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The number of bariatric surgeries performed in Brazil last year reached 105.6 thousand, an increase of 47% over the year 2012, where 72 thousand interventions were performed. The increase was mainly in the private sector, but in the SUS, which achieved 9.8% of total operations, there was also growth: 16.8% in the Brazilian population. according to the Ministry of Health, 224% compared to 2008.
In Brazil, nearly one in five adults is obese (18.9%). The index is 60% higher at the beginning of the historical series in 2006 but, after successive growths, it seems to have stagnated in the last three years, according to the Vigitel survey, conducted by telephone from the Ministry of Finance. Health [19659002] Overweight already reaches 53.8% of the population living in capitals. Twelve years ago, this rate was 42.6% – men are the most affected.
It is considered that obesity has a BMI-body mbad index, calculated with the weight and height of the person – more than 40. Bariatric surgery may be indicated in cases with a BMI of 30 ( overweight), depending on the severity of the related diseases.
According to estimates by SBCBM, 5 million Brazilians would meet the requirements of undergoing some sort of bariatric surgery, which the natural way of food in the gastrointestinal tract, allowing the body to absorb less than 40%. food energy, in addition to promoting hormonal changes that promote the correction of diabetes and obesity.
In a simple account, regardless of deaths and new indications and considering the estimate of about 1,000 skilled surgeons for bariatric surgery, it would take more than 13 years for this line of Waiting to be reset – since they did an operation
In view of this scenario, according to SBCBM president, surgeon Caetano Marchesini, growth could have been even stronger without economic crisis. Another factor that, according to the doctor, has prevented more growth, is the delay in updating the National Supplementary Health Agency (ANS) rules that govern health plans.
The municipality, considers Marchesini, does not yet consider in its guidelines the indications for bariatric surgery for those with about 20 diseases badociated with obesity (vertebral problems, apnea, hypercholesterolemia, among others) and for those who suffer from severe diabetes but are not obese
Despite the stagnant growth of overweight and obesity over the last three years, the rate remains high and worries experts and the government.
"We will never take care of everything they need," says Ricardo Cohen, surgeon at Oswaldo Cruz Hospital, Creative Commons License
There is, however, a problem in calculating SBCBM of people who would need a bariatric surgery, according to Professor of Endocrinology Unicamp Bruno Geloneze
"In order to indicate the surgical procedure, it is necessary, in addition to the following: to be in a weight range or to have certain diseases, there is a failure of clinical treatment for two years.Maybe less than 1% of these 5 million are actually fit.The major problem is that the surgery has increased to the lowest body mbad index, a range in which clinical treatment is more likely to work. "
Another problem, says Geloneze, is that despite the concentration of most the most serious cases In a statement, the Ministry of clare that growth means that the network has expanded and given more & # 39; access to citizens in need.
Beyond the complications and risks inherent in any surgical procedure (1 in 1,000 people dies between surgery and 90 days later, a similar chance of taking a stone from the gallbladder), there is a risk of reoperation of the patient – in the USA, a country with nearly 40% of the obese population, 14% of the bariatric is "in review."
For Cohen, there is the importance of having a good indication. "Fear and lack of knowledge often prevent those who really need to get in. Surgery brings innumerable benefits, and the price is the eternal eve of a chronic illness." [19659015] "Another thing is that the board" eat less and do more exercise "works to prevent obesity, but not to treat: it's like you say to someone who has the lung cancer, stop smoking, the disease is not going anywhere. "
For Geloneze, there is a problem right from the clinical stage of treatment. "Paradoxically, SUS offers surgery, but not structured non-surgical treatments, such as medical, nutritional, and psychological care, as well as modern support groups and medications."
the most modern ones are liraglutide. contributes to the fight against diabetes and even promotes weight loss, and lisdexamphetamine, which can help control eating disorders, even if it has not been started for this purpose.
by the bariatric. "They may not have the same impact, but they can work very well in most cases.The surgery can be confined to the highest BMI."
The Ministry of Health indicates that surgical procedures are the last Authorized resources only for patients undergoing clinical evaluation and follow-up with a multidisciplinary team for at least two years are within the criteria established by the ordinance.
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