METABOLIC BARIATRIC SURGERY The World Health Organization (WHO) declared obesity as a global pandemic in 1997.1 This disease affects over 650 million people worldwide, 13% of the adult population. This number is expected to grow to 1 billion in 2030.2 Obesity is defined as an excess amount of adipose tissue, associated with health risks including type 2 diabetes, hypertension, high serum cholesterol, cardiovascular disease, musculoskeletal disorders, sleep apnea, and cancer.3 These weight related health risks are related to the Body Mass Index (BMI), calculated as weight (kg)/height (m)2 (Table 1). The origin of obesity in an individual is multifactorial, including genetic, biological, mental health, sociocultural and economic factors, food consumption and energy expenditure.4 Living with obesity, a chronic illness, negatively impacts the disease adjusted life-years (DALY) and may lead to preliminary death.2 Table 1: Classification of Obesity and Prevalence in the Netherlands in 2022 BMI (kg/m2) Classifica2on Health Risk 5 Prevalence (%) 6 < 18.5 Underweight Increased 1.9 18.5-25 Normal weight Normal 47.9 25-30 Overweight Increased 35.1 > 30 30-35 35-40 > 40 > 50 > 60 Obesity Obesity Class I Obesity Class II Obesity Class III Obesity Class IV Obesity Class V High Very high Extremely high “ “ 15.1 10.8 3.0 1.3 BMI = Body Mass Index Prevention of obesity is the ultimate remedy. Globally, preventive measures are being taken focusing on counteracting factors as high calorie food consumption and reduced exercise. Treatment of obesity is aimed to reduce the burden of the disease, improve associated diseases and quality of life, and increase life expectancy. For individual patients living with obesity the cornerstones of treatment are lifestyle interventions, including dietary restrictions and exercise programs, sometimes accompanied by coaching or psychological treatment. As these lifestyle interventions alone often fail to induce and sustain significant weight loss, other treatment options include pharmacological therapy or surgery.7 This specific type of surgery is called bariatric surgery, weight loss surgery or metabolic surgery, often combined into 8 1
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