Obesity is considered a treatable chronic disease. It occurs when there is excess adipose tissue, also known as fat, accumulated around the body.

Although obesity is an individual clinical condition, it has become a serious public health problem that is increasing every day. In fact, it is being defined as the epidemic of the 21st century.

The World Health Organization (WHO) defines obesity when the BMI or body mass index, which is the calculation between the height and weight of the individual, is equal to or less than 30 kg / m². It is also considered a sign of increased obesity a waist circumference in men greater than or equal to 102 cm and in women greater than or equal to 88 cm.

Apart from the problem that in itself represents obesity, studies show that its most negative effects occur because it acts as an agent that exaggerates and exacerbates in the short-term very severe pathologies such as diabetes, hypertension, complications in cardiovascular disease (especially ischemic heart disease), and even some types of cancer such as breast and colon.

It is also known that excessive body weight predisposes to various diseases, such as: sleep apnea, osteoarthritis, stroke, among others.

Currently 97 million Americans, representing more than one third of the adult population suffer from overweight or obesity. It is estimated that between 5 to 10 million suffer from morbid obesity and that each year a minimum of 2.6 million people die due to obesity or overweight.

Figures reveal that Venezuela is currently located in the 6th place in the table of countries with the highest rate of obesity. But even more alarming is that Euro Monitor estimated that by the year 2020, Venezuela will be the first in Latin America.

Causes
Most cases of obesity are multi factorial in origin. Genetic, metabolic, endocrine and environmental factors are recognized. However, exogenous obesity or due to overeating is the main cause.

Environmental factors include both the increase in food intake and reduced physical activity.

In addition, psychological distress caused by the modern world, and a sedentary lifestyle and social and commercial pressures to eat too much seems to be the most important factors that justify the presence of this scourge today.

It should be noted that the ignorance of basic concepts of nutrition further aggravates the problem.

Types of obesity
Obesity is classified into two types: central or Android and peripheral or Gynoid.

The first is the most dangerous because it can lead to important pathological complications. Central obesity concentrates the fat on the trunk and predisposes the individual to suffer metabolic complications (particularly type 2 diabetes).

For its part, peripheral obesity builds up deposits of fat from the waist down, which creates strong overload problems in the area of the joints.

Morbid obesity.
Morbid obesity (MO) is one of the most characteristic diseases of our time, especially with the number of complications associated with it.

Regularly, MO is defined as the condition in which a person weighs 45 kg or more above their ideal body weight or has a BMI of 40 or more.

An important complication that generates obesity is sleep apnea, characterized by periods in which the person is not breathing and is waking up gasping. Since the individual can not rest during the dream phase, they experience episodes of daytime sleepiness, sleep or even driving to develop daily activities, leading to situations of personal risk or discomfort in the workplace.

MO patients also have lower fertility. Women suffer from menstrual disorders and a higher incidence of some cancers such as breast and uterine cancer. Many morbidly obese people have difficulty in establishing a proper relationship due to the high level of insecurity generated by their disease, as well as some degree of social stigma, they are generally not well accepted by the media, even by their own family. The reality is that the obese person is often socially relegated.

It is necessary to resort to surgery, since dieting alone does not have any kind of effect.

How to know if you are obese?
Obesity is determined by several parameters, but the most commonly used is called the body mass index, BMI, a relationship established between weight and height.

BMI provides the most useful population-level tool to measure the overweight and obese, because the way to calculate it does not vary by gender or age in the adult population. However, it should be considered as a rough guide because it may not correspond to the same degree of fatness in different individuals.

Diet, lifestyle changes and regular exercise are the elements that in most cases define the path of the patient seeking non-surgical alternatives.

However, it is estimated that less than 5% of people who participate in weight loss programs as an alternative to surgery lose a significant amount of weight and maintain that loss for a long time. The vast majority of patients however look at surgery as a solution for their obesity.

There are two major groups of surgical techniques:

In general any patient with severe obesity (more than 45kg of excess weight or 40kg/Mt2 of BMI) is an ideal candidate for weight loss surgery.

Patients who have less excess weight, but have other morbidities such as hypertension, diabetes, metabolic syndrome, among others, will widely benefit from Bariatric Surgery, not only because it improves their status of obesity but it also improves their existing comorbidities.

Bariatric Surgery improves diabetes type 2 in more than 80%, and hypertension in more than 70%. Patients who have type 2 diabetes, for less than ten years and their control does not warrant the use of insulin, have a chance of curing diabetes in the long term. Bariatric surgery results have enabled to make projections about the direct treatment of these diseases without the patient being obese, that's why the name of Bariatric surgery has been linked to metabolic surgery.

If you are not sure which procedure is the right option to choose, consult your bariatric surgeon. He will assess your different needs and concerns and recommend the procedure that best fits you, whether it be GASTRIC BANDING, LAPAROSCOPIC SLEEVE GASTRECTOMY, or LAPAROSCOPIC GASTRIC BYPASS. We have included a new procedure called LAPAROSCOPIC GASTRIC PLICATION which has proven to have good prospects since there are no cuts of the stomach or intestine, it has fewer complications and so far excellent results. To learn more about any of the procedures click on the links above.

Your life after surgery
After surgery your life will experience quite far-reaching changes. This varies somewhat depending on the type of surgery you have chosen. After your ntervention it will be necessary to correct patient behaviour. Motivation and cooperation must be reinforced on a day to day basis.

Remember that the stomach is reduced to a much smaller size and, as a result, the amount of food that can be eaten is very limited. In order to ensure good nutrition and health, you must also pay close attention to the type of food you eat, given that certain foods that were well tolerated before surgery, may cause discomfort afterwards.

Discussing your diet with the nutritionist both before and after Bariatric Surgery can prepare you to make informed healthy choices in relation to the food you will be eating. Maintaining an adequate intake of protein, minerals and vitamins, along with a strict diet and regular physical activity will be the keys to success.

Here are some simple tips to help you achieve your goals:
Tips for good nutrition:

1. Choose low fat foods.
2. Reduce sugar intake.
3. Distribute your food into 5 meals a day: breakfast, midmorning snack, lunch, mid afternoon snack and dinner.
4. Do not alternate periods of fasting with large meals.
5. Do not eat between meals.
6. Eat sitting down, slowly and chew foods thoroughly. Take small bites, with small amounts.
7. Between each bite leave the cutlery on the table.
8. Eat in a specific place, do not eat while walking or in improvised places.
9. Do not eat while watching television or reading.
10. Reduce the consumption of red meat and increase your fish intake.
11. Eat vegetables in abundance.
12. Eat 2 to 3 fruits a day. Avoid those with abundant sugar content: bananas, grapes, figs, cherries..
13. Drink plenty of water, between 1 to 2 liters per day.
14. Avoid or limit fried food.
15. Hide foods rich in calories. Always have  healthy snacks nearby: vegetables, nonfat yogurt, fruits.

Tips for buying food:

1. Go to the supermarket when you are not hungry.
2. Make sure you have a list of things to buy.
3. Go often to the store (it arouses less interest in new or appealing designs).
4. Avoid pre-cooked meals.

Tips for preparing food:

1. When cooking, remove all visible fat from meat or poultry.
2. Use simple cooking methods that do not require a lot of oil. Instead use an  iron, grill, oven, or microwave.
3. Use a pressure cooker for steam cooking with little water to cook and preserve all the properties of your food.
4. To cook meat and fish wrap in foil and cook in their own juice, leaving them tender and tasty without adding fat.
5. When making casseroles, prepare in advance. Let cool in the refrigerator and remove the fat layer with a spoon or spatula. By doing this you are preserving the flavor with little fat.
6. When preparing vinaigrettes, reverse the usual ratio to three parts vinegar to one oil. So that the taste is not too sour use flavored vinegar (apple, raspberry, etc.).
7. If you need a sauce to add to a salad use nonfat plain yogurt, thinned with lemon juice. You can also try soy sauce or adding some spice or herb per your liking.
8. To prepare milk or cheese sauces use skim milk or Parmesan cheese type, which contains fewer calories and is more aromatic.
9. In the preparation of some dishes that require mayonnaise, select those that are low in calories.
10. Do not buy commercial sauces because they often contain hidden fats.

Exercise also plays a fundamental role after bariatric surgery. Patients consume fewer calories immediately after surgery, which sometimes causes the body to react as if it were starving.

In search for more energy, the body can start burning muscle instead of fat. To avoid this, it is essential to start exercising regularly as soon as possible. This alters the metabolism so the body begins to burn fat instead of muscle. Exercise also helps patients lose weight quicker.