good results. However, practice shows that after 1-2 years, weight may start to increase. Therefore, it is very important to consistently follow the recommendations, because gastric reduction is only the beginning of a healthier lifestyle, and it should become an integral part of life. It is important to develop good habits, which, seeing positive changes, should become simple and pleasant,” emphasizes the surgeon.
Who and when is this procedure recommended? The doctor notes that patients with a body mass index (BMI) of over 30 should consult about gastric reduction. Especially if the person already has comorbidities. “On the other hand, even in the absence of comorbidities, when the BMI is over 30, a consultation is necessary. I encourage people to seek help from specialists and start treating obesity as early as possible, do not wait and gain weight. The lower the degree of obesity, the easier and more effective the treatment, the lower the risk of other comorbidities,” the surgeon encourages.