National report
Bariatric surgery in Brazil: Current status
Joel Faintuch , Francisco Karkow,
Fernanda Pezzi (Sao Paulo University Medical
School and Fatima Faculty, Caxias do Sul)
Introduction
Obesity is a growing epidemic not only in industrialized countries but also inthe developing world. The main difference in places like Brazil is the phenomenon ofnutrition transition. Till the recent past undernutrition was the main problem. The
rapid shift toward excessive body weight resulted in the relatively frequentcoexistence, in the same family and in the same house, of examples of the twoderangements, namely undernourished children with obese parents, or the oppositeassociation.
Antiobesity procedures were started in this country in the 1970´s, in the formof jejunoileal bypass. Multiple modalities were tested along the years, especially in
Hospital das Clinicas, Sao Paulo, which was the pioneer institution, till thecreation of the Brazilian Society of Bariatric and Metabolic Society (BSBMS) in 1999,
by Artur Garrido Jr.
Yearly congresses have been organized since that time, and the Society counts
more than 900 members including surgeons as well as allied health professionals.
Current president is Ricardo Cohen. A Bulletin was created in 2000 by Joel Faintuch
and Artur Garrido Jr and converted into a quarterly Journal five years later. Now theJournal has merged with the Brazilian Archives of Digestive Surgery, which also
appears every three months.
Acceptance of the specialty
Until the early 1990´s just a few dozen surgeons had interest in bariatric
operations and very few surgical residents had exposure to such the techniques.
However after the establishment of BSBMS growth has been exponential, notably after
government and private health providers accepted reimbursing the operations. At thismoment such procedures are very well established all over the country, and actively
sought by obese patients. Indeed, public hospital often suffer with long waiting
lines.
Surgical residents in large academic hospitals and also in certain private
ones have the chance of operating bariatric candidates during their rotations, and acouple of Centers of Excellence in Bariatric Surgery has been created in Sao Paulo,with a tendency to grow towards other cities as well.
Surgical procedures
The most practiced modality in the country is the Roux-en-Y gastric bypass(RYGB), which is the first intervention recognized and funded by the Federal Social
Security System. Approximately 75% of the candidates undergo this treatment, burmultiple other options are endorsed by BSBMS, namely vertical banded gastroplasty,
sleeve gastrectomy, gastric banding, Scopinaro procedure and duodenal switch, alongwith the endoscopically placed intragastric balloon.
Patient care and hospital facilities
A national consensus signed by six surgical and clinical professional societies
in 2007 established directives for most routines and indications concerning bariatricinterventions, from patient selection to hospital equipment and postoperative care.
Current statistics
Brazil has roughly 190 million inhabitants of which between 2 and 4 million are
morbidly obese, depending on the estimate. About 30 000 bariatric procedures are
conducted each year, of which 25-300 % are payed by the Federal Social Security
System, 60-70% by commercial Health Providers, and around 5 % privately financed.

Distribution of morbid obesity
A national survey under the initiative of BSBMS revealed that though morbidobesity doesn´t spare any of the regions of Brazil, distribution is not homogeneous.
The two poorest areas, namely the North and Northeast, display the lowest proportion(2%). The rich Southeastern region, which includes Sao Paulo, wasn´t bad either with
2.5% prevalence. The highest rates corresponded to the Western region and to theSouth, both with 5% values.
As concerns the South there is a rather obvious explanation. This area is quite
affordable, there is strong immigrant influence especially from Italian and German
people, and the population appreciates hearty meals. The Western region was asurprise and no obvious explanation is available, though meat is particularly
abundant in that area because of vast cattle-raising farms.
Metabolic surgery
In the last five years several groups have engaged in standard bariatric or
tailor-made operations for non-morbidly-obese diabetics, with variable results.
Animal investigations were atarted
in a number of University laboratories, andMaster´s as well as PhD theses are going on . Some controversy occurred when acouple of teams started performing such interventions on a routine basis. A consensus
established in 2009 decided that these treatments are still experimental and should
be conducted under approval of an Ethical Committee, for the purposes of scientificinvestigation only.
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Brazilian Society of Bariatric and Metabolic Surgery < www. sbcb.org.br >