Morbid obesity: endocrinological manifestations and surgical indications (Atena Editora)

Abstract

Morbid obesity is a condition characterized by excess weight that compromises the health and quality of life of individuals. Body mass index (BMI) is the main parameter used to define morbid obesity, being considered as such when the BMI is greater than or equal to 40 kg/m², or greater than or equal to 35 kg/m² in the presence of associated comorbidities. There are different bariatric or metabolic surgery techniques, which can be classified as restrictive, malabsorptive or mixed. Restrictives reduce the size of the stomach, limiting the amount of food that can be ingested. Malabsorptive disorders alter the path of the small intestine, reducing the surface area for nutrient absorption. Mixed ones combine the two previous mechanisms. Objective: to analyze the scientific evidence on the endocrinological manifestations and surgical indications of morbid obesity. Methodology: based on the PRISMA checklist, the PubMed, Scielo, Web of Science databases to search for articles published in the last 10 years. The following descriptors were used: morbid obesity, bariatric surgery, metabolic surgery, endocrinology, comorbidities. Articles that met the following inclusion criteria were selected: original articles, systematic reviews, meta-analyses, randomized clinical trials, observational studies, comparative studies, multicenter studies, studies in humans, studies in Portuguese, English or Spanish. Articles that met the following exclusion criteria were excluded: duplicate articles, articles unrelated to the topic, articles without a summary or full text available, opinion articles, letters to the editor, case reports, theses or dissertations. Results: 15 articles were selected. Morbid obesity is associated with endocrinological changes involving the hypothalamic-pituitary-adrenal axis, the hypothalamic-pituitary-thyroid axis, the hypothalamic-pituitary-gonadal axis, the renin-angiotensin-aldosterone system, the sympathetic nervous system and the immune system. Bariatric or metabolic surgery modifies the hormonal environment of the morbidly obese patient, reducing levels of orexigenic hormones (which stimulate hunger) and increasing levels of anorexigenic hormones (which inhibit hunger), in addition to improving insulin sensitivity and function. thyroid. Mixed techniques are more effective in weight loss and controlling endocrinological comorbidities than restrictive and malabsorptive techniques. However, mixed techniques also have higher postoperative morbidity and mortality than restrictive or malabsorptive techniques. Conclusion: Bariatric or metabolic surgery is an effective alternative for the treatment of morbid obesity, which brings benefits to patients' health and quality of life. Surgery modifies the patient's hormonal environment, improving metabolism and endocrine balance. Surgery also provides improvement or remission of comorbidities associated with morbid obesity, such as diabetes, hypertension, dyslipidemia, polycystic ovary syndrome and hypogonadism. However, surgery also presents risks and complications that must be considered when recommending and monitoring patients.