Following the news that 67 people have been infected with botulism in Europe, after undergoing a weight loss intervention in Turkey, with the use of botulinum toxin, it has become clear how safe these interventions are. For about ten years, Turkey has become the destination for low-cost surgeries and implants, and it is not always as cheap as they propose. In Spain, no case of botulism has yet been registered, but all hospitals are on guard in case it happens.
The cause of botulism is iatrogenic, that is, it occurs as a consequence of a medical intervention, but the origin is unknown, that is, if it has been produced by malpractice or by toxin contamination.
To begin with, the usefulness of botulinum toxin for weight loss has not been described beyond clinical trials. It is being used without scientific evidence and assuming risks that are unknown to begin with. The use of the toxin, by intragastric injection, seeks to relax the muscular walls of the stomach, thereby slowing down gastric emptying and the person perceives more satiety, which would lead to weight loss by eating less food. All this is in theory, because, I insist, there are no studies that prove it. If this method works, it should be repeated every five or six months, as the toxin gradually loses its effectiveness, which would mean undergoing surgery periodically.
Patients who had undergone bariatric surgery in Turkey have come to my office, and they did not even know what technique they had used, nor did they have a report, much less postoperative guidelines. Basically, they had been operated on, they had spent two days resting and they had gotten back on a plane, with all the risks that this entails. I do not doubt that there are clinics that do things correctly, but my experience is this: patients who do not know very well how to continue once the intervention is done, without postoperative check-ups, without nutritional guidelines, or even minimal medical control.
Bariatric surgery is contemplated when dietary re-education has failed, and there is a body mass index (BMI) greater than or equal to 35 kg/m², regardless of the presence, absence, or severity of comorbidities. And it is also considered with metabolic disease and BMI between 30 and 34.9 kg/m² (SECO Spanish Society of Obesity Surgery).
In addition, the psychological state of the patient must be assessed, if he suffers from eating disorders, or if he consumes toxic substances. Therefore, it is desirable that it be a multidisciplinary team made up of surgeons, nutritionists and psychologists or psychiatrists, who assess the suitability of the candidate. In addition, postoperative follow-up should be done.
Why do I tell all this?
How much all this because, although bariatric surgery is necessary and is successful in most cases, I believe that there is a part about which not so much information is given, or that is not taken into account when deciding to enter an operating room.
No matter how well the surgery is done, the person who undergoes it will have to make changes for life, in terms of diet, physical activity and care; This is not a matter of having surgery and that’s it. In addition, we must take into account the risks that any step through the operating room entails.
The change of diet, in most cases, begins before the intervention, where a liquid diet is usually prescribed at least two weeks before the intervention, to minimize the risks in the operating room, thus the patient arrives with less weight to Surgery. In the postoperative period, a liquid diet is also recommended, then a reintroduction of foods is made depending on their tolerance, up to a complete solid diet. When the digestive system is affected, there may be vomiting, diarrhea, difficulty swallowing, Dumping syndrome (rapid gastric emptying after eating, if it is early at 10 minutes and late at 2-3 hours).
At the nutritional level, a control must be carried out to avoid nutrient deficiencies and difficulties in addressing the regimen. In addition to guiding you, so that you adhere to a healthy diet according to your needs, lifestyle, social and economic context.
The physical change is very striking when there is an operation of this type, so it is recommended that there be a psychological follow-up, the body changes very quickly, but the head needs to assimilate these changes at the hands of a professional. Generally, there is a remnant of excessive skin on the body and bodily changes that must be confronted and accepted. And, of course, we must add revisions with surgery as in any intervention.
It is a much more complex process than what is heard out there. It is important that, if a decision is made, it is made with good advice and taking into account all the work and change that it implies, because, once again, health is not just a matter of kilos.
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Source: EL PAIS
