Comparação entre tratamentos cirúrgicos e tratamentos clínicos/hormonais em pacientes com obesidade
DOI:
https://doi.org/10.36557/2674-8169.2025v7n6p552-569Palavras-chave:
Obesidade; Cirurgia bariátrica; Tratamento clínico; Semaglutida; Controle metabólicoResumo
A obesidade é uma condição crônica multifatorial que representa um dos maiores desafios de saúde pública na atualidade, devido à sua alta prevalência e associação com doenças crônicas não transmissíveis. Diversas abordagens terapêuticas têm sido propostas para seu manejo, entre elas os tratamentos clínicos/hormonais e os procedimentos cirúrgicos. Métodos: Esta revisão integrativa da literatura foi realizada com base em artigos publicados entre 2020 e 2024 na base de dados PubMed, utilizando critérios de inclusão e exclusão previamente estabelecidos e a estratégia PICO para nortear a busca. Resultados: Os estudos analisados evidenciam que os tratamentos cirúrgicos, como o bypass gástrico e a gastrectomia vertical, tendem a apresentar maior eficácia na redução de peso e melhora de desfechos metabólicos, embora estejam associados a riscos como colelitíase e alterações psicológicas. Por outro lado, os tratamentos clínicos, especialmente com o uso de agonistas do receptor GLP-1 como a semaglutida, mostraram resultados positivos em termos de perda de peso e melhora de marcadores metabólicos, sendo alternativas viáveis para pacientes que não são elegíveis para cirurgia. Considerações finais: Conclui-se que as intervenções cirúrgicas tendem a ser mais eficaz no tratamento da obesidade e a escolha terapêutica deve ser individualizada, considerando o perfil do paciente, suas condições clínicas e o suporte multiprofissional necessário para promover um cuidado seguro, eficaz e sustentável.
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Referências
Garvey et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nature medicine - Volume 28, Issue 10, pp. 2083-2091 - published 2022-10-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/36216945/. Acesso em 20 de abril 2025 . DOI: 10.1038/s41591-022-02026-4
Murton et al. Bariatric Surgery and Psychological Health: A Randomised Clinical Trial in Patients with Obesity and Type 2 Diabetes. Obesity surgery - Volume 33, Issue 5, pp. 1536-1544 - published 2023-05-0. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/36964319/. Acesso em 20 de abril 2025. DOI:
1007/s11695-023-06537-y
Roebroek, et al. Weight Loss and Glycemic Control After Bariatric Surgery in Adolescents With Severe Obesity: A Randomized Controlled Trial. The Journal of adolescent health : official publication of the Society for Adolescent Medicine - Volume 74, Issue 3, pp. 597-604 - published 2024-03-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/38069930/. Acesso em 20 de abril 2025. DOI:
1016/j.jadohealth.2023.10.024
Schiavon, et al. Randomized Trial of Effect of Bariatric Surgery on Blood Pressure After 5 Years. Journal of the American College of Cardiology - Volume 83, Issue 6, pp. 637-648 - published 2024-02-13. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/38325988/. Acesso em 20 de abril 2025. DOI:
1016/j.jacc.2023.11.032
Koschker, et al. Effect of bariatric surgery on cardio-psycho-metabolic outcomes in severe obesity: A randomized controlled trial. Metabolism: clinical and experimental - Volume 147, Issue , pp. 155655 - published 2023-10-0. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/37393945/. Acesso em 20 de abril 2025. DOI:
1016/j.metabol.2023.155655
Axelrod, et al. Metabolomic Fingerprints of Medical Therapy Versus Bariatric Surgery in Patients With Obesity and Type 2 Diabetes: The STAMPEDE Trial. Diabetes care - Volume 47, Issue 11, pp. 2024-2032 - published 2024-11-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/39311919/. Acesso em 20 de abril 2025. DOI:
2337/dc24-0859
Lorkowski, et al. Bariatric Surgery Improves HDL Function Examined by ApoA1 Exchange Rate and Cholesterol Efflux Capacity in Patients with Obesity and Type 2 Diabetes. Biomolecules - Volume 10, Issue 4, pp. - published 2020-04-04. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/32260470/. Acesso em 20 de abril 2025. DOI: 10.3390/biom10040551
Haal, et al. Risk Factors for Symptomatic Gallstone Disease and Gallstone Formation After Bariatric Surgery. Obesity surgery - Volume 32, Issue 4, pp. 1270-1278 - published 2022-04-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/35143012/. Acesso em 20 de abril 2025. DOI: 10.1007/s11695-022-05947-8
Berk, et al. Differential effects of bariatric surgery and lifestyle interventions on plasma levels of Lp(a) and fatty acids. Lipids in health and disease - Volume 21, Issue 1, pp. 145 - published 2022-12-28. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/36577984/. Acesso em 20 de abril 2025. DOI: 10.1186/s12944-022-01756-1
Eriksson, et al.Short-term effects of obesity surgery versus low-energy diet on body composition and tissue-specific glucose uptake: a randomised clinical study using whole-body integrated (18)F-FDG-PET/MRI. Diabetologia - Volume 67, Issue 7, pp. 1399-1412 - published 2024-07-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/38656372/. Acesso em 20 de abril 2025. DOI: 10.1007/s00125-024-06150-3
Amaro , et al. Cardiometabolic risk factors efficacy of semaglutide in the STEP program. Postgraduate medicine - Volume 134, Issue 0, pp. 18-27 - published 2022-01-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/36691308/. Acesso em 20 de abril 2025. DOI: 10.1080/00325481.2022.2147325
Anveden , et al. Long-term incidence of gallstone disease after bariatric surgery: results from the nonrandomized controlled Swedish Obese Subjects study. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery - Volume 16, Issue 10, pp. 1474-1482 - published 2020-10-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/32654897/. Acesso em 20 de abril 2025. DOI: 10.1016/j.soard.2020.05.025
Aminian , et al. Patient-reported Outcomes After Metabolic Surgery Versus Medical Therapy for Diabetes: Insights From the STAMPEDE Randomized Trial. Annals of surgery - Volume 274, Issue 3, pp. 524-532 - published 2021-09-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/34132694/. Acesso em 20 de abril 2025. DOI: 10.1097/SLA.0000000000005003
Lannoo, et al. Comparative impact of Roux-en-Y gastric bypass, sleeve gastrectomy or diet alone on beta-cell function in insulin-treated type 2 diabetes patients. Scientific reports - Volume 14, Issue 1, pp. 8211 - published 2024-04-08. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/38589596/. Acesso em 20 de abril 2025. DOI: 10.1038/s41598-024-59048-w
Belzile D, et al. Heart rate variability after bariatric surgery: The add-on value of exercise. European journal of sport science - Volume 23, Issue 3, pp. 415-422 - published 2023-03-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/34890532/. Acesso em 20 de abril 2025. DOI: 10.1080/17461391.2021.2017488
Konttinen , et al. Prediction of Suicide and Nonfatal Self-harm After Bariatric Surgery: A Risk Score Based on Sociodemographic Factors, Lifestyle Behavior, and Mental Health: A Nonrandomized Controlled Trial. Annals of surgery - Volume 274, Issue 2, pp. 339-345 - published 2021-08-01. . Disponivel em: https://pubmed.ncbi.nlm.nih.gov/31850987/. Acesso em 20 de abril 2025. DOI: 10.1097/SLA.0000000000003742
Jovanović , et al. Metabolic and Hepatic Effects of Energy-Reduced Anti-Inflammatory Diet in Younger Adults with Obesity. Canadian journal of gastroenterology & hepatology - Volume 2021, Issue , pp. 6649142 - published 2021-01-01 . Disponivel em: https://pubmed.ncbi.nlm.nih.gov/33628758/. Acesso em 20 de abril 2025 . DOI: 10.1155/2021/6649142
Angelidi, et al. Early metabolomic, lipid and lipoprotein changes in response to medical and surgical therapeutic approaches to obesity. Metabolism: clinical and experimental - Volume 138, Issue , pp. 155346 - published 2023-01-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/36375643/ . Acesso em 20 de abril 2025. DOI: 10.1016/j.metabol.2022.155346
Li, et al.Effect of 5:2 Regimens: Energy-Restricted Diet or Low-Volume High-Intensity Interval Training Combined With Resistance Exercise on Glycemic Control and Cardiometabolic Health in Adults With Overweight/Obesity and Type 2 Diabetes: A Three-Arm Randomized Controlled Trial. Diabetes care - Volume 47, Issue 6, pp. 1074-1083 - published 2024-06-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/38638032/ . Acesso em 20 de abril 2025 .DOI:10.2337/dc24-0241
Salman, et al. Factors associated with resolution of type-2 diabetes mellitus after sleeve gastrectomy in obese adults. Scientific reports - Volume 11, Issue 1, pp. 6002 - published 2021-03-16. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/33727637/. Acesso em 20 de abril 2025 . DOI: 10.1038/s41598-021-85450-9
Hjelmesæth J, et al. Laparoscopic gastric bypass versus lifestyle intervention for adolescents with morbid obesity. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke - Volume 140, Issue 16, pp. - published 2020-11-10. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/33172240/. Acesso em 20 de abril 2025 . DOI: 10.4045/tidsskr.20.0526
Oster M, et al. Efficacy and Safety of Intragastric Balloon Therapy Compared to a Multidisciplinary Weight Loss Program (OPTIFAST) in a Real-World Population: A Propensity Score Matching Analysis. Obesity facts - Volume 16, Issue 1, pp. 89-98 - published 2023-01-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/36257288/. Acesso em 20 de abril 2025 . DOI: 10.1159/000524895
Hofsø D, et al. Bone Mineral Density and Turnover After Sleeve Gastrectomy and Gastric Bypass: A Randomized Controlled Trial (Oseberg). The Journal of clinical endocrinology and metabolism - Volume 106, Issue 2, pp. 501-511 - published 2021-01-23. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/33150385/ . Acesso em 20 de abril 2025. DOI: 10.1210/clinem/dgaa808
Jones , et al.The Metabolomic Effects of Tripeptide Gut Hormone Infusion Compared to Roux-en-Y Gastric Bypass and Caloric Restriction. The Journal of clinical endocrinology and metabolism - Volume 107, Issue 2, pp. e767-e782 - published 2022-01-18. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/34460933/. Acesso em 20 de abril 2025 . DOI: 10.1210/clinem/dgab608
Mocian, Coros. Quality of life assessment before and after laparoscopic sleeve gastrectomy: a prospective study. European review for medical and pharmacological sciences - Volume 25, Issue 22, pp. 6934-6940 - published 2021-11-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/34859855/ .Acesso em 20 de abril 2025. DOI: 10.26355/eurrev_202111_27242
Dang, et al. Roux-en-Y gastric bypass and sleeve gastrectomy induce substantial and persistent changes in microbial communities and metabolic pathways. Gut microbes - Volume 14, Issue 1, pp. 2050636 - published 2022-01-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/35316158/ .Acesso em 20 de abril 2025. DOI: 10.1080/19490976.2022.2050636
Karlsson, et al. Gastric Bypass vs Diet and Cardiovascular Risk Factors: A Nonrandomized Controlled Trial. JAMA surgery - Volume 159, Issue 9, pp. 971-980 - published 2024-09-01. Disponivel em: https://pubmed.ncbi.nlm.nih.gov/38959017/. Acesso em 20 de abril 2025. DOI: 10.1001/jamasurg.2024.2162
Almby, et al. Effects of Gastric Bypass Surgery on the Brain: Simultaneous Assessment of Glucose Uptake, Blood Flow, Neural Activity, and Cognitive Function During Normo- and Hypoglycemia. Diabetes - Volume 70, Issue 6, pp. 1265-1277 - published 2021-06-01 . Disponivel em: 01.https://pubmed.ncbi.nlm.nih.gov/33674408/. Acesso em 20 de abril 2025. DOI: 10.2337/db20-1172
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Copyright (c) 2025 Samuel Penaforte de Abreu, Felipe Freire Do Nascimento Meireles, Diego Santos Cordón, Italo Afonso Gedda Filho, Renata Aparecida Elias Dantas
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Os autores são detentores dos direitos autorais mediante uma licença CCBY 4.0.
