Morbid obesity, a disease

For the past two decades, Dr. Simon Marceau has seen patients with morbid obesity in his office. But do not count on him to accuse them of being responsible for their condition. “Not far from half eats better than me,” says the surgeon who believes an “undeniable” genetic link in the outbreak of what he considers to be a disease.

“I would say that 80% of a person’s weight is determined biologically, such as size, shape of the nose or age of menopause,” explains to the Sun the doctor attached to the University Institute of Cardiology and Pulmonology (IUCPQ).

For patients who are overweight (over 45 kg), bariatric surgery has been regarded since the beginning of the 1990s as the last-chance treatment, which will allow for long-term weight loss. Like his father before him, Dr. Marceau became a specialist in this operation.

“Some of the overweight people are obese, who enjoy themselves by eating excessively,” he explains, “but it’s a minority. They shadow all others. […] Even today, there are many people who mistakenly believe that it is a condition that depends only on food choices and exercise. We know that this is not the case. There is irreversibility, the patient can not go back by counting his calories and increasing his energy expenditure. […] The equation is very complex and depends on the genetics of each one. ”

The opinion of Dr. Marceau echoes a British study published this week that children inherit 40% of their body mass index from their parents. This percentage reaches 60% among the most obese children, which means that more than half of their predisposition to obesity is attributable to genetic factors.

Olympic Games

We are not equal to calories. The basic metabolism, ie the temperature of the internal furnace, and the capacity of absorption of food vary from one individual to another. Paired with an environment where food is omnipresent, individuals genetically predisposed to gain weight exponentially are the first victims.

People with severe obesity – some 300,000 in Quebec – have often tried, in vain, all the possible diets to lose weight. The only option for them remains bariatric surgery. “I believe with certainty that once you reach the stage of morbid obesity, it’s an Olympic feat to be able to reverse the situation. Those who get there are the exception, “says Dr. Marceau.

The expert regrets that reality shows, style The Biggest Loser ( Biggest Loser ), where obese lose weight to great trouble “almost superhuman”, in a controlled environment, help to maintain the myth that losing a lot of weight and Then remaining stable or achievable when the will is put there.

“Mr. or Mrs. Everyone who looks at it will have the reflex to say: see, it is done, and if there is a failure, it is his fault, as if it confirmed their mistaken bias that it Is controlled, “says Dr. Marceau. However, “it is often a condition to keep the weight practically impossible to maintain when the individual stops. Six years later, no show is shown to show where they are. ”

Slower metabolism

From the physiological point of view, the body adapts to the rationing of food. If weight loss from a diet is often significant in the first few weeks, it will become smaller and smaller later, as if the brain, believing that a famine is coming, ordered lower body temperature And make reservations. “The body gets used to a slower metabolism and, unfortunately, it will be more difficult to keep its weight,” says Dr. Marceau.

Although bariatric surgery is a relief buoy for many morbid obese patients, it is not infallible. Dr. Marceau estimates that about 40% of patients will recover “almost all of their weight” within 10 or 15 years of the operation. “If it’s a failure for the patient, for us it’s still 10 or 15 years when the person will have lived without diabetes and other complications.”

SUPPLIED BY MICHEL LAMBERT

Michel Lambert underwent bariatric surgery five years ago. Today, lighter 95 kilos, the 53-year-old man considers the operation to have literally saved his life. “I went into the wall.”

The new life of Michel Lambert has nothing to do with the one he underwent at the time when he weighed nearly 180 kilos (400 lbs). The simple gesture of tying his shoes had become an ordeal. At the restaurant, impossible for him to sit in a bench. “Just to buy clothes, I had to go to a specialty store in Montreal.”

The worker in the entertainment world and former owner of the Beauce radio station 101.3 explains that he began to fatten exponentially by eating at any time of the day, most often in restaurants, And to attend 5 to 7. And this, despite that he remained a rather active person, after playing junior hockey A.

“At one point, I no longer controlled my weight, not necessarily because I was eating more. I did not take even dessert, he says the sun . I was trying to lose weight, but I was still losing weight. If I lost 50 pounds, I would take 75-80. ”

Last chance

In 2012, Michel Lambert had had enough. He absolutely had to do something to change the situation. The operation – a gastrectomy coupled with a biliopancreatic derivation – carried out at the University Institute of Cardiology and Pulmonology in Quebec City, was his salvation board. In one year, he lost 90 kg (200 lbs), a rapid weight loss and much higher than the average patients.

Today, the fifty-year-old learns to live with his new body. He made it a duty to frequent the gym, to go cycling and walking. He changed “completely” his diet and eliminated the alcohol. All of his health problems – diabetes, high blood pressure, high cholesterol – are gone. He has taken the habit of taking his twenty tablets of vitamins and minerals every day.

Michel Lambert encourages all those struggling with a problem of morbid obesity not to wait to take action. “It was a privilege for me to undergo the operation. If I could help even one person sign up … ”

And postoperative pain? “It’s worse than having a tooth removed.”

Word for word
Gastrectomy: intervention to reduce the volume of the stomach to the size of a banana. A thin, vertical tube of the stomach is allowed to contain only a small portion of the food.
Biliopancreatic derivation: a mixed procedure that consists of reducing the amount of food in the stomach and absorbing it through the intestine. The stomach is resected and the small intestine, divided in two. The stomach is connected to the part that brings food to the large intestine. The other part carrying the digestive secretions of the liver and the pancreas is attached to the small intestine. The majority of foods therefore pass directly into the large intestine without being ingested.
Source: Bariatric Surgery – Steps and Benefits. College of Nurses of Quebec
Operate more to save money
Three thousand bariatric surgeries are performed in Quebec each year. For Dr. Simon Marceau, it should be practiced three times, with the operation demonstrating that it contributes to improving the quality of life for patients and, by the band, saving the government millions.

At present, in proportion to the population, the number of operations in the province is “well below” the ratio observed in several western countries like the United States and France, deplores the doctor of the IUCPQ.

“There are 300,000 morbidly obese people in Quebec. We should aim for close to 10,000 surgeries per year. In three years, the operation is paid, then the savings are saved. There is no medical gesture that offers a better return on investment. ”

Studies show remission of diabetes in 60% of patients who underwent gastrectomy. The percentage reaches 90% for the biliopancreatic derivation. The problems of hypertension and cholesterol also decrease in most of them. If the condition persists for a period of ten years, for example, it is as long as the patient has not had to consume drugs “that cost a fortune”.

“A 40-year-old who has become unable to work because of his weight, it would be crazy to leave it like that if you can offer him an option that has proven to be effective. It is someone who still has a contribution to bring to society, “says Dr. Marceau.

Advantage for Women

Obese young women wanting to start a family would also benefit from bariatric surgery. “Pregnancy is going to be safer, with a lower risk of preeclampsia and caesarean section.”

The game is all the more worth the effort, says Dr. Marceau, that the progress of medicine and the refinement of the intervention, increasingly practiced by laparoscopy, made the operation less and less risky, The order of one death per 1000 patients, namely the mortality rate of a gallbladder surgery.

In numbers
2966: number of bariatric surgeries performed in Québec (April 1, 2014 to March 31, 2015)
2065: number of patients awaiting initial consultation at the IUCPQ
243: number of patients awaiting surgery at the IUCPQ
22: number of weeks waiting, on average, for an operation at the IUCPQ

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