BARIATRIC SURGERY AND THE PROGNOSIS OF OBESITY PATIENTS

Abstract

Introduction: Obesity, defined as an excessive accumulation of body fat, transcends the concept of a purely aesthetic condition to be recognized as a chronic, multifactorial disease and one of the most serious public health epidemics on a global scale. Its impact was manifested not only by excess weight, but mainly by the strong association with the development and exacerbation of multiple high-risk comorbidities, such as type 2 diabetes mellitus, systemic arterial hypertension, dyslipidemias and various cardiovascular diseases, which historically reduced the life expectancy and quality of life of affected individuals. Given the difficulty of many patients in achieving sustained weight loss with conventional clinical treatments alone, metabolic and bariatric surgical procedures emerged as a highly effective therapeutic alternative, capable of inducing profound physiological and hormonal changes that went far beyond simple food restriction or malabsorption. Objective: The objective of this systematic literature review was to analyze and synthesize the available scientific evidence, published in the last ten years, on the impact of bariatric surgery on the medium- and long-term prognosis of patients with obesity. Methodology: The methodology of this review was based on the PRISMA checklist guidelines. A systematic search was performed in the PubMed, Scielo, and Web of Science databases for articles published in the last ten years. The following descriptors were used: "Bariatric Surgery", "Obesity", "Prognosis", "Weight Loss", and "Treatment Outcome". The inclusion criteria were: (1) studies that evaluated adult patients undergoing bariatric surgery techniques; (2) articles that reported prognostic outcomes such as weight loss or resolution of comorbidities; and (3) observational studies or clinical trials. The exclusion criteria were: (1) studies focusing exclusively on weight regain without prognostic analysis; (2) case reports or editorials; and (3) studies conducted in pediatric populations. Results: The results found in the analyzed literature consistently indicated that bariatric surgery promoted a substantial improvement in the prognosis of patients. The main outcome observed was a significant and sustained weight loss in most individuals. Additionally, a high rate of remission or significant improvement of comorbidities was demonstrated, with emphasis on glycemic control and remission of type 2 diabetes mellitus, in addition to the normalization of blood pressure and lipid profiles. The studies also pointed to a significant reduction in mortality from all causes and from cardiovascular causes in the group of patients undergoing surgical treatment when compared to controls with clinical management. Conclusion: It was concluded, based on the scientific evidence analyzed, that bariatric surgery was established as the most effective therapeutic intervention to promote a positive and lasting change in the prognosis of patients with obesity. The procedure's ability to induce robust and sustained weight loss, combined with the remarkable resolution of metabolic and cardiovascular comorbidities, resulted in a proven reduction in mortality and a significant improvement in quality of life, consolidating surgical treatment as a fundamental pillar in the management of this chronic condition.