Today, obesity is recognized as a disease and various treatment strategies are being developed. Among these, the most notable treatment is’obesity metabolism surgery’, which reduces the amount of meals through gastric sleeve resection and restricts the absorption of nutrients such as sugars into the body.It is also called’diabetes surgery’ because it is effective in controlling blood sugar as well as weight loss. . In Korea, it was recognized as an official treatment for obesity in 2019, and national health insurance benefits were applied.
This obesity metabolic surgery is a “gastric sleeve resection,” which reduces the size of the stomach, and ▲ a “ruwai gastric bypass grafting,” which directly connects the small intestine to the small intestine, leaving the stomach a little near the esophagus. It can be categorized as’replacement surgery (biliary pancreatic diversion)’. If weight loss is the main purpose, reducing the amount of meals with gastric sleeve resection can have a great effect. In the case of obesity with severe diabetes, it is recommended to perform Ruwai gastric bypass surgery or biliary pancreatic diversion. By bypassing the intestine and shortening the length of the small intestine through which food passes, it is the principle that even if you eat the same amount, it is absorbed less.
Since the intake and absorption of nutrients as a whole decreases after surgery, care must be taken not to deplete essential micronutrients such as vitamins and iron. In particular, the lack of nutrients before surgery can become more severe after surgery, so it is important to identify them in advance and prevent them through management. However, there have been difficulties in preparing standard guidelines since there have been no studies in Korea that have investigated the nutritional status of patients before and after obesity metabolic surgery in Korea.
Accordingly, Prof. Young-Seok Park’s team conducted a study to investigate the state of nutrient deficiency of patients before surgery using data from 215 people who underwent obesity metabolic surgery at Seoul National University Bundang Hospital in 2019.
As a result, it was confirmed that the most common nutrient deficiency before obesity metabolic surgery is vitamin D, and 80% of all patients are’deficient’ and 14% are’insufficient’. Vitamin D is related to calcium metabolism and bone mineral density. If the body weight and muscle mass are decreased after surgery and at the same time, the bone density decreases due to vitamin D deficiency are accompanied, the risk of fracture may increase. In addition, caution is required because it may affect the onset of chronic cardiovascular diseases including myocardial infarction.
After vitamin D, vitamin B1 (18.3%), folic acid (14.2%), iron (11.8%), and zinc (7.6%) were in the order of high deficiency. All four are essential nutrients for our body, and if they are deficient, symptoms such as beriberi disease, anemia, and reduced immunity may appear, so they must be managed continuously. In particular, because folic acid deficiency is also related to the onset of congenital neurological diseases in children, women of childbearing age must check and supplement the deficiency before surgery.
The results of this study are expected to serve as an important basis for establishing standard preoperative and postoperative nutritional management guidelines for Koreans amid the gradual expansion of obesity metabolic surgery in Korea.
Prof. Young-Seok Park, who led the study, said, “There is a perception that obese patients are overnutrition, but there are many deficient nutrients because they have little physical activity and their diet is inclined to one side.” If you identify and supplement in advance, you can achieve the goal of losing weight and reducing blood sugar in a healthy way while minimizing nutritional deficiencies after obesity metabolic surgery.”
The results of this study were published in the SCI-level international academic journal’Obesity Surgery’ of the World Federation of Obesity Metabolism Surgery.