Obesity, which is one of the most common diseases of the modern age, is a serious health problem because it plays a role in the development of many types of acute or chronic fatal diseases, as well as the problems it creates in the body. Obesity is a risk factor for many acute or chronic diseases, in addition to causing an aesthetically undesirable appearance and psychological disorders. For this reason, all individuals who want to maintain their health should maintain their ideal weight, and patients with obesity problems should reach their ideal weight under the leadership of a physician and dietitian.
What is Obesity and Obesity Surgery?
Obesity in general ; It is a condition in which the amount of fat mass in the human body is excessively increased compared to the lean mass containing other components such as bone, muscle and water. In other words, obesity can be defined as body mass being much greater than height. Excessive increase in adipose tissue is among the primary causes of many chronic diseases such as insulin resistance and diabetes. Obesity is a disease that can be prevented and treated with weight loss diets and some practices that support the diet. However, in severe obesity patients with advanced obesity, especially when the risk of developing serious complications is high, sleeve gastrectomy , gastric reduction , in line with physician recommendationsTreatment can also be performed with bariatric surgery applications such as gastric bypass . These methods can also be called bariatric surgery applications.
What are the symptoms of obesity?
The most basic symptom of obesity disease is excessive accumulation of adipose tissue in the body. However, excess weight can bring along some health problems as well as visual problems of obesity. Problems and symptoms associated with obesity include:
- Don’t get tired easily
- Shortness of breath
- Snoring and sleep apnea
- skin problems
- Back and joint pain
- Psychological problems and low self-esteem
In order to prevent the formation of all these problems and to prevent chronic diseases that may occur due to obesity, individuals with overweight problems should be careful to lose weight and maintain their ideal weight before reaching obesity.
What are the causes of obesity?
The main reason for obesity is that the energy taken into the body with food is more than the energy spent with metabolism and physical activities, and accordingly, the increased energy is stored in the form of fat. This situation occurs when energy intake above the requirement continues for a certain period of time. Body mass index (BMI) of underweight, obesity and obesity evaluated by a method called Obesity patients are patients with a body mass index of 30 and above, which can also be considered as a kind of obesity test. This value, also called body mass index (BMI), is calculated by dividing the body mass in kilograms by the square of the height in meters. According to the classification determined by the World Health Organization, obesity is classified as follows according to the body mass index (BMI), which is also used for calculation:
- Under 18.5 — Underweight
- 18.5 – 24.9 — Normal Weight
- 25.0 – 29.9 — Excess Weight
- 30.0 – 39.9 — Obese
- Above 40.5 — Morbid (serious)
- 50 and over — Designated as Super Obese.
Excess energy leading to obesity may occur due to unhealthy or unbalanced nutrition, and some genetic predispositions may also form the basis of obesity. In addition, hormonal disorders, thyroid diseases, and the use of certain medications can also be among the causes of obesity.
What are the consequences of obesity?
- Diabetes-Insulin Resistance
One of the most common chronic diseases that develop due to obesity is diabetes, which is popularly known as diabetes mellitus. Excessive increase in adipose tissue in humans reduces the sensitivity of the cells in the body to the hormone insulin, and this causes a health problem called insulin resistance. Since the sugar in the blood cannot be taken into the cells that have become desensitized to insulin, high blood sugar is observed. The situation in question is the problem that is effective in the development of Type-2 diabetes. Type 2 diabetes is the most common type of diabetes, and many people with obesity have insulin resistance. Insulin resistance is observed in patients at the initial level, which is called prediabetes and where diabetes has not yet fully developed. weight loss diet or Elimination of obesity with treatment methods such as bariatric surgery is very important in terms of preventing diabetes before it occurs by reducing insulin resistance in patients with prediabetes.
Hypertension disease, which is common in our country and throughout the world, is observed approximately 3 times more in obese patients than in individuals of normal weight. Among the causes of hypertension in obese individuals, there are many factors such as the increase in adipose tissue, accordingly excessive insulin production (hyperinsulinemia) and insulin resistance, and deterioration in vascular and cell structures. Therefore, it is very effective for obesity patients to reach their ideal weight, to prevent hypertension or to prevent its progression.
- Coronary Artery Disease
In obese individuals, excessive fat, especially in the abdomen, can negatively affect its functioning by putting pressure on the heart. In addition, as a result of insulin resistance developing due to obesity, blood sugar may rise and cause structural deterioration in the vascular walls, which may form the basis of cardiovascular diseases. As a result of all these, the probability of cardiovascular diseases in obese patients is much higher than in healthy people. Treating obesity as early as possible is important in terms of preventing these diseases.
- Gallbladder Diseases
Obesity patients are mostly individuals with high cholesterol values in the blood. If the level of cholesterol in the blood, which is also in the content of bile produced in the gallbladder, is above normal, the quality of bile will deteriorate, which leads to the formation of stones in the gallbladder. For this reason, gallbladder diseases , which progress with negativities such as stones in the gallbladder and obstruction in the bile ducts, are directly related to obesity.
- Paralysis (Stroke)
Another health problem in which obesity is considered as a risk factor is paralysis , also known as stroke . The loss of the ability to voluntarily move the muscles in a part of the body for any reason is a condition called paralysis. The incidence of serious acute complications such as myocardial infarction (heart attack) and cerebral hemorrhage increases significantly in obesity patients due to structural deterioration in the vessels and increased risk of hypertension.
- Sleep apnea
In patients with obesity, sagging and enlargement of the palate and uvula, narrowing of the airways and shortness of breath are common. During sleep, there is a narrowing in the respiratory tract due to the weight created by the abdominal region in the body in the supine position. As a result of these complications, sleep apnea , a health problem characterized by the cessation of breathing for a certain period of time while asleep, occurs.
Asthma , which is one of the diseases that seriously reduces the quality of life , is much more severe in obese individuals than in individuals of normal weight. Asthma attacks can be seen more frequently in patients due to the increase in weight and it becomes difficult to keep the disease under control. Therefore, it is important to provide weight control in order to increase the success rate in the treatment of asthma disease coexisting with obesity.
- Psychological problems
In addition to the medical complications it causes, obesity patients who experience negative aesthetics also experience problems such as not being tolerated or excluded in the society. In this situation, the possibility of some psychological problems such as depression, lack of self-confidence, and obsessive-compulsive disorder increases. The psychological problems that develop in these patients and the problems they cause can be minimized by providing weight control and reaching the ideal weight of the individuals.
As stated above, obesity is a health problem that greatly affects human life and plays a role as a primary risk factor in the formation of many diseases, therefore it must be treated. When the mortality (death) rate in obese people is able to handle the treatment process with weight loss methods based on diet, weight loss should be carried out in a programmatic manner with a nutrition plan prepared by the dietitian individually. However, if obesity has led to severe and life-threatening complications, some treatment methods called bariatric surgery may be required. gastric bypassHow and in which situations these methods such as gastric sleeve surgery, gastric sleeve surgery, and gastric reduction surgery will be applied should be decided in the light of the detailed examination performed by the bariatric surgeon.
What is the treatment approach in morbid obesity?
The incidence of excessive and morbid obesity has increased significantly in recent years due to changing lifestyles and dietary habits. So much so that one third of the population of developed countries, especially the USA and England, suffer from obesity. Obesity; Contrary to popular belief, it does not just mean overweight. Especially morbid obesity prepares the environment for many additional clinical problems such as type 2 diabetes , cardiovascular diseases, joint problems, sleep apnea, psychological problems, dermatological problems. In patients with obesity, there is not only a mass increase in subcutaneous adipose tissue, but also lubrication in all organs (such as liver fat) and an increase in surrounding fatty tissues.
Obesity also increases the risk of developing cancer. In some studies, it has been shown that maternal and infant problems are much more common in morbidly obese pregnant women compared to those who weakened and became pregnant after bariatric surgery. The burden of each additional problem on both the patient and the total economy is quite high. For example, in a patient who develops diabetes, it will be necessary to use many additional medications, to have tests, to deal with the clinical problems that diabetes brings, and to apply to many more doctors.
What is bariatric surgery and which patients is it applied to?
Today, it is possible to treat this condition with surgical methods in patients with morbid obesity who have a high probability of developing serious complications. In addition, surgical treatment is the most radical and the most effective treatment option in today’s conditions. Although most morbidly obese patients lose weight for a while with diet and exercise programs, the success rate is low (3%) and the risk of regaining weight is high. Metabolism changes in patients undergoing surgical treatment, especially after gastric sleeve surgery.There is a very serious loss of appetite, and since the stomach volume is very small, eating is restricted. For such reasons, it is not possible to compare surgical treatments and medical treatment methods in terms of success. However, considering that this application is a surgery and a serious decision, the first treatment approach should always be diet and sports in patients with the appropriate profile. Most of our patients have tried it many times; however, it consists of patients who applied to us because they were unsuccessful.
Morbid obesitySurgical operations are interventions that should be performed with a multidisciplinary approach. Patients should also be evaluated by an endocrinologist, dietitian and, if necessary, a psychologist. The endocrinologist should definitely evaluate whether the patients have hormonal problems and their suitability for surgery, especially before the surgery. Again, before the operation, endoscopy should be performed in order to detect another possible pathology in the stomach. Patients should be informed in detail by dietitians about how they will be fed before the operation and in the post-operative period. Especially in the first few months, this follow-up is very important in terms of the adaptation of the diet and metabolism to the new situation. In addition, patients may be subjected to psychiatric examination in terms of their psychological status before surgery.People who will have morbid obesity surgery should also have full family support, if possible. The presence of motivation and approval from the family at all stages, from the meal order at home to the surgery process, is at least as important as the patient’s decision.
Morbid obesity surgeries are generally in the form of restrictive applications, applications for impaired absorption, or a combination of both. If there is no other obstacle, all surgeries are performed laparoscopically, that is, with the closed method.
What are the bariatric surgery applications?
- Tube Stomach Surgery (Sleeve Gastrectomy)
Gastric sleeve surgery is an operation performed by removing approximately 75-80% of the entire stomach . The application has taken this name because the shape of the stomach remaining after the operation resembles a tube. Since most of the stomach is surgically removed and a volume of 50-100 ml remains, the amount of food consumed is limited . As it can be understood from here, sleeve gastrectomy surgery is a restrictive type of surgery and allows weight loss by reducing food intake. Since the appetite hormone (Ghrelin) secreted from the stomach part (Fundus) removed in this surgery decreases after the procedure, patients experience a serious decrease in appetite. The fact that patients do not return to their old appetites after surgery is a serious advantage that increases success.
Gastric sleeve surgery has a very high effect on diabetes and hypertension. In particular, the drugs used by diabetics and hypertensive patients who are only treated with oral medication are often not needed. This positive effect starts right after the surgery in patients.
- Mide Bypassı (Roux-en-y gastric bypass)
It is an operation performed in the form of bypassing a large part of the stomach, with a very small part just after the esophagus . In this application, the small intestine is brought to the stomach part in accordance with the technique and sutured. Therefore, both the volume of the stomach is reduced and a part of the intestines is disabled. As a result, both the amount of food consumed will be less and its absorption will be affected. With this method, especially the blood sugar control of insulin-dependent diabetics is regulated more effectively.
How is it determined which method to use?
In today’s conditions, it is seen that there is no big difference between the two operation techniques in terms of results. Gastric sleeve surgery is a more physiological method and has lower rates of complications and operation-related mortality. The application period of sleeve gastrectomy surgery is shorter and it is easier for the surgeon to apply. After both techniques, some patients may regain weight 3-4 years after the surgery. If the technique is sleeve gastrectomy surgery, these patients can undergo resleeve surgery or gastric bypass surgery. If the patient has had gastric bypass before, there is no chance for a second surgical treatment in case of weight regain.. The point that should be known here is that the preferred operation technique should be determined specifically for the patient as a result of the examinations and tests to be performed by the physician.
What are the complications of bariatric surgery?
The most important complications of surgery in both sleeve gastrectomy and gastric bypass techniques are leakage and bleeding . Today, with the developing modern techniques and experience, their rates have decreased significantly and the ability to treat has increased. Both techniques are applied with minimally invasive techniques (laparoscopic, robotic). This allows patients to quickly return to their normal life after surgery, while reducing the rates of pain and wound complications. These operations, also called bariatric surgery, can be safely performed in childhood patients and adolescents with an appropriate profile . It is known that 75% of children who are morbidly obese at puberty will be morbidly obese in the future.
What is a non-surgical gastric balloon application?
Gastric balloon is an inflatable medical material made of silicone. The operation, which is performed by placing and inflating this balloon into the stomach by endoscopic method , is called the gastric balloon technique . Thus, it is aimed to obtain a feeling of satiety by creating a volume that creates fullness in the stomach. After six months, the balloon can be easily removed from the stomach. The application requires approximately 20 minutes. It is not a surgical intervention and is often applied to patients who do not consider a surgical operation. In addition, it can be preferred in patients with super morbidly obese (BMI=50-60) patients in order to achieve a weight loss of 10 kg to reduce the liver volume, thus facilitating surgery.
If you are an obesity patient, or if you find that your body mass index is 30 and above when you calculate it, you can apply to a health institution to have your routine check-ups and evaluate treatment options together with your doctor. You can protect yourself from obesity and the complications it may cause by starting your treatment process as soon as possible in line with the recommendations of your doctor as a result of examinations and tests.
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