SONIA MARIA FABRIS LUIZ
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- Disability in the post-obese bariatric patient: Old and new problems(2013) FAINTUCH, J.; SOUZA, S. A. F.; FABRIS, S. M.; ROSENBLATT, A.; CECCONELLO, I.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. © 2013 Springer-Verlag Berlin Heidelberg. All rights are reserved.
- Bariatric surgery: Current techniques and results(2013) FAINTUCH, J.; SOUZA, S. A. F.; FABRIS, S. M.; CECCONELLO, I.Half a century ago obesity was not a public health problem, however, gastroduodenal ulcers were ubiquitous. Many gastrectomies were conducted at that time and patients eventually lost weight. That is how bariatric surgery commenced, naturally expanding to a variety of techniques and accesses. Success has been both bigger and smaller than expected. Yes, bariatric operations became so popular that they already represent one of the five most performed major operations in some countries. They are followed by strong secondary benefits particularly concerning diabetes remission, to the point that a new subspecialty has arisen, metabolic surgery for diabetes. No, they are not carefree and they have not solved the problem of severe obesity, at least from the epidemiological point of view. They were actually not designed to be a mass treatment. The pursuit of new therapeutic avenues and the reinforcement of old ones is still mandatory, if the worldwide obesity epidemic is to be curtailed. © 2013 Springer-Verlag Berlin Heidelberg. All rights are reserved.
- Are Knee and Foot Orthopedic Problems More Disabling in the Superobese?(2013) FABRIS, Sonia M.; FAINTUCH, Joel; BRIENZE, Sergio L. A.; BRITO, Gilberto B.; SITTA, Isabela S.; MENDES, Estevao L. P.; FONSECA, Ines C. B.; CECCONELLO, IvanAiming to ascertain whether frequency and severity of knee and foot problems were different between morbid obesity (MO) and superobesity (SO), a prospective clinical study was designed. Bariatric candidates (N = 81, body mass index 40-81.3 kg/m(2), 43.2 % with SO) were submitted to knee and foot radiologic assessment, baropodometric footprint measurement, and the questionnaires Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Foot and Ankle Outcome Score (FAOS). Main outcome measures were imaging diagnosis of knee osteoarthritis and flatfoot, along with functional impact on activities of daily living estimated by the questionnaires. Knee osteoarthritis was radiologically diagnosed in 74.1 % (60/81), and the entire cohort suffered from flatfoot according to both footprint index and talar-first metatarsal radiographic angle; nevertheless, distribution was not different between SO and MO. However, WOMAC and FAOS scores were markedly worse in SO, affecting joint pain, stiffness, and general mobility. This is the first protocol of our knowledge to address foot and knee derangements in SO. Functional impairment was more severe in SO, despite a morphologic pattern similar to MO. Even though amelioration is probable with weight loss, long-term orthopedic assistance might be required in such circumstances.