Although its negative effects have been known for a long time, obesity, which is considered a body structure with excess fat tissue, has started to be accepted as a disease in recent years. So what is obesity? A body mass index (BMI) of 30 and above is considered obese. Although the World Health Organization (WHO) does not distinguish a BMI above 40, in practice, in some clinics, values of 50 and above are defined as super obese. However, in some Asian countries, the obesity limit is lowered even further. For example, China considers over 25 kg/m2 and Japan considers over 28 kg/m2 as obese. Rapid socio-economic development after the Second World War resulted in a logarithmic increase in the frequency of obesity. A rough idea about the prevalence of obesity can be obtained by looking at the socio-economic development map (Figure 1). Nowadays, it has become a complete public health problem. The American Medical Association classified obesity as a disease in 2013. In the USA, where one-third of the population is obese, the rate of overweight people reaches 60%. Today, it is reported that more than 500 million people around the world are obese, more than 90 million of whom are in the USA. More than 35 million are added to this number every year. In the USA, there has been a fourfold increase from 5% to 20% in the last 40 years. In Turkey, according to 2010 data, the obesity rate is approximately 17%. Obesity has become a public health problem in our country. A program to combat obesity was implemented by the Ministry of Health in 2010. The reason why obesity is a serious health problem is that it causes many complications or predisposes to many diseases (Table 1). Table 1: Condition caused or contributed to by obesity Cardiovascular System Ischemic heart disease Angina Myocardial ischemia (Heart attack) Congestive heart disease Hypertension High cholesterol level Deep vein thrombosis (Blood clot formation) Pulmonary embolism Endocrine and Reproductive Diabetes (Diabetes) Polycystic Ovarian syndrome Menstrual disorders Infertility Increasing complications during pregnancy Congenital disorders Intrauterine death (Stillbirth) Neurology Stroke Migraine Dementia Intracranial hypertension Multiple sclerosis Psychiatry Depression S social isolation Dermatology Striae Acontosis nigricans Lymphedema Cellulite Hirsutism Intertigo Gastrointestinal Gastroesophageal reflux Fatty liver Cholelithiasis (Gallstone formation) Increase in cancer formation Breast Oesophagus Colon and rectum Liver Pancreas Gallbladder Stomach Endometrium Cervix Prostate Kidney Multiple myeloma Non-Hodgin's lymphoma Left unum Obstructive sleep apnea Obesity hypoventilation syndrome Asthma Rheumatology and Orthopedics Gout Mobilization limitation Osteoarthritis Back and waist pain Urology and Nephrology Erectile dysfunction Urinary incontinence Chronic renal failure Hypogonadism Buried penis Sexual dysfunction All these problems bring obesity to the top among the causes of death. New studies show that approximately 20% of deaths in the USA, especially in white women, are caused by obesity-related problems. Based on the whole population, it is the most common cause of death after tobacco use. All this explains why some writers use the term “plague of our age.” Obesity and the additional problems it causes impose a serious burden on the health systems of countries. When the annual average health expenditures in the USA were examined in 2010 data, it was seen that obese patients spent six times more than non-obese patients and the average annual cost was around 3500 dollars. In 2005, 87 billion dollars were spent on obesity-related problems, which caused approximately 9% of health expenditures, and in 2010, 190 billion dollars, corresponding to 21% of total health expenditures, were spent. Although there is no clear data in our country, the percentages can be thought to be similar. For this problem, which is now more concerning to our country, the "Obzeitis Fighting Program" was put into practice by the Ministry of Health in 2010. The basis and priority of the fight is to eliminate the causes of obesity in terms of public health. Changing lifestyle starts with changing eating habits and doing more exercise. In order for these to be permanent, studies aimed at the younger generation are much more important. The other aspect of the struggle is the treatment of existing obese people. Although one can start with diet and exercise, their chances of success alone are very low. As BMI increases, this success increases. a also decreases. Although intensive research has been carried out on medical treatment methods, clear success has not been achieved yet. Although various endoscopic methods have been proposed for the treatment of obesity, these studies are still far from the desired point. Gastric balloon application is a method that has become quite common. Low complication rates and easy applicability make the procedure an attractive option. Many companies have launched many products with different features. However, after the balloon is removed, most patients start overeating again and gain back the weight they lost. On the other hand, in super obese patients, pre-surgical BMI can be reduced and surgery complication rates can be reduced. It can also be used easily in patients who cannot undergo surgery. In terms of surgery, methods have been developed that have gained momentum in the last twenty years and are being applied more and more frequently. There is no gold standard for the method, and long-term results have not been published yet. Although patients lose weight after surgery, a significant improvement in diabetes and hypertension is observed in the first week of surgery. This improvement can be observed after almost any type of surgery. This improvement is the basis for metabolic surgery. However, it should not be forgotten that surgical treatment alone is not sufficient. It also requires changes in the patient's lifestyle. In our country, these surgeries are performed at much lower costs than abroad. Although there is no clear data in our country, studies conducted abroad report that approximately 2500 dollars are saved annually in patients who undergo surgery. Therefore, although the initial surgery cost may seem high, it is very profitable in the medium and long term, both economically and for health financing providers. Much more important than all these economic and epidemiological data and statistics are the incredible changes that occur in the patients' feelings and lives. Patients who come for a check-up after the surgery say that they have "been reborn, started a completely different life, at peace with society and themselves, and can now play and travel with their children." In light of all these data, encouraging policies should be implemented for surgery, which is an integral part of the fight against obesity. is.
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