Obesity is generally defined as body weight exceeding the ideal level according to height, as a result of an excessive increase in the ratio of body fat mass to lean mass. The main causes of obesity include conditions such as polycystic ovary syndrome, diabetes, sleep apnea, cardiovascular diseases, as well as psychosocial problems. Obesity is a disease that can reduce the average human life by 12-14 years. Common problems experienced by obese people can be listed as: increased morbidity and mortality, decreased productivity, increased health expenditures, and social and economic exclusion.
In order for obesity surgery to be performed, the person's body mass index (BMI = height/m2) must be 40 kg/m2. It must be over m2. Individuals with a body mass index range of 35-40 kg/m2 must have an additional complication such as diabetes, hypertension, sleep apnea, arthritis for obesity surgery.
Apart from this, if we ask who can undergo obesity surgery: the above body mass index and There may be adults aged 18-60 with complicating conditions. Age is not an exact criterion, as US sources give the age as over 12 years old. However, it should not be applied to people with hormonal conditions such as Cushing's syndrome, people with psychiatric diseases, people with alcohol and drug addiction, and people who are mentally incompetent.
Today, the most frequently preferred surgery method is lap sleeve surgery, known as sleeve gastrectomy. method. This surgical method is the most frequently applied method all over the world and in our country. 75% of the stomach is removed. The person also experiences a significant loss of appetite. Since the digestive flow does not change, vitamin, mineral and protein absorption problems do not occur. This is one of its biggest advantages. Women who have undergone gastric sleeve surgery should not become pregnant before 1 year. Weight loss after surgery allows people to restrict their food intake. It is the grehlin hormone, known as one of the hunger hormones that is most affected in people.
If we look at the postoperative nutrition stages;
1. Clear liquid period: The patient drinks clear liquids on the first day. It is fed with. Generally, fruit juices such as apple juice, cherry juice, herbal teas and water can be consumed.
2nd Liquid Period: The patient should not consume nutrients on the 2nd and 3rd days. It feeds on turbid liquids. Generally, protein-containing foods such as ayran and diluted kefir can be consumed. Between the 3rd and 14th days, thick liquids can be consumed. Here one can eat soups. Generally, soups that do not contain legumes are used to prevent gas.
3.Soft solid nutrition:Soft foods that can be crushed with a fork and eaten between 15-30 days are preferred. Generally, foods such as minced meat vegetable dishes, steamed fish, soft-boiled eggs and soft cheeses can be preferred. At this stage, the person's diet should be enriched. A protein source should be consumed every day. Cooking techniques should be explained well to the patient. The person should not prefer fried foods and should use boiled and steamed cooking methods in his diet. Solids and liquids should not be consumed at the same time, and this rule should be explained to the patient at this stage. Exercise can be started gradually in the first month. You should start with light exercises and increase the exercise load over time.
4.Transitional period:30-45 days, here the transition to optimal nutrition takes place. For main courses, choices such as meatballs, minced meat dishes and stuffed vegetables can be made. At this stage, people should be given nutrition education and the contents of each meal should be explained.
5.Transition to optimal nutrition:Adequate and balanced nutrition education should be started for patients on days 45-60. The most important reason for this is that the patient who underwent surgery has an eating disorder.
Since the microbiota is negatively affected after the surgery, providing the patient with probiotic use for 1.5-2 months has a great effect on the treatment of dysbiosis. Additionally, the person should not be given salads and legumes until 2 months after the surgery. Protein-enriched foods, such as high-protein milk, may be preferred after surgery.
People may experience a decrease in calcium absorption after surgery. B12 deficiency is frequently observed, and B9 and iron deficiency may also be encountered. Vitamin D deficiency may occur. If the person has an alcohol problem and it continues after surgery, Wernicke encephalopathy may develop due to vitamin B1 deficiency.
If we look at the possible problems that may develop after surgery; nausea, vomiting, bad breath, diarrhea, constipation, weakness , headache, dizziness, dumphing syndrome, smelly stools, gas, gastric intolerance and emotional eating may occur. If we take a deeper look at some of these topics:
If the person has nausea, vomiting and bloating; Fast food should not be eaten or drunk. Foods should be chewed well. Very cold and hot foods should not be eaten or drunk. You should not eat too much food and eat slowly, at least one meal should be finished within 20 minutes. Fried foods containing high amounts of fat should not be consumed.
Dumphing syndrome causes rapid gastric emptying and can be frequently encountered after bariatric surgery. Appropriate treatment and nutritional therapy should be applied.
In cases of gastric intolerance; Hard and dry foods should not be consumed, and meat products containing a lot of nerves should not be used. Bread and pastries that are very fresh and doughy should not be consumed. Pasta and rice should not be consumed. Attention should be paid to cooking techniques. Meals that are heated repeatedly should not be eaten, especially if they contain protein.
Emotional eating; The best support that can be given to a person to cope with this is accurate and satisfactory detailed nutrition education. In these trainings, adequate fluid intake should be explained in detail, and adequate protein intake should be emphasized. The balance of carbohydrates, proteins and fats should be ensured in meals and this should be taught and become permanent. A person should be taught how to choose food logically. The distinction between solid and liquid must be adopted and remain a permanent behavioral change. If there is an additional vitamin supplement given to the person, it should be taken. The importance of control should be emphasized and the person should be taught lifestyle changes and correct meal planning, not temporary solutions.
After the surgical operation, many people lose weight, but there are many patients who cannot maintain it. The first and most important detail for a person to maintain the weight he has lost is to have a good bariatric surgery operation. The other important golden rule is for the patient to receive nutrition education and acquire permanent behaviors. The other rule is to add exercise to your life permanently.
Proper nutrition education and timely check-ups are very important. This both eliminates the person's post-operative nutrition-related health problems and changes the patient's permanent nutritional behavior. Motivation is kept high to minimize sagging as a result of the large weights lost through exercise. These stages are provided in a multidisciplinary manner, accompanied by a doctor, dietitian and psychologist.
Finally, it should not be forgotten that; If the patient does not cooperate with the team, does not maintain a proper diet, refuses the training provided, and does not include exercise regularly, he/she will gain back the weight he/she lost. Bariatric surgery remains an inadequate method without behavioral changes.
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