Disability in the post-obese bariatric patient: Old and new problems

Abstract

Sustained and lifelong weight loss for severely obese people is not anymore an impossible dream, and a Swedish journal has described bariatric surgery as the fairy tale about the ugly duckling (Olbers 2011). Of course this is a bittersweet remark, because although for millions such is an advantageous and even life-saving intervention, all of them have to cope with the post-obesity status. Obesity is a chronic incurable disease and the postobesity status is an attenuated albeit ongoing illness, not a mere sequela. Appropriate follow-up and secondary interventions, be they surgical, clinical, physiatric, dietary, or psycho-social, may be demanded. Obesity entails widespread disorders involving as far away organs, structures, needs and abilities as the teeth, the central nervous system, the gut microbiome, the susceptibility to cancer, the performance at the workplace, and the demand for health care resources. Subsequent weight gain and comorbidity relapse is a permanent possibility, as endogenous and environmental obesogenic stimuli are not suppressed, only weakened. Gastrointestinal restriction and bypass are highly successful maneuvers when correctly indicated and conducted, however, they do not signal the end of the battle. Patients have to be educated and followed for life. It is hoped that such experience along with general public-health initiatives will eventually trickle down to their families, their offspring, and society in general, so that the new generations might be born and nurtured with obesity prevention in mind.