Obesity and Metabolist Unit

In recent years the prevalence of obesity and the metabolic disorders associated with it (coronary heart disease, type 2 diabetes mellitus, high blood pressure, sleep apnoea and even the risk of some forms of cancer) has increased significantly. It is calculated that by 2030 a third of the world's population could suffer from such problems.  Obesity has become the second biggest cause of avoidable death after smoking: in the case of morbid obesity, life expectancy may be reduced by between 6 and 14 years.

Moreover, the build-up of fat under the diaphragm and on the chest wall can exert pressure on the lungs, resulting in breathing difficulties and shortness of breath with even the slightest effort. Obesity can also cause orthopaedic problems such as lower back pain, and can exacerbate arthrosis, especially in the hips, knees and ankles. It can also lead to skin problems, as obese people are unable to eliminate body heat efficiently and therefore sweat more.

Obesity means having too much body fat, measured according to the body mass index (BMI), which is calculated by dividing a person's weight in kilos by their height in metres squared. A person is classed as obese if their BMI is over 30 and morbidly obese if it exceeds 40.

Apart from habits such as unhealthy eating, a sedentary lifestyle and a lack of physical exercise, there are also genetic and organic factors that can lead to obesity, especially among women. Socio-economic factors can also play a part. Obesity also tends to be associated psychological disorders due to the prejudice and discrimination that obese people often suffer.


The best way to lose weight is to maintain an active lifestyle, exercising and eating healthily. Certain pharmaceuticals can also help in some cases.

Some people try again and again to lose weight without success. They need to resort to other techniques involving specialist centres and healthcare professionals such as those at the Obesity and Metabolism Unit of the IMQ Zorrotzaurre Clinic.

When other treatments have failed, the problem can be tackled using endoscopic and bariatric surgery, both of which are available at the Obesity and Metabolism Unit. The choice of which technique to apply is made by the medical team on a case by case basis.

  • The main techniques are intragastric balloons and gastric suturing methods such as POSE and APOLO, which are indicated for patients suffering from moderate or severe obesity with whom medical treatments have failed, or as a supplement to such treatments.


      This may be the main treatment to obtain weight-loss or a bridging technique to help the patient lose some weight prior to bariatric surgery. There are various models, but they all work in the same way. The space occupied by the balloon quickly causes the patient to feel full. It also slows down the gastric emptying process. Dietary education and behavioural control measures with anxiety management are required. It is reasonably effective in bringing about weight loss of between 10 and 25 kg in 6 months, but there is a tendency for weight to be put back on when it is removed.


      An endoscopic suturing mechanism is used to imitate restrictive surgery, modifying the anatomy of the stomach and reducing gastric compliance, thus making the patient feel full after eating less. At present the two most widely used techniques are:

      • POSE (Primary Obesity Surgery Endolumenal Procedure) This enables permanent folds to be made in the bottom of the stomach, thus reducing the amount of food that it can accommodate and inducing a feeling of fullness after eating small amounts. It is a safe, feasible method that results in an average weight loss of 13 kg.
      • Vertical sleeve gastrectomy This entails a system of mechanical suturing adapted to the tip of an endoscope (overstitching). It creates rows of stitches in a Z-shaped pattern over the whole length of the stomach, making it narrower and substantially reducing its capacity.

But surgery is not the end of the treatment for morbidly obese patients. To ensure long-term success, we at the IMQ Zorrotzaurre Clinic follow up and monitor patients after their operations. This task is handled by the same multi-disciplinary team that provides the treatment, through rgular check-ups.


The various treatments for obesity, especially bariatric surgery, must be provided at centres where a multi-disciplinary team is available, such as the Obesity and Metabolism Unit of the IMQ Zorrotzaurre Clinic. In this setting the incidence of complications is very low, in spite of the complexity of the techniques used.

There are various procedures available, suited to different cases, so it is advisable to involve a multi-disciplinary team of specialists. The Obesity and Metabolism Unit at the IMQ Zorrotzaurre Clinic is staffed by specialists from various areas, including endocrinologists, nutritionists, psychiatrists, endoscopic surgeons and bariatric surgeons, all with proven experience.