Effect of employment of botulinum toxin linked to dietary guidelines for the treatment of preoperative super obese

Abstract

Obesity is a medical condition in which there is an excessive body fat accumulation that causes an adverse effect on the maintenance of health and welfare. The prevalence has increased in Western countries in the past decade, reaching epidemic proportions.(1)It is estimated that 97 million U.S. adults are overweight or obese, with body mass index (BMI) greater than 25 (2). In Brazil it is estimated that 40% (70 million) of the population is overweight, and obesity is responsible for about 80,000 deaths a year with an increase of 240% in only 10 years in childhood obesity (3, 4). This condition causes an increase in the morbidity and mortality, to the point that in its most severe form, it is named morbid obesity. The annual cost for its treatment reaches ten billions of dolars.(4)Obesity has been traditionally treated by programs involving diet, exercise, behavioral and psychological orientations, and the use of drugs to decrease appetite. Although this approach is able to reduce weight, it can not maintain long-term results. (2-8)One of the objective methods to measure obesity is BMI, which classifies the weight divided to the square of the patient's height. Currently, overweight is defined as a BMI 25 to 29.9 kg / m² and obesity is considered a BMI of 30 kg / m² or greater.(9) Extreme or morbid obesity is generally defined as a BMI equal to or greater than 40 kg / m². Super obese is defined by a BMI of 50 kg / m² or higher and is a growing category. A major concern for the obese patient is the substantial increase in complications associated with obesity, a multifactorial disease, which increases the risk of morbidity and mortality, some disorders such as type 2 diabetes mellitus, hypertension, cardiovascular disease, stroke, osteoarthritis, hepatobiliary disorders and sleep apnea are common in these patients. (10)This disease has been associated with increased mortality in general and seen as directly responsible for the deaths of 300,000 people per year. (2)Surgical treatment is the most effective in most patients, especially in morbidly obese patients, but it also has high rates of complications, from 5 to 8%, and mortality rate of approximately 1%.(11-13) In fact, despite the risks, the bariatric surgery has a lower incidence of mortality than untreated long term obesity. In 1988, the National Institute of Health (NIH), U.S., met to decide a consensus for obesity. The goal of the NIH has been to research obesity in the literature and make recommendations on the management of obese patients, based on existing scientific studies. One of the recommendations was that patients should reduce 10% of body weight through non-surgical measures before trying more invasive weight reduction. It was considered reasonable that this should be done within six months.(2)The reason for this loss of 10% of body weight is that even a modest weight loss can significantly reduce the risk of obesity-related diseases such as pulmonary dysfunction, diabetes, hypertension and other physiological risks. Besides improving the general health of the patient prior to bariatric surgery, weight loss pre-operative will show the willingness of patients to lose weight in long term, reduces the risk of complications, makes patients get used to a healthier lifestyle and possibly increase the total weight reduction. (2 to 7, 14). These factors together can increase the likelihood of success in long term reduction of weight.Over time, the goal of weight loss of approximately 10% pre-operative has been recommended by other associations like the American Dietary Association and the Framingham Heart Study Group.(15-18) In addition, several clinics and hospitals that perform bariatric surgery are recommending or requiring patients to lose 10% or 25% of initial excess weight before the surgery. (AU)