Obesity is a chronic metabolic disease characterized by excessive accumulation of adipose tissue in the body. It is associated with more than 200 health complications but the greatest risk factor are cardiovascular diseases. It is assessed by body mass index (BMI) and waist circumference measurement. The approach to treating obesity should be focused on reducing body weight in order to reduce the risk of cardiovascular and metabolic diseases and prevent weight gain. Treatment is primarily focused on changing bad lifestyle habits. Diet should definitely be adjusted and physical activity should be increased. In some cases, this is quite enough to reduce body weight, but for some patients lifestyle changes alone are not enough so pharmacotherapy, behavioral-cognitive approach, endoscopic and surgical treatment methods are combined with it.
The aim of this paper is to present the treatment procedure for obesity in a tertiary health institution – Cliical Hospital Center Rijeka which is multidisciplinary and to emphasize the newer endoscopic treatment methods that are available.
At the Clinical Hospital Center Rijeka overweight patients report to an endocrinologist on the recommendation of a family doctor who conducts an initial interview with the patient. During the first examination a targeted search is made for the causes of obesity. After taking the patient's history and physical status the diagnostic tests that need to be performed are determined,.
Motivation is key to treating obesity. When working with patients a sense of trust should be developed, not judgmental and education should be prioritized which is a fundamental part of treating obesity and treatment begins with it. It is carried out in the Endocrinology Day Hospital over a period of one week and is carried out by nurses specially trained in this area. During the education, the patient is trained to independently create a plan for lifestyle changes, changes in diet and physical activity. In addition to nurses a nutritionist, psychologist and physiotherapist are also involved in the education.
Pharmacotherapy is also useful in treating obesity where the use of medications reduces the feeling of hunger and stimulates satiety which ultimately leads to reduced calorie intake. If we have a patient with morbid obesity or pharmacotherapy alone does not provide satisfactory results a gastroenterologist endoscopist is also involved in the treatment who suggests endoscopic methods of treating obesity. The first method of choice is the placement of intragastric balloon which helps with weight loss by limiting the amount of food that can be eaten and allows for a faster feeling of satiety. A typical loss is about 7% to 15% of body weight.
In addition to this method, the endoscopic method of gastric mucosa ablation (GMA) with argon plasma coagulation (APC) is used for the treatment of obesity with which body weight can be further reduced by 13%. With tjis method stomach is reduced by ablation of tissue. At the same time, the production of ghrelin so-called hunger hormone is reduced which results in a reduced feeling of hunger.
Treatment with these endoscopic methods usually gives very good results. With patient motivation and cooperation it is possible to achieve a weight loss of up to 30%. Bariatric surgery is a good way to treat people with morbid obesity, with which long-term weight loss can be achieved, but it should only be applied when education and use of pharmacological and endoscopic treatment do not produce the expected results.
Approach to the patient should be individualized and in treatment are involved a multidisciplinary team. A special role is played by nurse educators at the Endocrinology Day Hospital and endoscopic nurses who participate in the preparation, performance and monitoring of patients during endoscopic procedures.