Obesity – disease number E66

Obesity around the world

The statistics are implacable and, without doubt, no improvement can be expected if current trends continue. Estimates from the World Obesity Federation clearly indicate that by 2035, more than 4 billion people worldwide will be overweight or obese. Among these 4 billion people, as many as 1 in 4 will be obese[3]. The alarming figures also apply to the youngest. According to the report, the obesity rate among children could as much as double by 2035 compared to 2020 levels. The World Obesity Federation alerts that by that time as many as 208 million boys and 175 million girls will be classified as obese[4]. In 1998, the WHO identified obesity as the most serious global health problem. The literature has even begun to use the term “globesity”, a combination of the words “global” and “obesity”[5]. The problem is so serious that obesity has been included in the International Classification of Diseases and given the number E66[6].

The risk of obesity in Poland. Simulation created based on World Obesity Federation data. Source

Obesity and its comorbidities

The causes of obesity range from genetic to hormonal to environmental and social factors. However, our lifestyle will certainly have a major impact on its development. Increased intake of simple carbohydrates and fats, lack of physical activity or irregular diet will take its toll on our health due to increased energy balance. Among the determinants of this phenomenon in children, eating patterns will play a major role[7]. Not only is this a disease in itself, but it is also a trigger for other diseases.

Poland is ranked 52nd among countries with the highest obesity rate among adult men. Source: https://data.worldobesity.org/rankings/

Obesity in Poland

The Polish National Health Fund (NFZ) indicates that three out of five adult Poles in Poland are already overweight, and one in four is obese. The NFZ estimates that by 2025 there will be as many as 25% obese women and 30% obese men. In a ranking published in October 2022 on obesity rates in 213 countries around the world, Poland was ranked 70th[9]. The figures for children in Poland are also worrying. The WHO alarms that Polish children are gaining weight the fastest in Europe. Treating the consequences of obesity is extremely difficult and requires both the involvement of many specialists from different fields and specialised equipment. The World Obesity Federation estimates that, if current trends continue, the cost of treating obesity and its comorbidities could reach 3% of global GDP. Slowing the epidemic by 5 per cent could lead to savings of USD 420 billion, and keeping it at 2019 levels would save USD 2.4 trillion[10].

Obesity treatment

For some patients, the last hope is bariatric surgery, which is gaining popularity worldwide. Such a group includes people with morbid obesity[11], i.e. a BMI higher than 40 kg/m². It is worth noting here that morbid obesity is a condition that will not improve on its own. Surgical treatment of obesity is complex and, in addition to the surgery itself, includes nutritional support, psychological assistance and physical therapy. For surgical treatment, the most commonly used methods are sleeve gastrectomy and gastric exclusion with loop or Roux-Y anastomosis[12]. The surgery is performed laparoscopically and the patient should remain in the care of the facility providing bariatric treatment after the surgery[13]. A 2021 study indicated that the treatment of obesity and the diseases resulting from it cost the health service in Poland approximately PLN 15 billion. The analysis took into account only direct costs including, among others, medical services, drugs, educational campaigns or medical equipment[14].

Bariatric centres in Poland

There are few centres in Poland that provide comprehensive treatment for patients with morbid obesity. Data from the Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons state that there are exactly 40 such centres[15]. In 2021, the Ministry of Health launched a pilot programme for comprehensive medical care of surgically treated patients with morbid obesity (KOS-BAR). Fifteen centres across Poland have qualified for the programme. The Ministry estimates that approximately 2,900 patients will be covered by the programme. Unfortunately, this is a drop in the ocean of needs, and these are enormous – in Poland, about 700,000 people struggle with morbid obesity[16].

Famed HYPERION – bariatric operating table with a maximum load of up to 500 kg.

Polish hospitals lack adequate equipment

People with morbid obesity in Poland do not have an easy life. Access to appropriate medical care is severely limited due to staffing problems, insufficient public awareness or lack of appropriate equipment. There are only a few dozen obesity treatment specialists in the whole country – about 40 surgeons performing bariatric surgery and a dozen obesitologists acquiring their knowledge abroad, as there is no such specialisation in Poland[17]. Hospitals do not have adequate equipment to care for and treat patients with a BMI above 40 kg/m2. A key aspect of such equipment is its maximum load as well as width. Hospital beds with a load higher than 250 kg are still rare in Polish hospitals[18].

Bariatric operating table and accessories

Equipment in the operating theatre also requires a special approach. The bariatric operating table should have a high maximum load parameter while maintaining all table movements. Another important consideration here will be the width of the tabletop (above 600 mm) and the possibility of extending the tabletop with accessories. Then there is the availability of accessories, which in the case of bariatric surgery are dedicated attachments and have completely different parameters than equipment used in general surgery. Most bariatric surgery is performed using laparoscopic techniques that require good access for the operator[19]. The ability to adjust the height of the table – the lower the better – will help in assuming the right position over the patient.