Obesity Is Not Your Destiny
In general, obesity is the excessive increase in the ratio of body fat mass to lean mass, resulting in an increase in body weight above the desired level relative to height. Adipose tissue constitutes 15-18% of body weight in adult men and 20-25% in women. An increase in this rate above 25% in men and above 30% in women creates the obesity.
Diseases Associated with Obesity
Insulin resistance – Hyperinsulinemia, Type 2 Diabetes Mellitus, Hypertension, Coronary artery disease, Hyperlipidemia – Hypertriglyceridemia, Metabolic syndrome, Gallbladder diseases, Some types of cancer (gallbladder, endometrium, ovarian and breast cancers in women, colon and prostate cancers in men), Osteoarthritis, Paralysis, Sleep apnea, Fatty liver, Asthma, Respiratory disturbance, Pregnancy complications, Menstruation irregularities, Excessive hair growth, increase in Surgery risks, mental problems (Anorexia nervosa (not eating) or Blumia nervosa (not benefiting from the foods eaten by vomiting), Binge eating, night eating syndrome or trying to achieve psychological satisfaction by eating something more), Social incompatibilities, skin infections due to excess subcutaneous adipose tissue as a result of losing and gaining weight at frequent intervals, fungal infections in the groin and feet, musculoskeletal problems, high cholesterol and lipids.
How is Obesity Measured?
The World Health Organization's classification of obesity is used to determine obesity and is usually measured by Body Mass Index (BMI). Body mass index is obtained by dividing weight in kilograms by the square of height in meters. Morbid obesity is a BMI of more than 40 kg/m2
Obesity in Turkey
According to the researches, obesity has been determined in a quarter of men (25%) and nearly half of women (44%) in Turkey. While this rate had been much less 10 years ago, today it is doubled in men and increased from less than 40% to 50% in women over the age of 50.
What is Obesity Surgery?
Bariatric surgery is basically based on two principles; reducing the volume of the stomach and/or 'malabsorption', that is, preventing the absorption of food at some stages. When the most appropriate of these operations is performed on the right patient at the right time, it is life-saving.
For Whom is Bariatric Surgery Suitable?
Obesity surgery is recommended for patients with a body mass index of 35 and above who cannot lose weight with methods such as medical nutrition under expert supervision, exercise and medical treatment. In addition, it is recommended for patients with a body mass index above 30, high blood pressure, diabetes, sleep apnea, which affect the quality and duration of life of the patient. The appropriate surgery is determined as a result of various examinations and inspections.
By using laparoscopic or robotic surgery methods for bariatric surgery, patients can be offered a comfortable recovery period compared to open surgery. After surgery, patients return to their daily lives in a short time and adapt to new nutrition patterns with the follow-up of metabolism specialists and dietitians.
Bariatric Surgery Methods
- Gastric Balloon
In this method, a hollow balloon is inserted from the mouth to the stomach with an endoscopy instrument. Then, the balloon is inflated and a feeling of fullness is created in the patient's stomach. Gastric balloon, unlike the other three methods, is defined as a non-surgical method. However, an important difference from other methods is that the balloon is removed after a certain period of time (6 months) and the results provided are not permanent.
How Is It Applied?
In this method, with the help of endoscopy, a balloon is inserted into the stomach by passing the esophagus through the mouth. The procedure, which is completely bloodless, is performed under a mild anesthesia. When the deflated balloon is sent into the stomach through the mouth, after reaching the stomach, it is filled with approximately 900 cc of air through the tube connected to the end and inflated, and easily separated from the tube to which it is attached and left in the stomach.
Period after Surgery
The balloon is used in the temporary treatment of obesity, helps with weight loss and maintenance of lost weight. In addition, before bariatric surgery, it helps patients to lose weight before surgery and reduce surgical risks. However, the balloon can be left in the stomach for a maximum of 6 months. After the balloon is removed, the person may gain weight again if they do not adopt a proper diet or exercise program.
- Sleeve Gastrectomy
In the surgical treatment of obesity, weight loss is achieved in two ways. First one aims to reduce the amount of food eaten. In this type of surgery, the stomach volume is reduced. The second one aims to reduce the absorption of ingested food. This type of surgery closes the small intestine to the passage of food in different lengths. Sleeve Gastrectomy is a procedure performed only to reduce the volume of the stomach. The stomach is cut longitudinally and part of it is removed. The volume of the remaining stomach becomes smaller. The shape of the stomach resembles a thin banana. As it looks like a tube in this form, it is also called stomach tube.
- Gastric By-Pass
In gastric bypass surgeries, a large part of the stomach is bypassed and a small volume (about 30-50 cc) stomach section is prepared and sutured to the small intestine. In this surgery, as in other bariatric surgeries, it is aimed to reduce the stomach volume and to disable a part of the intestines and to discard some of the consumed food without being absorbed. Thus, patients are satiated with less food as well as some of the food they get is absorbed.
How Is It Applied?
Gastric bypass surgery, like other bariatric surgeries, is usually performed by laparoscopic method. The operation is performed by entering through small incisions made in the abdomen. Thus, the patient is largely protected from possible wound infection and hernia risks that may develop after surgery. Robotic surgery method is also used for gastric bypass surgeries.
Period after Surgery
After surgery, patients can easily feel satiety with the intake of small amounts of food, and after a while this satiety turns into a loss of appetite. Total food intake is significantly reduced. Due to the reduced size of the newly formed stomach and reduced absorption of food, it is necessary to follow the instructions of the surgeon and dieticians for the use of the necessary vitamin and mineral supplements. Thus, the patient can lose weight without loss of vitamins and minerals. Patients are sent home three or four days after surgery.
Weight Loss after Surgery
After bariatric surgeries, patients are recommended to follow a diet and exercise program regularly and the success of the surgery is considered to be linked to the patient's compliance with this regime. All patients who follow these recommendations lose weight very quickly. They reach the targeted weight in about 1-1.5 years and step into a new life. The following improvements in the health status of patients can be achieved with bariatric surgery:
- High blood pressure gets better. 70 percent of patients are able to completely stop their blood pressure medication.
- Blood cholesterol gets better. Cholesterol levels were reported to decrease in 80 percent of patients. Values can return to normal 2-3 months after surgery.
-The risk of heart disease reduces.
- Very few patients diagnosed with type II diabetes need to take medication.
- Patients with borderline diabetes, usually recover completely.
- Asthma attacks are greatly reduced, completely recovers in some patients.
- Breathing problems gets better within a few months after surgery. Many patients are able to return to their normal routines and activities that they had to quit because of breathing problems.
- Obesity-related sleep disorders, such as sleep apnea syndrome, disappear.
- Acid reflux disease disappears.
- The weight loss achieved by these methods is permanent, provided that the rules are followed.