Summary of multidisciplinary comprehensive treatment for obese patients

  Obesity has now become a global epidemic, and WHO has positioned it as an important disease, which has become an important public health problem worldwide. It has become an important public health problem worldwide. It seriously threatens the life and health of human beings and their quality of life. Domestic survey shows that in 2002, the incidence of overweight and obesity among adults in China was 22.8% and 7.1% respectively. Overweight and obesity have affected 260 million people, and the total cost of treating obesity and its related diseases is as high as 10 billion RMB/year, which is especially obvious in large and medium-sized cities, and the results of the 2007 Beijing sample survey conducted by Peking Union Medical College Hospital show that the incidence of overweight and obesity reached 36.4% and 13.5% respectively. In the United States, 64.5% of the population is overweight and obese, and the cost of preventing and treating obesity and its related complications is rapidly increasing, reaching $75 billion in 2003, $90.7 billion in 2006, and up to $147 billion in 2009.  Obesity not only seriously affects people’s health and quality of life, but also can cause hypertension (obese prevalence of 25-55%), diabetes (obese prevalence of 14-20%), coronary heart disease (obese prevalence of 10-15%), hyperlipidemia (obese prevalence of 35-53%), sleep apnea (obese prevalence of 10-20%), depression (obese prevalence of 70-90%). The prevalence rate is 70-90% in obese people), and other diseases directly related to life expectancy and quality of life, including tumors, infertility, stones, etc. Obesity treatment includes exercise therapy, diet control, drug therapy and surgery, etc. Among them, weight reduction surgery is the only method to make patients with severe obesity obtain long-term and stable weight reduction effect, and it is also the most effective method to treat metabolic disorders such as obesity-related type 2 diabetes, primary hypertension, hyperlipidemia and obstructive respiratory sleep apnea.  In modern times, with the progress of science and technology, the degree of specialization of clinical disciplines has been gradually refined, and the treatment of obesity has shifted from simple diet, exercise and medication to a multidisciplinary and comprehensive treatment mode. The multidisciplinary team (MDT) of Peking Union Medical College Hospital has been practicing the multidisciplinary treatment model of obesity since 2009. For patients with severe obesity, especially those with more comorbidities, the multidisciplinary integrated treatment model is especially needed. The multidisciplinary treatment team of Peking Union Medical College Hospital includes: gastrointestinal surgery, endocrinology, nutrition, cardiology, respiratory medicine, anesthesiology, ICU, obstetrics and gynecology, psychological medicine, plastic surgery, orthopedics and radiology. Among the patients who had completed gastric band reduction surgery, the average age before surgery was 31.0 years, the average weight was 135.1 kg, the average BMI was 47.2 kg/m2, and the average waist circumference was 136.1 cm. 60% of them had hypertension, 60% had OSAS, 53% had type 2 DB, 5 had menstrual disorders, 1 had inferior wall infarction, and all of them had insulin resistance. The maximum weight of the patients before surgery was 185 kg, and the maximum BMI of the patients before surgery was 67.1 kg/m2. the average weight loss of the patients so far was 20.6 kg, the average BMI was 8.3 kg/m2, and the average waist circumference was reduced by 18.9 cm.