During the anamnesis of the patients and in the analysis of the 100 selected medical charts (70 women and 30 men), we observed several significant changes, which affect the bodily health as a whole (body and soul), thus affecting the professional, social and emotional life of each individual. We selected 20 morbidly obese patients, between 20 and 60 years old. Normally, the obese person, upon arriving at his/her cardiologist’s office, invariably hears: You have to lose weight! We know that, with years of experience, even though there are hundreds of diets, it is not easy to lose weight. One of the objectives of the “Workshops” was precisely the exchange of experiences among the obese themselves and the multidisciplinary relationship among the specialists, showing the advantages of weight loss and the disadvantages of remaining obese. Within the “Workshops”, we established healthy occupational therapies, which included everything from music and singing to physical exercises, even if the manual, the important thing was not to stay inert, just depending on the ingested calories. We also showed the consequences that being overweight could have on them. The most frequent and common changes found were:
1) Dermal: Acanthosis nigricans, cellulite, acne, fungi, stretch marks, hirsutism, dark spots in the skin folds, and furunculosis .
2) Orthopedic: Incorrect posture, limitations of many movements, genu valgum, femoral epiphysiolysis, osteochondritis, arthritis, and flat feet .
3) Lipids: Increased serum triglyceride levels, low HDL-cholesterol, and variations up and down in serum LDL levels .
4) Hemogram (FBC): Few changes in general, 50% with Typical Lymphocytes below the desired level; 10% with alterations in TGO, TGP, FAL, and the Gamma Glutamyl Transferase—GGT (hepatic enzymes), where the “T” stands for Transaminase, the “G” Glutamic, the “O” Oxalacetic, the “P” Pyruvic, the “F” Phosphatase. Depending on the result, it means hepatic changes . It was noticed two cases of alcoholism in male patients.
5) Fasting Glycemia: Above 120 mg/dl in 70% of cases and above 300 mg/dl  in 4 cases.
6) Arterial Hypertension: In 70% of men, blood pressure was above 160 × 100 mm/Hg; and, in 60% of women, it was above 150 × 100 mm/Hg .
7) Obstructive Sleep Apnea: Sleep disturbance. Defined as a respiratory pause during sleep, it was observed in 22 patients; and, in most of them, with reports of snoring .
8) Thyroid (TSH and free T4): Decreased thyroid hormones, requiring very high L-thyroxine doses, associated with hypothyroidism in 8% of cases, mostly women. Increased Peptin and Insulin levels were noted .
9) Renal Function: In these selected cases, we did not observe diabetic nephropathies or hypertensive nephrosclerosis. In addition, there was no case of nephrolithiasis (formation of stones inside the urinary system), which had already been observed in other patients not participating in this study .
10) Exercise Test: We observed the short time that patients endured doing the exercises. Some arrhythmias were detected; and, for this reason, in almost all cases, we opted to suspend the test in order to avoid disorders .
11) Cardiovascular: We are aware of the high rate of cardiovascular diseases (CVD) in obese people. In Framingham’s works, during his 26 years of experience with this type of patient, the occurrence of cardiovascular events and strokes was verified . In almost all cases, we find problems with hypertension and diabetes .
12) Social Behavior: In addition to compromising health and quality of life, obesity interferes substantially in the following sectors: psychological, social isolation, loss of self-esteem, less education, as well as emotional, economic, clothing, deambulation, and early mortality-related problems .
The degree of satisfaction of both the physician and the patient was very high. We had cases of weight loss voluntarily, without bariatric surgery, with the loss of 80 to 103 kg of body mass. Of course, the “Workshop” helped to lose a few more pounds, so that the patients could, subsequently, undergo bariatric surgery or plastic surgeries for body relief, removing excess breasts and/or abdominal tissues, each in their own surgical time, which greatly reduced the potential risks of bariatric surgery. Who does not like to do good to others? For this reason, we have great memories of the meetings, which were full of gratitude. Many true friendships were made in this period.
We have already recalled, in this manuscript, the endocrine and metabolic changes caused by obesity   , their consequences, and the degree of obesity defined by BMI. It is a retrospective study, based on the experience and routine of 47 years of medicine and 30 years of working with morbidly obese patients of the coordinator of this work. The 100 medical charts were selected from a group of more than a thousand patients, who sought the hospital with the objective of finding a treatment for their pathology or just wanting to prevent it. The lectures were given on dates previously scheduled by the project coordinator and disseminated by the participants themselves. All 20 morbidly obese patients included in this manuscript were operated on. The average audience was 325 people (Figure 1), including patients in the preoperative phase of body relief surgeries, pre and postoperative bariatric surgery, and pre and postoperative plastic surgeries, some guests, besides professionals from different areas of health. Those who had already been operated on gave testimonies about their histories before and after the surgeries, the problems caused by obesity and the advantages of weight loss (Figure 2). In order to accomplish the bariatric surgeries, different techniques were chosen by the responsible team, according to the analyzed case .
We considered as patients with dyslipidemia the people who manifested an altered value of CT, HDL, LDL, TG and BMI between 35 and 39.9 kg/m and greater than or equal to 50 kg/m . In the “Obese Workshops”, during the lectures, the participants were always reminded that wherever a scalpel passes, there will always be a scar. Even so, almost everyone preferred the scar rather than the excess fat and skin. After the preliminary Workshop, that is, the one with more than 300 participants, we selected those who were already at the ideal weight, to undergo the Reconstructive Plastic Surgery. This surgery was only accomplished after they underwent a series of tests and passed all of them. We indicated only one surgery at a time, that is, when we accomplished a mastoplasty, we did not associate it with abdominal dermolipectomy or liposuction. With this decision, we never had a death or serious infections, which could cause any harm to the patient. We are aware that, after six hours of the open wound, it is considered contaminated.
Figure 1. Hall fully crowded with participants in one of the “Obese Workshops”.
Figure 2. Dr. José Humberto Resende with their slimmer patients.
In the preoperative period, the following laboratory tests were requested: complete blood count, coagulogram, urea, glucose, creatinine, cholesterol, and triglycerides. As for cases of breast surgery, we asked for mammography and ultrasound for all operated regions. Electrocardiogram with surgical risk was also requested in all cases. In the event of any type of alteration, we would suspend the surgery and reschedule it only after written authorization from the clinician.
All surgical items were sent to the Pathology Service, regardless of any suspicion. Without exception, patients signed an informed consent form prior to the surgery, which contained all necessary authorizations and information, including the use of photographs for the purpose of scientific publications. The team was previously chosen and we gave preference to all size 3 surgeries to begin at the first time. In obesity, we always opt for general anesthesia, with two anesthetists in the room, one holder, and one auxiliary. At the beginning of the surgery, we used the drug named Keflin® 1 g (cephalothin), venous, every two hours, in order to avoid infections of the lungs, skin, soft tissues, urinary system, blood and bones, as well as during the procedures. We avoid antibiotics in the postoperative period, unless there were any disorders or signs of infection in the postoperative period. In the immediate postoperative period, for each case, we opted for an ideal position , always in the sense of protecting the operated region. Semi-occlusive dressings were used and changed every day, except for what we call “Brown”, used in graft protectors, generally open on the fourth postoperative day. Before discharge, we took one photograph; and, as a follow-up, we took other ones, monthly, until we completed one year of surgery, when we took the last photograph . In cases of abdomen and hip gigantism, we performed the dermolipectomy in the form of an anchor; and, after three months, we completed with liposuction on the sides of the body (Figure 3 and Figure 4). We cannot deny the explicit satisfaction on the patients’ faces after conquering all these stages (Figure 5).
In the postoperative period of the selected patients, we observed 2 cases of temporary hematomas, 1 case of corrected dehiscence and 1 case of drained lipolysis. There was no case of severe complication, because we chose to do one
Figure 3. Preoperative front view.
Figure 4. Postoperative front view.
Figure 5. The joy on the participants’ faces after their conquests.
operation at a time. Each surgical time was a maximum of 3 hours. Patients were followed up for one year .
In addition to the fact that the obese person has various pathologies, interfering with the functioning of several organs, what we observed most were the physical discomfort caused by body deformity and the difficulty in social and intimate relationships. The main complaint varied from patient to patient, but the predominance of the verb “to be” was notorious, such as: “I am unhappy”, “I am fat”, “I am ugly”, “I am deformed”. These phrases were repeated over and over again in all anamneses. With very few exceptions, we heard: “I am happy, just like that”, “I am treated very well by my husband”.
In Brazil, we have few hospitals in which this pathology is treated as a priority. With all our experience in this specialty, we can say that it is very difficult to lose weight by any method. Perhaps, in the “Obese Workshops”, we find a degree of solidarity, encouragement and support, which has reached many people and their dreams of wanting and being able to be thin and have facilitations wherever they go. We have been successful in many cases, but, among physicians, the question remains: Why, after being so close to victory, did so many give up? The suggestion of an open field for future multidisciplinary research remains.
The general observation is that, after losing 5 kg of body weight, all patients already had testimonies of significant improvement in arterial hypertension and diabetes. At the end of the tunnel, a light of hope appears that had already been forgotten by them. A simple act of wearing old pants, which had been tight before, or a brassiere that she (patient) had not worn in years, caused a high degree of happiness.
In this conclusion, we can say that if we do not decrease the amount of calories consumed in a day, we will never achieve weight loss. There are hundreds of theoretically tested regimes; however, in all of them, there must be a reduction in the consumed food. Furthermore, in order to achieve any goal, we have to say the phrase: “I want.”
Our desire is to take the “Obese Workshop” to the whole world, where, with the truth, we can prevent the obese person from becoming the morbidly obese person, and society from rejecting them, even knowing the need for multiple reconstructive plastic surgeries.
Work held in partnership with Alfredo Nasser University (UNIFAN) with Clínica Brasil.
*Publications Coordinator of the Faculty of Medicine of UNIFAN
#Medical Students at UNIFAN
†General Coordinator of Research at UNIFAN
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