Obesity

Today, obesity has become a major health problem not only in developed countries but also in developing countries like ours. The increase in income levels, the establishment of a western lifestyle, the spread of fast-food and standing snacking, and high-calorie and fatty nutrition have a major role in the increase in the obesity rate. Taking in excess calories through nutrition and not spending too many calories triggers obesity. Today’s people avoid physical activity, spend hours in front of the computer, television, and phone, and in the meantime, they constantly eat high-calorie snacks. With the increase in transportation vehicles, people walk less, and with the increasing penetration of technological devices into our lives, they work less. The fact that as a society, we have very little habit of doing sports also plays a major role in this increase.

The Disease of Our Age: Obesity

What are Obesity and Morbid Obesity?

We can briefly define obesity as excessive fat accumulation in the body. WHO (World Health Organization) defines obesity as “abnormal, excessive fat accumulation in the body in a form and proportion that will cause diseases”.
Morbid Obesity is defined as advanced obesity that seriously threatens life due to the fatal problems it causes. Those with a Body Mass Index (BMI) over 40 are considered morbidly obese.
The average body fat ratio is 25-30% in women and -20 in men.

What are the dangers of obesity, what kind of diseases does it cause?

Obesity causes disorders in all systems of the body. Experts say that obese people live 12-15 years less than their peers. Obesity causes many diseases such as type 2 diabetes mellitus (diabetes mellitus), hypertension, cardiovascular diseases, fat metabolism disorders, sleep apnea, reflux, sexual disorders, bone and joint problems, respiratory system disorders. Since the physical appearance of obese patients is distorted, the social life and mental health of these patients are also disrupted, and many problems such as depression occur. Some types of cancer such as breast and colon cancer are more common in obese patients.

How should obesity be treated?

There are 1. Diet 2. Exercise 3. Drug therapy 4. Surgical treatment options in obesity treatment.
Diet and exercise play a major role in treatment. First of all, patients should change their lifestyle. Patients should receive good nutrition education and learn the mistakes in this regard. Exercise must be a part of life. When all these are insufficient, medications can be tried in certain groups of patients. However, most of these have been found to have serious side effects, and today there is still no very effective medication with few side effects.

Studies have shown that the rate of permanent weight loss with non-surgical methods in the treatment of morbid obesity is around 2%. Today, the permanent and effective treatment of morbid obesity is surgery.

Obesity treatment is completely a team effort. A team consisting of endocrinology, general surgery, psychiatry, and nutrition and diet specialists should evaluate the patient and determine the treatment method.

For which obese patients do you recommend surgical treatment?

Even if there is no additional comorbid disease in morbidly obese patients with a BMI of 40 kg / m2 and above,
surgical treatment is indicated in the presence of at least one of the following diseases in obese patients with a BMI of 35-40 kg / m2: hypertension, cardiovascular diseases, type 2 DM, hyperlipidemia, sleep apnea syndrome, etc.

What methods are used in surgical treatment?

A) Restrictive surgeries:

1) Adjustable gastric band: It is also known among the public as a gastric band. It is no longer used much because of its high complications and its loss of effectiveness when excessive liquid calorie food is consumed. The problems caused by this surgery in the past have a major role in our people’s distance from obezite surgery.

2) Sleeve gastrectomy (Tube stomach): The stomach is cut lengthwise with special staples and narrowed by turning it into a tube. It is a physiological surgery and can be converted to another method in the future. For this reason, the most popular surgery in recent years has been tube stomach surgery. Gastric tube both restricts eating and reduces appetite.

3) Stomach folding: This is a surgery that has been on the agenda in recent years. The stomach is narrowed with stitches from top to bottom. It has few complications, but its effect is limited because the feeling of hunger continues.

4) Gastric Balloon: It is not actually a surgery. A balloon is placed in the stomach with endoscopy and inflated. It creates a constant feeling of fullness in the stomach. It is not a weight loss method on its own. However, it is used in super morbidly obese people, i.e. very overweight people, to make the surgery easier by losing some weight or to support other treatments. It needs to be removed in an average of 6 months. It has side effects such as perforation, damage to the stomach, and intestinal obstruction.

B) Malabsorptive surgeries:

1) Gastric By-pass: It is the most commonly performed surgery in the world. The stomach is both reduced and the stomach is connected to the small intestines far below, thus reducing the distance of the small intestine where absorption is made. Thus, even if the patient eats a little too much, these foods are excreted without being digested. Lifelong vitamin and mineral support is essential.

2) Mini gastric bypass: It is easier to perform than normal bypass. Approximately 2 m of small intestine is disabled in absorption.

3) Duodenal Switch surgery: It is a very effective but difficult surgery to perform. The stomach is first turned into a tube, then connected to a very low level small intestine. Lifelong mineral and vitamin support is required.

4) Duodenal bypass/ sleeve gastrectomy: Similar to the previous surgery, lifelong mineral and vitamin support is required.

Does everything end with surgery?

No, it does not. Surgery offers the patient a great chance. The patient should definitely have their check-ups, follow the recommendations, and adopt a new lifestyle. Vitamin and mineral supplements should not be forgotten. Diet and sports should be a part of life.