Fight against obesity during COVID-19 Pandemic

More than ten percent of our world population suffers from obesity (BMI>30). We already knew that obesity is associated with an increased risk to develop cardiovascular disease, diabetes mellites, sleep apnea and arthrosis. Since the beginning of 2020, a new reason not to become obese or loose weight is added to this row. It seems that if you are obese, the chance to become hospitalized, need mechanical ventilation and die from COVID-19 is seriously increased!

Here I want to share with you the options to lose weight in an effective manner. First of all, you should abandon all carbon hydrates from your diet. Besides take a good look on the calories you take in with your drinks. Realize that for example that in Coca Cola, Ice Tea and alcoholic drinks a lot of calories are hidden. Try to chew your food as frequent as possible (at least 20 times). Then I would advise everybody to install a step counter on your cell phone. Try to move as much as you can. A target number can be 10000 steps a day. Personally after a day working in our big University hospital in Maastricht, I frequently already reach this number by never making appointments in my room, always go to the other person and when possible plan meetings with one or two persons while walking instead of sitting.

If you are really motivated to lose weight and have tried everything to achieve this and your BMI (weight in kg divided by length in meters²⁾ stays above 40 and many people in your family suffer from severe obesity and their comorbidities perhaps surgery can be an option to help you.

If you do not suffer from gastro-esophageal reflux and you like to eat much (volume-eater) probably a gastric volume reduction operation is the best choice (sleeve resection or band if you prefer a totally reversible procedure). If you have serious diabetes mellites, increased triglycerides and you are a sweat-eater, probably a malabsorptive procedure is the best choice (gastric bypass). In this type of surgery an volume reduction of the stomach is combined with the bypass of a large segment of your small intestines.

Of course, you have to realize that if surgery is performed you do not only have per-operative and direct postoperative risks like bleeding, leakage of the anastomosis or thrombo-embolic complications but you also are exposed to risks on the longer term. Once having had an operation through the abdominal muscles you can develop weak spots in the abdominal wall or internal herniations and adhesions that in 10% of the people can be the cause of re-operation within 10 year. Adhesions can be so severe that they can kink the bowel so severe that passage of food is not possible anymore.

To avoid these complications of performing surgery through the abdominal wall, last years a lot of new surgical techniques are developed to reduce gastric volume or cause malabsorption without the need to cut through the abdominal muscles by performing surgery through the mouth.

I would like to share with you an overview of these techniques and discuss their efficiency. You have to realize that there are both temporary and more structural solutions.

Temporary options causing weight loss by procedures through the mouth

–       Gastric balloons (Elipse)

–       Duodenal sleeves (Endobarrier)

Permanent options causing weight loss by procedures through the mouth
Endogastric plications