Bariatric Surgery in Brazilian Public Health System: The Good, the Bad and the Ugly, or a Long Way to Go. Yellow Sign!

Tonatto-Filho, Antoninho José; Gallotti, Felipe Melloto; Chedid, Marcio; Filho, Tomáz de Jesus Maria Grezzana; Garcia, Ana Maria Stapasolla Vargas

doi:10.1590/0102-672020190001e1470

Cited by 29 publications

(34 citation statements)

References 13 publications

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“…O besity has become a worldwide epidemic 7,27 . Although there are indications that it is metabolically healthy, there is consensus on its harm and various risks present in obese individuals who have visceral fat deposition 5,20,23,28 . The greater the volume and the percentage of body fat with the increase in body mass index (BMI), there is also deposition in visceral fat 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Regarding the measurement of the abdominal perimeter (waist), the adequacy of the cutoff point established at 102 cm for men and 88 cm for women 12 is questioned for populations of different ethnicities. Some studies with lower levels -94 cm for men and 80 cm for women -have been considered more appropriate 6,10,18,20,28 . It is still mentioned that different ethnicities have different somatotypes, and consequently different fat distributions, so that cut-off values predictive of risk in a given population may not be valid for others.…”

Section: Introductionmentioning

confidence: 99%

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Can Stature, Abdominal Perimeter and Bmi Index Predict Possible Cardiometabolic Risks in Future Obesity?

Lucas¹,

Nassif²,

Tabushi³

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: Obesity changes the anatomy of the patient. In addition to the aesthetic change, the high percentage of fat determines evident functional changes. Anthropometric normality in measuring abdominal circumference and height can serve as a basis for measuring cardiometabolic risks of obesity. Aim: To verify if it is possible to determine parameters of normality between waist and height in people with normal BMI and fat percentages, to serve as a basis for assessing risks for obesity comorbidities. Methods: A sample of 454 individuals with BMI and percentages of fat considered within the normal range was extracted. It was divided into age groups for both men and women between 18 and 25; 26 to 35; 36 to 45; 46 to 55; 56 to 65. A total of 249 men and 205 women were included. Results: Regarding the percentage of height as a measure of the abdominal perimeter, the total female sample had an average of 44.2±1.1% and the male 45.3%+1.5. For women, this percentage determined the equation of the waist-height ratio represented by X=(age+217) / 5.875, and for men X=(age+190.89) / 5.2222. “X” represents the percentage of the height measurement so that the individual falls into the category of adequate percentage of fat and BMI. Conclusion: Between the stature of adult men and women with normal fat percentage and BMI, there is a common numerical relationship, with is on average 44% for women and 45% for men.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can Stature, Abdominal Perimeter and Bmi Index Predict Possible Cardiometabolic Risks in Future Obesity?

Lucas¹,

Nassif²,

Tabushi³

et al. 2020

ABCD, arq. bras. cir. dig.

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“…The Brazilian public health system offer freely bariatric surgery aiming to prevent possible complications related to obesity, but the lack of more accurate information about costs of the surgery, pre-and post-hospitalization and possible effectiveness can delay the spread of this procedure in the population. 47 Data information on multiple health outcomes associated with health care costs of bariatric surgery throughout presurgery period until follow-up at individual level may provide important information for public policy decision making; particularly considering data from high complexity hospital considered reference health care institution in Brazil. [48][49][50][51][52][53] The current study addresses the limitations in the literature by presenting an analysis of patient-level data in Brazil to examine the impact of bariatric surgery on multiple outcomes (including anthropometric, hemodynamic and biochemical parameters) using an interrupted time series approach.…”

Section: Introductionmentioning

confidence: 99%

Impacts of bariatric surgery on costs and health outcomes of patients in Brazil: Interrupted time series analysis of multi-panel data

Jao

et al. 2020

Preprint

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Obesity is one of the most important public health problems worldwide, presenting significant socioeconomic impacts in health systems. Considering the rising costs of health care and the escalating burden of obesity in diverse countries, there has been increasing trends in examination of cost-effectiveness of health interventions towards prevention and treatment of obesity and its effects on comorbidities. Bariatric surgery has been considered an effective intervention for reducing moderate to severe obesity and improvement of obesity-related morbidities. Methodology: Interrupted Time-Series Analysis (ITSA) on costs and health outcomes from retrospective cohort of 114 patients who had bariatric surgery at the Hospital of Clinics from the University of Sao Paulo. Medical records encompassing complete data on anthropometric, hemodynamic and biochemical parameters, utilization of resources and costs for health care procedures and regular assessments of patients health status associated with bariatric surgery at individual level were included in the study. Data on utilization of resources during outpatient and inpatient health care were used for estimation of patients direct costs referring to bariatric surgery, and 6-month pre- and post-intervention periods, adopting health system perspective in micro-costing approach. Results: Mean direct costs of hospitalization (-US$2,762.22; -23.2%), image exams (-US$7.53; -0.8%) and medication (-US$175.37; -25,7%) presented decrease after bariatric surgery, and total direct cost (US$1,375.37; +138%), consultations (US$0.42; +2.4%) and laboratory exams (US$68.96; +63.4%) had increase. Reduction in weight, BMI, LDL, triglycerides, insulin, glucose-linked hemoglobin, and glucose showed improvements in patients health status after bariatric surgery. Cholesterol, VLDL, and HDL presenting increase after surgery. Conclusion: Bariatric surgery represents an effective intervention for treatment of moderate to severe obesity with extensive benefits regarding health promotion and reduction of burden of disease. Trends in direct costs and multiple health outcomes showed post-intervention improvements in patients health status and reduction of health care needs of individuals.

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“…The presence of GERD was pointed out as a contraindication for VG by 57% of specialists during the International Sleeve Gastrectomy Expert Panel Consensus Statement in 2012 24 . However, the subject remains controversial, and there is still no consensus in the literature on the subject 1,3,5,20,21,31,32,35,36 .…”

mentioning

confidence: 99%

Vertical Gastrectomy vs. Extended Vertical Gastrectomy: What Is the Impact on Gastroesophageal Reflux Disease in Obese Rats?

Valadão

Leal

Oliveira

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. Aim: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. Methods: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. Results: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. Conclusion: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.

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Bariatric Surgery in Brazilian Public Health System: The Good, the Bad and the Ugly, or a Long Way to Go. Yellow Sign!

Cited by 29 publications

References 13 publications

Can Stature, Abdominal Perimeter and Bmi Index Predict Possible Cardiometabolic Risks in Future Obesity?

Can Stature, Abdominal Perimeter and Bmi Index Predict Possible Cardiometabolic Risks in Future Obesity?

Impacts of bariatric surgery on costs and health outcomes of patients in Brazil: Interrupted time series analysis of multi-panel data

Vertical Gastrectomy vs. Extended Vertical Gastrectomy: What Is the Impact on Gastroesophageal Reflux Disease in Obese Rats?

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