The State of Obesity and Bariatric Surgery in the Nordic Region

| April 24, 2014

This month: The State of Obesity and Bariatric Surgery in the Nordic Region
An Interview with Dr. Magnus Sundbom

Bariatric Times. 2014;11(4):8–9.

Introduction
The state of obesity and bariatric surgery varies from country to country. In this series, authors from around the world will discuss obesity and bariatrics in their country, answering questions on the most recent trends, most frequently performed procedures, access to care, health coverage, requirements, accreditation, and cultural considerations.

This series is dedicated to providing updates on the global state of obesity.

What is the obesity rate in the Nordic region? Is it increasing or decreasing? How about children?

Dr. Sundbom: In Sweden, 10 percent of the population have a body mass index (BMI) over 30kg/m2, and this figure is probably similar for the whole Nordic region. The rate is increasing in adults and children, but at a slower pace than in the United States.

Is there anything unique about the country culture/lifestyle that may contribute to the obesity rate (e.g., extreme cold or heat, dominant occupations, access to food and drink)?

Dr. Sundbom: Not really. We have an increased sedentary lifestyle and 24/7 access to food and drink, as all Western countries. This is often called the “McDonald’s-effect” and is blamed on the United States media.

What percentage of the obese population actually undergo bariatric surgery? Are those numbers increasing or decreasing?

Dr. Sundbom: In Sweden, three percent of the adult population (175,000 individuals) are estimated to a have a BMI over 35kg/m2, and thus eligible for bariatric surgery. At present, with 7,500 procedures perfomed annually, five percent of the obese population undergo bariatric surgery. The number of bariatric procedures have increased 10-fold during the last decade. The situation is very different in the other Nordic coutries, as demonstrated in Figure 1 and Figure 2, and presented at the 2nd Nordic Bariatric Meeting held in Uppsala, Sweden in March 2014 (summarized in Table 1).

Are there any requirements that individuals must meet in order to undergo bariatric surgery?

Dr. Sundbom: All Nordic countries have used the IFSO-criteria from 1991. In Denmark in 2010, the BMI-limit was set to 50kg/m2, allowing those with a BMI of 35kg/m2 to be considered only if they also presented with serious comorbidities, such as difficult to regulate diabetes. The dramatic effect on bariatric surgery can be seen in Figure 2.

What are the current trends in bariatric surgery in your country? Meaning what are the most popular procedures ?

Dr. Sundbom: Laparoscopic gastric bypass dominates (95%), but in 2013 a small rise in sleeve (5% of all procedures) was seen. Remaining procedures (e.g., duodenal switch, gastric plication) are performed in selected centers. (Figure 3)

At present, 97 percent of all procedures are performed laparoscopically.

What procedures do you perform at your center? Please order from most frequent to lease frequent and provide statistics, if available.

Dr. Sundbom: Gastric bypass, duodenal switch, and few sleeves. As a tertial referral center, we have an increased proportion of revisional surgery (VBG/band to GBP and GBP to DS) and super obese patients. Figures 3 shows time trends. Note: the small amout of sleeves, BPD, and GBP-related revisions are not included.

What is the healthcare/insurance system like in your country? How do patients pay for weight loss surgeries?

Dr. Sundbom: We have public-financed health care, available to all citizens irrespective of income or private insurance. However, the cost is hidden in high taxes.

What is your prediction for the future of bariatric surgery in your country?

Dr. Sundbom: After the 10-fold increase, the number of bariatric procedures will probably remain rather stable at this new high level (Figure 1). The numbers will increase when metabolic surgery (treatment of diabetes and other typical comorbid diseases in patients with BMI<35) develops.

If you would have to choose a bariatric procedure for yourself or a relative of yours, which one would you choose?

Dr. Sundbom: I would choose to undergo laparoscopic gastric bypass. If I had a BMI over 50kg/m2, I would choose duodenal switch.

Funding: No funding was provided.

Disclosures: The author reports no conflicts of interest relevant to the content of this article.

Category: International Perspective, Past Articles

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