Behind the "sleeve stomach" weight loss magic
China News Weekly reporter/Huo Siyi and Li Xiangmao
Issued in the 993th issue of China News Weekly on 2021.4.26
In August 2020, Yixin Entertainment CEO Yang Tianzhen, who had served as the agent of Lu Han, Zhang Yixing and other well-known artists, announced in a live broadcast that he would undergo gastric surgery. This news immediately made the hot search list, and for the first time, " The concept of "cutting the stomach" is pushed to the public eye.
In some specific groups of people, stomach surgery has already become popular.
Unlike Yang Tianzhen’s purpose of treating diabetes, more people undergo gastric surgery to reduce weight.
For several different surgical methods, including gastric resection, there is also a more general but clear name: bariatric surgery.
Using "weight loss" as a keyword on Weibo or Douyin, dozens of weight loss doctors, weight loss hospitals, and weight loss training camp users can be searched.
Bariatric surgery has become a new industry in China, but as Francisco Rubino, Chairman of Metabolic and Weight Loss Surgery, King’s College London, UK, said, “In the end, only a few of those who come for surgery really need it. Yes, most of them are often unnecessary."
"Sleeve stomach" rises
The full name of Yang Tianzhen's gastrectomy is "laparoscopic sleeve gastrectomy" (LSG), or "sleeve stomach" for short.
In China, weight loss and metabolic surgery represented by the "sleeve stomach" has a history of more than 20 years, but it has only become popular in recent years.
The "gastric bypass surgery" is mainly for extremely obese patients and severely diabetic patients.
Its principle is to connect a small part of the stomach directly to the jejunum, allowing food to pass through a small stomach sac, and then directly into the end of the small intestine, bypassing most of the small intestine.
Compared with the "sleeve stomach", the advantage of gastric bypass is that it can lose more weight and has a better hypoglycemic effect.
But the disadvantage is that the risk of postoperative complications is higher and may cause long-term malnutrition.
According to the "Chinese Obesity Metabolic Surgery Database: 2019 Annual Report", in 2008, there were only 117 cases of weight loss and metabolic surgery carried out nationwide, but by 2019, it has soared to 11,700 cases, a 100-fold increase in ten years.
In 2013, out of a total of 4,106 weight loss and metabolic surgeries nationwide, only 777 cases of “sleeve stomach” surgery were performed. At that time, nearly 80% of weight loss and metabolic surgeries used “gastric bypass”.
But in 2014, the number of "sleeve stomach" surgeries jumped to 2,200 cases, almost equal to 2,920 cases of "gastric bypass surgery".
Since then, "sleeve stomach" has become more and more popular. By 2019, it has accounted for 85.78% and has become the most mainstream metabolic surgery for weight loss in China.
"Reduce weight and reduce blood sugar, Meng Hua will help you."
This is a classic opening line in the Douyin video of "Menghua Medical Online".
As the chief physician of General Surgery of the China-Japan Friendship Hospital and the head of the Bariatric Diabetes Surgery Health Management Center, Meng Hua’s Douyin account has millions of fans less than a year after it was opened. He is also called "domestic bariatric surgery" by some people. First person".
Since 2012, Menghua has carried out more than 4,000 weight loss and metabolic surgeries.
According to the "China Obesity Metabolic Surgery Database: 2019 Annual Report", it is estimated that between 2012 and 2019, there were less than 55,000 weight loss metabolic surgeries nationwide.
In 2020, affected by the epidemic, the Menghua team only began to perform operations in July, but by the end of the year it had performed more than 500 cases.
Meng Hua told China News Weekly that if nothing goes wrong, China-Japan Friendship Hospital will have more than 1,000 weight loss and metabolic surgeries in 2021.
"Currently, there is no hospital in China that has 1,000 operations per year. Many hospitals can only do dozens of cases a year, and I do it in a hundred years." He said.
Just one day before New Year's Day in 2021, Meng Hua completed 7 operations.
But even if he is so "desperately", the supply is in short supply.
"China News Weekly" learned that if you want to have a "sleeve stomach" operation at the China-Japan Friendship Hospital, you have to wait 4 to 5 months at the earliest.
But Meng Hua believes that the current number of surgeries in China is far from meeting demand and should continue to expand.
"Mainland China only performs 10,000 weight loss and metabolic surgery operations a year. Look at Taiwan, there are only more than 23 million people, and more than 3,000 cases are performed a year. We have a population of 23 million in Beijing, and there are only about 1,000 cases a year. At present, there are still 100 times the space for surgery. There are 330 million people in the United States who perform 300,000 to 350,000 weight loss and metabolic surgeries each year, which is 1% of the population. According to this ratio, China can also perform at least 1 million cases each year. Now it’s only one percent.” He said that is not without basis-China has nearly 90 million obese people and 129.8 million diabetic patients, both of which rank first in the world.
The principle of the "sleeve stomach" operation is very simple. It removes 75% to 80% of the stomach directly, leaving a remnant stomach the size of a banana. Because it is shaped like a slender vertical sleeve, it is named "sleeve stomach". cut".
The operation is irreversible and permanently changes the size of the stomach.
After the capacity of the stomach is reduced, the amount of calories eaten in each meal is reduced.
On the other hand, due to the removal of part of the stomach fundus containing "ghrelin", not only does the amount of food eaten after the stomach is cut, but it also hardly feels hungry.
"The hunger factor has been reduced by at least 70%, and studies have shown that it can still be maintained at this level after 5 years." Michelle Gargner, a professor of clinical medicine at Florida International University in the United States, said in an interview with China News Weekly.
Gargner is the inventor of the "sleeve stomach" surgery. He performed the world's first "laparoscopic sleeve gastrectomy" in 2000 and served as the International Federation of Obesity and Metabolic Surgery (IFSO) in 2014. Chairman.
He explained that when the stomach becomes "slim", food enters the stomach from the esophagus and enters the small intestine through the stomach in a shorter time. This also stimulates other hormones to act on the hypothalamus and signal to stop eating.
The most direct result of these changes is a rapid weight loss.
Generally, the decline is most obvious in the first year after surgery. Ideally, 60% to 70% of the overweight can be lost, and the lowest can reach more than 50%.
The so-called overweight part is the difference between one's own weight and the standard weight under the corresponding height.
Before bariatric surgery, there were not many medical treatments for obesity. Obese people mainly lost weight by improving their lifestyles.
But at present, weight loss metabolic surgery has been regarded by the medical community as the most effective way to treat morbid obesity, and "sleeve stomach" is one of the "star surgery", and its other important therapeutic effect is to alleviate diabetes.
The main purpose of Yang Tianzhen's surgery is to lower blood sugar. She has 6 years of diabetes history and has to inject insulin before every meal.
However, due to long-term staying up late and working overtime, irregular work and rest, the effect of relying on drugs to control sugar is not good.
She thought of adopting a more radical approach.
"We quickly realized that the stomach and intestines are not only digestive organs, but also endocrine organs. The effect of cutting the stomach is not only in breaking down food, but also changing the level of hormones in the intestines and stomach." Gagner said.
In 2007, the first diabetes surgery summit was held in Rome.
Francisco Rubino, one of the organizers of this conference and chairman of the Department of Metabolic and Weight Loss Surgery at King's College London, UK, was one of the first experts to study the mechanism of weight loss metabolic surgery to alleviate diabetes.
He told China News Weekly that after this meeting, experts gradually realized that metabolic surgery for weight loss can be used to treat diabetes, which should be its main purpose, not a side effect of treating obesity.
But in China, the main population of bariatric surgery is not diabetic patients, but obese patients or beauty lovers who think they are fat.
Radical expansion under the "BMI-only theory"
What are the conditions for a person to have a "sleeve stomach" operation?
According to the "Chinese Obesity and Type 2 Diabetes Surgical Treatment Guidelines (2019 Edition)", there are two main indications for "sleeve stomach" surgery: when the BMI exceeds 32.5, surgery is recommended; when the BMI is between 27.5 and 32.5 , Requires at least two metabolic syndromes, such as hypertension, type 2 diabetes, endocrine dysfunction, hyperuricemia, male sexual dysfunction, polycystic ovary syndrome, renal dysfunction, etc., and through changes in lifestyle and internal medicine Treatment is difficult to control before surgery can be considered.
BMI stands for body mass index, and its calculation formula is weight (in kilograms) divided by the square of height (in meters).
"China News Weekly" found in an investigation that in clinical practice, not only many private hospitals, even public hospitals, did not strictly implement the above-mentioned surgical indications, which lowered the threshold for surgery.
As a patient, the reporter consulted the Second People's Hospital of Xinxiang City, Henan, Changchun Jiahe Surgical Hospital of Jilin, Jinshazhou Hospital of Guangzhou University of Traditional Chinese Medicine, Shanghai Ninth Hospital, Third Xiangya Hospital of Central South University, Chengdu Third People's Hospital and Zhengzhou Second People’s Hospital and other hospitals.
These hospitals have performed a lot of "sleeve stomach" operations.
It turns out that they can all perform gastric surgery for people with a BMI of less than 30 and no comorbidities.
Searching for keywords such as "stomach cutting" and "sleeve gastrectomy" on Baidu, the advertisements of Shanghai Hongqiao Hospital always appear in the forefront.
The staff of the hospital even told the consultant that as long as the BMI reaches 27.5, simple obesity can also cut the stomach, but the price of the operation is more than 70,000 yuan, and medical insurance cannot be reimbursed.
A patient who underwent gastric resection at Beijing Chaoyang Hospital recalled that when she first consulted the hospital for surgery, her BMI was only 24.6 and there were no other comorbidities. At that time, the hospital “did not agree or refuse”.
After that, she let go of eating within six months, and she gained more than 20 kilograms in weight. The preoperative BMI was close to 30, but she still had no comorbidities.
"I remember the doctor asked about my occupation when I was registered. He said that for gastric surgery, some people need weight loss and some people need body shape. This means that although your BMI is not enough, if you I hope this surgery will become thin and beautiful, and it can also be done. This is a different need." She said.
Meng Hua administers "flying knives" at the Ninth Hospital of Xingtai City and Julu County Hospital in Hebei Province. Wu Canghui, the director of general surgery of the hospital, is his student.
The reporter consulted Wu Canghui by telephone as a patient in early January 2021. He made it clear that when the BMI is less than 30 and there are no other comorbidities, surgery can also be performed.
He also said that Menghua would choose one or two weekends to perform surgery in the hospital every month. If he chooses Menghua as the surgeon, he will need to pay him an additional fee of 10,000 yuan.
"Menghua has queued more than 1,500 patients in the China-Japan Friendship Hospital, and the operation will be scheduled until April this year. But when we make an appointment for Menghua surgery at our hospital, the operation can be performed before the end of January, so the 10,000 yuan is about the same as the gasser fee. "Wu Canghui explained.
Liu Yang, another apprentice of Meng Hua and the current deputy chief physician of General Surgery of Beijing Friendship Hospital, also said that if BMI is only 28~29, it is not fat for men, but fat for women, so there is no comorbidity. can do.
He also emphasized that the Friendship Hospital has also done some sleeve gastrectomy with a small base weight, and the effect is also good.
The price of "sleeve stomach" surgery varies greatly between different hospitals, ranging from 40,000 to 90,000 yuan.
Compared with other surgical procedures, gastric incision is a relatively simple laparoscopic operation, and the main difference between each family is the number of openings.
Most "sleeve stomach" surgeries are three-hole or five-hole surgery, and some hospitals can perform higher-end single-port surgery, that is, only one mouth is opened at the belly button of the abdomen, and the laparoscope enters the operation through this.
The single hole is more expensive. For example, the price of Jinshazhou Hospital of Guangzhou University of Traditional Chinese Medicine is 99,000 yuan, and that of Changchun Jiahe Surgical Hospital is 88,600 yuan.
In Menghua’s private hospital, Beijing Mingde Hospital, the cost of a single-port operation is about 90,000 yuan.
A patient who was still waiting in line for gastric surgery said that she learned about the operation through Douyin and followed three groups on Douyin, namely Chengdu No. 3 Hospital, Beijing Menghua and Zhengzhou Xige (Zhengzhou Central Hospital) Hu Yangxi).
"Meng Hua's schedule is too long. Brother Xi is Meng Hua's apprentice. I didn't even see the doctor's assistant at the Chengdu Third Hospital." She recalled.
Wang Cunchuan, chairman of the Obesity and Diabetes Surgeons Committee of the Chinese Medical Doctor Association and vice president of the First Affiliated Hospital of Jinan University, told China News Weekly that there are currently about 400 hospitals in China that can perform minimally invasive bariatric surgery. There are 30-40 companies with more than 100 operations.
At present, most of the doctors who carry out bariatric surgery in China are performed part-time by doctors of gastrointestinal surgery, gastrointestinal tumor or hepatobiliary surgery.
In this group of doctors, there are no more than 10 full-time bariatric surgery doctors in China.
In the newer field of weight loss and metabolic surgery, in order to open up the "market", doctors not only rely on word of mouth, but also promote themselves on various We-media platforms, and expand potential patient groups by building WeChat groups.
In the postoperative patient group of a doctor in Chengdu, the group leader is the doctor.
He deliberately asked the group of friends to bring people who intend to undergo surgery directly into the group without asking him alone.
BMI seems to be the only criterion for surgery.
Many patients told China News Weekly that they contacted the doctor for consultation through Douyin or Weibo. The other party only asked them what their BMI was, and then they judged that they were eligible for surgery.
Some patients even make an appointment directly without registering, and then go to the hospital for a comprehensive examination when they arrive, and then move to the operating room a few days later.
The whole process is like an assembly line operation.
Rubino pointed out that BMI is very easy to fluctuate. Just using BMI as a standard will cause many people to eat more to gain weight in a short period of time in order to achieve the lowest threshold for surgery. This situation occurs in the United States and Europe. Ever, especially in private medical institutions.
In China, it is not uncommon to reach the threshold of surgery by eating wildly.
In a preoperative patient group in Menghua, many patients shared their own experience of eating madly for BMI compliance. One patient jokingly called this behavior "to gain weight for weight loss."
In the first consultation with a doctor from the First Affiliated Hospital of Nanjing Medical University, Zhang Xinrui weighed 125 kg and had a BMI of 25.7. However, she did not tell the truth, but reported her weight a lot higher.
In the next two months, she quickly gained weight by eating wildly, from 125 jin to 138 jin.
"In the end, the doctor didn't find that I had increased my weight. I just consulted on WeChat, and the doctor said that I could make an appointment with the nurse." She recalled.
Due to obesity, many patients will have various problems, such as high blood sugar, high blood lipids, fatty liver, and even polycystic ovaries are also common in overweight women.
For patients with BMI between 27.5 and 32.5 who have such problems, the "Guide" has clear definitions: lifestyle changes and medical treatment are difficult to control.
But in practice, many hospitals loosely apply the condition of "combined with at least two metabolic syndromes" in their assessment.
A patient said with emotion to China News Weekly that fat people will always have problems of this kind. After an examination, the doctor will definitely let you cut it.
Scott Kahan, chairman of the National Center for Weight and Health of the United States, told China News Weekly that this condition was initially introduced internationally for some patients whose BMI is not particularly high, but surgery will bring great benefits. An opportunity, because BMI does not necessarily reflect the body's specific fat distribution and health risks, some metabolic indicators are closer to the true state of health at the moment.
However, in practice, metabolic syndrome has become an excuse for doctors to expand surgery. For patients, it is not clear how to conduct risk assessment rationally. Any symptoms reflected in their own body will amplify this discomfort, but if doctors do not perform Correction, it is easy for some people who are not suitable for surgery to feel that they have to cut their stomachs.
In this regard, Li Guangwei, the eighth vice chairman of the Endocrinology Branch of the Chinese Medical Association and the former director of the Endocrinology Department of the China-Japan Friendship Hospital, used the term "radical" to describe the current trend of expanding weight loss and metabolic surgery in China.
Stomach folding is "medical and aesthetic surgery"?
Cui Zhiyu is 27 years old, 1.65 meters tall and 76 kilograms in weight.
Prior to this, she tried almost all weight loss methods, but failed due to lack of self-control.
Her BMI is 27.9, which happens to be in the range of 27.5-32.5, but she has no complications such as diabetes or hypertension.
In an outpatient clinic at the China-Japan Friendship Hospital, Meng Hua told her that for her "small weight" people who especially want to lose weight, they can’t have a sleeve stomach, but they can do another simpler and reversible one. surgery.
"He said to put a supporting stomach tube in. If you remove the excess stomach along the greater curvature along the stomach tube, it will be a sleeve-shaped stomach. If you don't cut the stomach, fold the stomach inward along the stomach tube, and then sew it up. , The stomach is folded, so you can open it again if you regret it." Cui Zhiyu recalled.
Meng Hua told her that the only difference between the two operations is that one is recoverable and the other is irrecoverable, but if managed well after the operation, the effect is the same.
He also explained, "The'sleeve stomach' is therapeutic. If the stomach is folded, it is actually a medical beauty project and cannot be called an operation."
However, Li Bin, chairman of the medical beauty chain and Rieger Medical Beauty Group, pointed out that according to the "Regulations on the Management of Medical Aesthetic Surgery Grades", stomach folding surgery is not a medical beauty project, and regular medical beauty institutions do not carry out such operations.
At the same time, in the newly revised "Guidelines for the Surgical Treatment of Obesity and Type 2 Diabetes in China" in 2019, there is no mention of "gastric folding".
Among the recommended surgical procedures, only three are listed: "cuff stomach", gastric bypass, and biliary-pancreatic bypass duodenal transposition (BPD/DS), and a clear surgical adaptation is proposed for the three procedures Disease standards.
The reporter found in Menghua’s preoperative patient group that several patients whose BMI did not meet the standards for gastric resection were also recommended for gastric folding surgery.
However, a patient who had already asked Meng Hua for gastric surgery told reporters that in her view, stomach folding is just a conventional marketing technique. First, tell small-weight patients that there is an alternative to regret and don’t hear about stomach surgery. I was afraid, so I dismissed the idea of surgery, and then I would find a lot of problems when I waited for the hospital examination.
"Fatty has too many problems, stomach folding is recommended when not in hospital, there must be enough reason for you to cut it after hospitalization," she said.
In the video sharing surgical experience on Meng Hua's Douyin account, only one patient underwent gastric folding surgery.
Meng Hua explained that her BMI was 28.8 and there were no serious complications.
Yao Qiyuan, the chief physician of the Department of Weight Loss and Metabolic Surgery of Huashan Hospital affiliated to Fudan University, also vigorously promoted "stomach folding" surgery on his Douyin account, which he called "the new gospel for overweight people with a small base."
According to the analysis of many foreign experts, this approach actually bypasses the existing standards of surgical indications that have been recognized in the industry and deliberately performs operations on people who should not have undergone surgery, but because the official guidelines do not provide for "gastric fold operation". It puts forward clear restrictions and regulations, thus circumventing supervision.
Stomach folding surgery began to appear in China around 2010.
However, the chief physician of gastrointestinal surgery in a tertiary hospital in Beijing told China News Weekly: “In the next one or two years, this operation was gradually eliminated by the industry. Few doctors were doing it, and many doctors were still performing gastric folding. They are all illegal operations." He pointed out that the medical profession has confirmed that stomach folding is not of much value for weight loss.
There will be some weight loss effects when just finished, but after a year or two, it will be almost completely restored.
More importantly, almost all the sutures in the operation are fully stretched after half a year, and the operation will fail after the gastric capacity is restored.
Moreover, if the stomach folding fails, the risk and difficulty of other weight loss surgery will be great.
Wang Cunchuan also confirmed to China News Weekly that "gastric folding surgery has been eliminated."
He pointed out that although stomach folding did not cut the stomach, it changed the shape of the stomach, but the secretion of gastric acid did not decrease, so reflux would be more serious, which is one of the reasons for being eliminated.
In the United States and Europe, "stomach folding" surgery has become popular for a while, but it quickly became history.
"At this stage, I highly do not recommend anyone to perform this operation on patients." Gagner said.
Can cutting the stomach really lose weight?
In many public hospitals such as the China-Japan Friendship Hospital, weight loss surgeons told patients who came for consultation that gastric surgery can reduce 70% to 80% of excess weight.
However, some patients pointed out to China News Weekly that there is a certain gap between the postoperative weight loss effect and the initial doctor told them. For some girls with a larger weight base, the gap can reach 10-20 kg.
However, in the eyes of many foreign experts, this is an unscientific propaganda technique and part of the construction of the "myth of bariatric surgery."
What the patients who come to the consultation don't know is that 70%~80% is just the best estimate for the first year after surgery.
"Like any operation, the long-term maintenance of the postoperative effect is the most important test." Kahan emphasized.
In the United States, medical institutions are generally more cautious, pointing out that gastric surgery can reduce patients' excess weight by about 50%. It also emphasizes that patients have the best weight loss effect within 4 to 6 months after surgery, but they must maintain long-term results. , You must practice a healthier lifestyle.
Yu Jianchun, chief surgeon of Peking Union Medical College Hospital, and others tracked the postoperative conditions of 75 morbidly obese patients who underwent “sleeve stomach” surgery in the hospital from 2012 to 2017, and found that they lost an average of overweight in the first year after surgery. Part of 81.6%, even if it declined in the third year, it also reached 79.7%.
In the paper "Analysis of the efficacy of laparoscopic sleeve gastrectomy in the treatment of obesity and its comorbidities" published in 2018, they concluded that sleeve gastric surgery can effectively reduce the weight of Chinese obese patients in the middle and long term after surgery.
In addition, due to factors such as differences in ethnic origins between the East and the West and differences in dietary structure, the "sleeve stomach" surgery has a definite weight loss effect on morbid obesity in Chinese people, and the effect is likely to be better than that of Westerners.
However, according to international practice, the evaluation of the long-term effect of a surgical operation should be traced at least five years later, preferably more than ten years.
The paper also stated at the end of the article that nearly half of the cases were followed up for less than three years, which may lead to bias in the final results.
A five-year follow-up published in the World Journal of Gastroenterology Surgery in 2017 showed that the researchers analyzed 156 patients who underwent “sleeve stomach” surgery from 2006 to 2016 in the US electronic case database.
In the first year after surgery, they lost an average of 82% of their excess weight, but by the fifth year, this number had dropped to 60%.
Another study pooled and analyzed 16 long-term tracking items, including a total of 492 "sleeve stomach" patients, involving a longer time span. The result found that the average excess weight loss of patients was maintained at 54.8 at the 8th year after surgery. % Around the level.
Many experts also pointed out that compared with gastric bypass surgery, "sleeve stomach" surgery has a higher probability of regaining weight.
Gargner explained that because the small intestine is still intact after the stomach is cut, the absorption has not deteriorated, so if the patient still consumes a high calorie postoperatively, it will still rebound.
"We are not manipulating genes, but manipulating the body," he said.
According to Gagner, the genes of each individual are already set. It tells us that a person should have multiple at a certain age. If you try to change it, the powerful genes will be reversed in various ways. The effects of surgery, such as stretching the stomach pouch.
With the passage of time, the remaining "banana stomach" after the resection will increase a little, and the absorption will become better and better.
For patients with small body weight, the probability of regaining weight after surgery will be higher, because if the weight base is small, the original weight loss will be very limited and the body will be easier to return to the past.
Abuse and underutilization coexist
What is happening in the Chinese bariatric surgery operating room has a meaning beyond medicine itself.
Whether it is the moderate "relaxation" of the threshold for "sleeve stomach" surgery by major hospitals, or the packaging of the eliminated stomach folding surgery into a "new gospel for small base overweight people", they are striving to satisfy more people's "slimming" Demand-or fantasy.
Such fantasies are not only happening in China.
In recent decades, the stigma of obesity and "weight stigma" has intensified in every corner of the world.
Rubino, chairman of the Department of Metabolism and Bariatric Surgery at King’s College London, told China News Weekly that the causes of obesity are very complex and are the result of a combination of individual, environmental and genetic factors.
Compared with men, women are under greater social pressure in this regard, which is one of the driving forces for the increasing number of weight-loss metabolic surgeries in recent years.
More and more women want to lose weight, "They feel that this is a kind of magic." Kahan said.
In Kahan's view, behind China's "radical" weight-loss and metabolic surgery is the "compulsion" of doctors and patients.
Kahan is an authoritative doctor in the field of weight loss in the United States. He has consulted for the White House and the U.S. Food and Drug Administration (FDA).
He pointed out to China News Weekly that doctors want to make more money and scale the operation, while some patients are dissatisfied with their body. Many female patients still want to have surgery even though they are very thin.
They do not proceed from a medical point of view, nor even to lose weight themselves, but to pursue a kind of "beauty" in a sociological sense.
According to the fourth annual report of the International Federation of Obesity and Metabolic Disorders Surgery (IFSO) published in 2018, the Federation has counted 394,431 weight loss metabolic surgeries from 51 countries and found that between 2014 and 2018, there were 73.7 % Of surgical patients are women.
In China, according to the "Great Northern China Weight Loss and Metabolic Surgery Clinical Data Database 2019 Annual Report", 2259 cases (about one-fifth of the year) from 19 provinces, municipalities, autonomous regions, and municipalities directly under the Central Government (approximately one-fifth of the year) weight loss and metabolic surgery records show that women Accounted for more than 70%, the median age is 31 years old.
In 2014, Rubino conducted an interesting experiment at the New York Presbyterian Hospital.
The hospital has set up two special departments, one is called bariatric surgery and the other is called metabolic surgery. The two departments are in the same corridor of the hospital and share the same doctors and beds to carry out the same weight loss and metabolic surgery.
Rubino randomly selected 100 patients from two departments. He found that the majority of patients who came to the bariatric surgery were women, accounting for about 74%, and there were more young people.
The proportion of men and women who come to the Department of Metabolic Surgery for medical treatment is similar, with men accounting for about 42%. They are generally older, many of whom are over 60 years old, have developed serious cardiovascular diseases, and want to treat diabetes through surgery.
In bariatric surgery, anxious women desperately want to lose weight.
Rubino pointed out that aesthetic discrimination and social prejudice surrounding obesity are the main reasons for the differences in the gender structure of patients.
Compared with the role of weight-loss metabolic surgery in relieving diabetes, people always pay more attention to its weight-loss function, and simply regard it as a kind of weight-loss surgery. This is a common misunderstanding and misconception.
At the same time, many men with severe diabetes who need surgery more, are unwilling to undergo surgery because they are worried about being considered weak. This is why few men in any country seek metabolic surgery for weight loss.
According to the "Great North China Weight Loss and Metabolic Surgery Clinical Data Database 2019 Report", out of the 2169 valid data that year, only 618 patients had type 2 diabetes, accounting for only 28.5% of the total.
Many experts pointed out that for those who “do not need surgery”, choosing surgery is a “very uneconomical business”.
Kahan believes that for those who have a small weight base and do not have too many health problems, the benefits of surgery are very limited. They only reduce some weight, but they have to bear a greater risk, that is, weight loss. The possible complications of metabolic surgery, as well as the radical changes in lifestyle after surgery, have brought burdens on the individual's body and mind.
Rubino emphasized that the biggest problem now is: On the one hand, weight loss and metabolic surgery is abused, and too many people who are not necessary perform surgery. This has brought people's worries about the expansion of surgery, thereby deepening the misunderstanding of surgery.
On the other hand, people who really need it did not undergo surgery for various reasons.
These people who really need it include patients with diabetes and severe obesity. There is already a lot of evidence that weight loss metabolic surgery can improve the health of these people.
The problem of abuse has caused "underutilization" to a certain extent.
Rubino said that in most countries, less than 1% of people who meet the criteria for surgery have undergone surgery.
In the United States, this figure is 0.9%, the United Kingdom is only 0.2%, and Canada is 0.5%.
According to current surgical standards, 99% of patients have not yet undergone surgery.
Therefore, he emphasized, “Surgery must be provided to those who really need it. If this is the case, there is no reason to worry about excessive expansion of the operation. Expansion is necessary.”
(Cui Zhiyu and Zhang Xinrui are pseudonyms)
China News Weekly, Issue 16, 2021
Statement: The publication of the "China News Weekly" manuscript is authorized in writing