Propuesta y fundamentos para una norma de manejo quirúrgico del paciente obeso: Año 2004 / A proposal of guidelines for surgical management of obesity

Obesity is a chronic disease with an increasing prevalence in all groups of age, and is associated to increased general mortality and cardiovascular risk. The multidisciplinary non surgical approach must be the treatment of choice for obese subjects. However, the results of such approach among subjects with severe or morbid obesity, are unsatisfactory. In this group of patients, bariatric surgery and specifically gastric bypass achieves good long term results, maintaining a low body mass index, reducing complications and improving quality of life. Considering the widespread practice of bariatric surgery in Chile, the Nutrition Unit of the Ministry of Health formed a task force to propose update guidelines for the surgical treatment of obesity. These guidelines were proposed after a thorough literature review and discussion with groups that practice bariatric surgery using defined protocols. This document provides a summarized version of the guidelines. The first section discusses the background for bariatric surgery and the second part give specific recommendations for patient management and the formation of reference centers for surgical management of obesity.

Gasto energético de reposo medido en obesos y no obesos: comparación con la estimación por fórmulas y ecuaciones propuestas para población chilena / Measured and predicted resting energy expenditure in obese and non obese chilean subjects: a proposal of predictive equations for the chilean population

Background: The commonly used predictive equations to calculate resting energy expenditure (REE) can yield inaccurate results. Aim: To compare measured REE, with estimated REE in normal and obese adults. To develop specific predictive equations for our population. Patients and Methods: Eight hundred sixteen women aged 18 to 74 years old with a body mass index (BMI) between 18.5 and 69.7 kg/m2 and 441 men aged 18 to 71 years old with a BMI between 185 and 67.9 kg/m2 were studied. REE was measured by indirect calorimetry and fat free mass by tetrapolar bioimpedance. REE was also estimated using FAO/WHO (F/W) and Harris-Benedict (H/B) equations. Results: Measured REE in controls was 20.7 ñ 1.9 and 23.6 ñ 3.3 kcal/kg/day in women and men respectively. The figures for overweight women and men were 19.8 ñ 1.9 and 20.0 ñ 2 kcal/kg/day, for obese women and men were 18.3 ñ 1.7 and 19.0 ñ 1.8 kcal/kg/day and for morbidly obese women and men, were 16.9 ñ 1.8 and 16.1 ñ 1.7 kcal/kg/day. When REE was corrected for fat free mass, no differences between controls and different degrees of obesity, were observed. The difference between estimated and measured REE ranged from -420 to 617 kcal in women and from -400 to 900 kcal in men. The equations derived using data obtained in the present study, showed a better predictive accuracy. Conclusions: An important error was detected when REE was predicted using FAO/WHO or Harris Benedict equations, in Chilean obese subjects. Therefore these equations must be used with caution, local equations must be devised or resting energy expenditure must be measured by indirect calorimetry

Gasto energético de reposo medido versus gasto energético estimado por fórmula en niños obesos / Measured resting energy expenditure versus estimated energy expenditure by formulas in obese children

Con el objetivo de comparar el gasto energético estimado (GEE) por fórmulas de FAO/OMS (F/O), Fleisch (F) o Schofield (S), con el medido por calorimetría indirecta GEM, se estudió a 51 niñas y 27 niños entre 10 y 14 años con sobrepeso u obesidad. Resultados: x ñ DE. El GEM medido fue de 1.524 ñ 215 kcal/día. El GEE fue de 1.674 ñ 184, 1.656 ñ 233 y 1.606 ñ 247 kcal/día con F, F/O y S, respectivamente. La sobrestimación del GEM fue de 10,6 ñ 8,0 por ciento con F (151 ñ 12 kcal/día), 9,0 ñ 8,0 por ciento con F/O (132 ñ 14 kcal/día), y 5,7 ñ 9,0 por ciento con S (83 ñ 16 kcal/día). La siguiente ecuación describe el GEM (kcal/día) en el presente grupo: (13,2 x kg peso) + 596 en niñas, y (11,1 x kg peso) + 889 en niños. Conclusión: la amplia variabilidad en el GEM y su frecuente sobrestimación con las fórmulas hace recomendable efectuar mediciones individuales en niños obesos para la planificación de un programa de reducción ponderal

Drogas anorexígenas en el tratamiento de la obesidad / Anorexigenic drugs in the treatment of obesity

Obesity is highly prevalent and has several adverse effects on health. Its treatment is thus warranted and must aim to modify dietary and physical activity habits. The opinion of this association is that anorexigenic drugs with cathecolaminergic action (diethylpropion, phentermine, mazindol and phenylpropanolamine) or serotoninergic action (fenfluoramine and fluoxetine) may be used in moderate or severe obesity (BMI >30 kg/m2) after a complete clinical assessment and in the context of an integral medical treatment. This association recommends a close surveillance of the use of these drugs, specially when formulated as non-propietary prescriptions