OBE SI TY

We put our opinion at the table.Do you want to join us?

Index

Ponto de VistaUIB Benefícios

January 2014

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Bariatric Surgery An expert insight.

Periscope

Risk factor? A thick point of view.

Opinion

Obesity and pregnancy

Clarify your doubts with our Doctor.

Doctor’s office

Who signed this edition

Instructions

Obesity

Risks and problems which

overcome the scale limit. 

Spotlight

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4

14

20

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Opinion

Vertumnus - Giuseppe Arcimboldo, 1590

Ponto de VistaUIB Benefícios

January 2014

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Concern with the population’s health is no longer an exclusive government matter. Nowadays, it is present in our homes and companies, generating lots of questions and raising people’s interest to collaborate with others’ health.With a visible and gradual raise range, obesity has been mentioned among the five biggest risk factors to people’s and companies health. Combined with situations such as sedentary lifestyle, diabetes, hypertension and heart diseases, it may generate even more severe concerns.Obesity is not related only to aesthetics. Physical aspects and, mostly, psychological shall be considered more broadly by the implementation of losing weight or health condition control programs.In order to contribute with this discussion, Ponto de Vista (Point of View) brings out some of the obesity aspects which need to be observed for peoples, companies and contributors’ health and quality of life improvement. Enlightenment and monitoring are fundamental tools to fight against obesity. Furthermore, of course, user’s good disposition to face the problem without prejudice or frustrations.

Enjoy your reading!

Ricardo LobãoCEO UIB Benefícios__

BARIATRIC SURGERY

W h e n t o d o i t ?

The main purpose of bariatric surgery or gastroplasty is to help on slimming process, especially in patients that present a morbid obesity scenario (body mass index above 40) or obesity associated with other diseases, such as diabetes and hypertension.

To become eligible to the surgery, the patient needs to accomplish with the requirements established by the Ministry of Health. In case of private service, it is also necessary to observe the General Conditions provided by his Health Insurance, especially the ones related to grace period, coverage and approval proceedings.

Often, the authorization to perform the procedure is denied by the Health Operator, who claims that is a simply an aesthetic procedure. Besides, there are cases where the patient does not have the requirements to become eligible to the surgery.

On the first hypothesis, Judiciary recent decisions indicate that, more than an aesthetic procedure, bariatric surgery may improve and even save lives. It is provided in the list of mandatory coverage and, thus, there should be no refusal by the Operator.

Periscope

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January 2014

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related to the use of new surgical techniques substituting obsolete techniques provided on the agreements, besides the coverage to eventual plastic surgeries, a logical consequence to the bariatric surgery. Because it is a procedure often needed to survival of one who pleads the surgical intervention, in some cases the decisions indicates that is no need to observe the grace period expected in the General Conditions.

For this reason, before the automatic refusal to the surgery accomplishment, it is recommended a careful assessment of each case to avoid that the claimant has to appeal to Judiciary to guarantee his right, generating unnecessary court costs and the operator image damage.__

Judicialization of health

In case of patients who have not achieved the required BMI (body mass index) and/or do not present any comorbitity associated to obesity, Judiciary has expressed itself pro the Health Operators when the coverage is denied. This position, though, has become minority.

Currently there is a growing movement to lawsuits favorable to the author-patient, a fundamental decision to the Law number 9.656/1998, comprising healthcare coverage and outpatient medical hospital for morbid obesity treatment.

Consumer Defense Code considers abusive any agreement clause which restricts the consumer rights. On the same track, new Superior Court of Justice positions have been favorable to the patient, for example,

Arterial hypertension

Thrombosis and embolism (clots in the veins)

OB ES IT Y

Spotlight

A voluptuary under the horrors of digestion - H. Humphrey, 1792

Obesity-related diseases

Coronary arteriosclerosis

(stroke)

Cerebrovascular accident (brain hemorrhage)

Diabetes Mellitus

Osteoarthrosis (degenerative joint disease)

Sleep disorders (snoring and apnea)

Cancer

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January 2014

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Why do we get obese?

There are many causes. Most of the time it is a result of interactions, starting with our genetic heritage (familiar or personal), worsen by poor nutritional habits, with excess of caloric intake and low level or even lack of physical activities (sedentary lifestyle). Hormonal factors may also aggravate this condition, which occurs less frequently.

Which are the consequences?

Obese people present movement limitations, aggravated by the lack of physical activities, joint overloading, especially knees, ankle and spinal column, besides being a risk factor to several diseases. The lack of treatment may contribute to reduction of life quality and expectancy and also cause risk of sudden death.

RISK LEVEL

Healthy weight

Moderated

High

Very high

Extreme

TYPE OF OBESITY

Healthy person

Overweight

Level 1 Obesity

Level 2 Obesity

Level 3 Obesity (morbid)

BMI (kg/m2)

18 to 24,9

25 to 29,9

30 to 34,9

35 to 39,9

40 or more

How to diagnose?

Calculating the BMI (Body Mass Index), dividing the weight number (kilos) by height (meters) squared.

Spotlight

Ponto de VistaUIB Benefícios

January 2014

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Increased risk

Increased risk

Greatly increased risk

Greatly increased risk

Another form of evaluating obesity is the measure of abdominal circumference, considered a risk indicator of complications caused by weight excess.

80cm

88cm

94cm

102cm

To calculate your BMI, download

here our app

The obese person shall be assessed by detailed clinical exam, familiar historical, diabetes exam

(glucose test) and cholesterol and triglycerides levels.

In cases of arterial hypertension or cardiovascular disease, specific exams may be executed in order

to program the diet and the physical activity without taking the patient under the risk of problems related

to organism overload.

Obesity causes

Nutritional disorder

Fat-rich diets, sugar and starch (flour, rice,

potato and pasta)

Lack of physical activity or sedentary lifestyle

Lack of regular physical exercises, joints diseases, heart conditions and other

disabling conditions.

Spotlight

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Ponto de VistaUIB Benefícios

January 2014

What are the recommended treatments?

Nutritional education and gradual physical education represent the base for a long-term treatment. Nutritional education reduces the total caloric intake introducing a diet called hypocaloric balanced. Physical activity provides energy burn and shall be planned and structured to improve physical conditioning, meaning, the capacity to keep the exercises for an extended time, at least 30 to 40 minutes, three or four days per week. The secondary obesity, such as hormonal diseases, deserves specialized treatment.

Existe prevenção da obesidade?

Yes! A healthy nutrition shall be encouraged since childhood, including the breastfeeding period. Breast milk up to six months of age is the best way to prevent obesity in childhood and adolescence periods.Besides nutrition, we shall establish and encourage the habit of physical activity and leisure on open environments, with intense body movements, contributing to a healthy life style.

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Imperador Kubilai Khan - Anige of Nepal, 1294

Doctor’s Office

& OBESITY PREGNANCY

What is the importance of weight control before pregnancy?

There are possible complications for women weighting above ideal. The recommendation is to control weight before they get pregnant. It is also important to start the use of folic acid as soon as a woman decides to get pregnant.

Which are the obesity complications during pregnancy?

At the beginning of the pregnancy period, obesity raises the risks of neural tubes defects (brain and spinal column) or at the oral cavity (lips and palate malformation), besides heart diseases.

When there is no control, obesity also offers higher risks of diabetes, arterial pressure increase (arterial hypertension), excess of amniotic fluid (causing higher discomfort to the pregnant woman), and labor anticipation (premature birth).

Furthermore, it may provoke the baby’s obesity, which turns normal labor more difficult and raises the possibility for cesarean, with all the complications to the mother and her baby.

A d a n g e r o u s a s s o c i a t i o n

Is there an obesity risk to the baby in the future?

Yes! If the birth weight is higher than four kilos, the number of cells which store fat (adipocytes) shall be higher than the normal rates, which induces to gradual weight gain, especially in case of artificial feeding (bottle feeding), raising the risk of obesity in the future.

How to control weight?

The weight control shall be obtained with healthy nutrition and control of worthless calories excess (confectionary, cakes, ice cream, pasta, rice, potato, flour, starch, fried food, soda, chocolate, etc.). Those items shall be substituted by healthier options such as greenery, vegetables, fruits, salads, brown rice, on appropriate proportions, preferably under dietician orientation.

It’s a mistake to think that the excess of calories intake during pregnancy is okay. The association between pregnancy and obesity increases the incidence of complications, bringing risks to mother and baby.

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January 2014

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“

“

At the beginning of the pregnancy period, obesity raises risks of

neural tubes defects (brain and spinal column) or at the oral

cavity (lips and palate malformation), besides heart diseases.”

Pregnant Woman - Milan Nykodym, 2010

!Avoid advices or recommendations

from laypeople.

Poster for a side show at the Vermont state fair, Rutland - Jack Delano, 1941

Doctor’s Office

Ponto de VistaUIB Benefícios

January 2014

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Can physical activity help on weight control?

For sure! Once the obstetrician approves physical activities, exercises such as walking, yoga and hydro gymnastics, under appropriate professional orientation, are good alternatives to help on weight gain control. In any chosen activity, avoid forcing your joints (feet, knees, ankles and spinal column). It is always important to talk with the obstetrician about the subject.

How to perform a more rigorous weight control?

By Body Mass Index (BMI) control, calculated by dividing the weight in kilograms by the person’s height in centimeters squared. The ideal BMI on the beginning of pregnancy period is close to 25 kg/m², with tolerated indexes from 25 up to 30 kg/m² (bringing low risks of the mentioned complications). If the BMI is superior to 30 kg/m², it is necessary a rigorous orientation related to nutrition, physical activity, folic acid and D vitamin supplementation, besides other vitamins in order to avoid the obesity effects in the organ formation, especially on the first three months of pregnancy.

Which would be the weight control intentions?

A healthy pregnancy balanced with proper weight gain avoids diabetes during pregnancy, blood pressure increase, heart diseases and even difficulty of the pregnant woman brain oxygenation caused by the breathing obstruction during sleep (sleep apnea, revealed by the presence of snoring).

Weight gain for women with BMI from 18, 5 up to 24, 9 kg/m², is from 11, 5 kg up to 16 kg. In case of BMIs from 25 up to 29, 9 kg/m² (overweight), the limits are from 7 up to 11, 5 kg.

To obese women (BMI higher or equal to 30 kg/m²), the total weight gain shall be between five and nine kilograms, meaning, a weekly increase limited between 170 and 270 grams.

Is there any special orientation for those who have performed bariatric surgery?

In cases where the bariatric surgery was executed before the pregnancy, chances of getting gestational diabetes, arterial hypertension and other labor complications are reduced. There is a need for using vitamins in specific doses, avoiding a possible deficiency. For additional info, consult your obstetrician.It is also important to get orientation from nutritionists, endocrinologists and professionals trained in giving pregnant women physical activities orientation.__

!Ask your partner if you snore while sleeping.

!It is not easy! But also not impossible for women who act with determination.

Instructions

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Nice to meet, UIB Benefícios

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Our tools aim to enhance the benefits programs for companies, public or private, applying creativity in projects and methodologies of risk management. One of our major highlights, present in our DNA, is to work with the stop loss concept, a kind of reinsurance which guarantees to the companies coverage for high medical expenses and beyond expected.

Competences and methodology developed by UIB Benefícios have contributed to HR personnel to enlarge the companies’ knowledge about their programs and contributors. That knowledge helps to minimize the difficulties encountered by corporations, especially the costs frequent raises and their users’ health conditions.

Visit our website and find more information about us:www.uibbeneficios.com__

Point of ViewUIB Benefícios

January 2014

Dr. Waldemir Rezende UIB Benefícios Advisor

Doctor with MBA in Health Executive Management, graduated at IBMEC / Insper; Specialization in Hospital Administration and Health Systems, graduated at Getulio Vargas Foundation; specialist in Breast Unit, Obstetrics and Gynecology; UIB Benefícios Advisor in customer service as intermediary physician, responsible for technical analysis, monitoring and claims controls, monitoring of chronic and pregnant, 2nd medical opinion and medical audit programs.

Contributed to this edition:

Dr. Wanderley Rezende UIB Benefícios Technical Director

Specialization in Orthopedics and Traumatology; Graduated in Health Management at Getúlio Vargas Foundation; member of the American Academy of Orthopedic Surgeons and of the American Society of Spinal Column Surgery; Technical Consultant at Bradesco Health, Mediservice, Unimed Seguros, Oswaldo Cruz Foundation, Cia Pulp and Paper and BRC Health.__

Dra. Alessandra Reichelmann UIB Benefícios Legal Manager

Lawyer, Diffuse and Collective Rights expert, graduated at Paulista School of Law and Business Agreement expert, graduated at Getúlio Vargas Foundation; Legal Manager at UIB Benefícios, responsible for legal advice, technical and regulatory issues at ANS and SUSEP.

Instructions

21

The Vegetable Gardener - Giuseppe Arcimboldo, 1590

Ponto de VistaUIB Benefícios

January 2014

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