Disease Definition
Obesity means the accumulation of fat in the body in a way that impairs health more than the standards. In the calculation of obesity, the body mass index calculation is used over the height and weight of the individual. The body mass index (BMI) is obtained by dividing the weight in kilograms by the square of the height in meters. From its diagnosis, it is observed that insulin cells slowly decrease. In healthy metabolisms, foods are broken down in our intestines to turn into glucose (sugar), pass from the intestines to the blood and begin to increase the sugar rate in the blood. At this point, sugar is transported into the cell with the help of the hormone insulin produced by the pancreas. If; If the insulin hormone is not enough in the body or cannot function, the sugar in the blood cannot be transported to the cells and the glucose level in the blood continues to rise. As a result, diabetes develops.
Is obesity a disease?
Obesity, as it has been perceived for many years, is caused by overeating and not being able to control oneself. It is not a cosmetic problem. Many international organizations, especially the World Health Organization, accept obesity as a chronic and progressive disease caused by different environmental, genetic and psychological causes. Obesity occurs as a result of excessive accumulation of fat in the body. In order to maintain a healthy life without gaining weight, the energy we get from food in a day should be equal to the energy we spend all day. If we take in more than we spend, this excess energy that cannot be spent is stored as fat in the body, causing weight gain, and obesity develops as a result of this persisting for a long time.
How is obesity diagnosed?
The ones that make up the total weight of our body are muscle, bone and fat tissues and other elements. Fat ratio in the body can be calculated using many different methods for the diagnosis of obesity, but these methods are both expensive and time-consuming. Instead, it is a practical calculation called "Body Mass Index" (BMI) all over the world. plating method is used. A classification is made according to this calculation and the treatment is programmed by determining the possible health risks for each group.
What happens if obesity is not treated? It is not a cosmetic problem, but a chronic disease that affects many organs and systems. Due to its negative effects on the endocrine system, menstrual irregularities, infertility and polycystic ovary syndrome can be seen in women, and infertility and erectile dysfunction (impotence) in men. In addition, due to the increase in the amount of fatty acids circulating in the blood, insulin resistance and type 2 diabetes, heart diseases, hypertension and high cholesterol, pancreatitis and gall bladder problems can be observed. Sleep problems (sleep apnea syndrome, snoring), shortness of breath, joint disorders and back problems may occur due to the physical stress created by weight.
The most frightening danger is the risk of cancer development, which is more common in overweight and obese people. According to a study conducted in the USA, the risk of developing cancer in smokers is 33%, while this rate is 20% in overweight and obese people. The most common cancers are breast, uterus, cervix, colon, esophagus, pancreas and prostate cancers. In addition to all these, its negative psychological effects affect almost all obese patients.
How is our health affected by weight loss?
There are many people all over the world who evaluate the positive effects of weight loss. scientific study has been done. In the light of these;
A decrease of 1 kg in body fat provides 2 mmHg in systolic blood pressure (in systolic blood pressure) and 1 mmHg in diastolic blood pressure (in diastolic blood pressure).
When the amount of energy taken in a day is restricted by 1%, body weight decreases by 0.28 kg.
Who should undergo surgery for the treatment of obesity?
Those with a BMI value > 40 kg / m² or between 35 and 40 kg / m² and those with metabolic diseases such as diabetes, hypertension and sleep apnea syndrome, can make a previous lifestyle change (diet and exercise) effectively. Surgery may be considered to treat obesity of people who have tried but failed.
Example: Is a person 165 cm tall and 120 kg in weight a candidate for surgery?
Body Mass Index = Weight (kg) / Height (m)²
Body Mass Index = 120 kg / 1.65 m x 1.65 m
Body Mass Index = 120 kg / 2.72 m²
Body Mass Index = 44.11 kg/m²
This patient in the example is classified as "Morbid Obese" according to the BMI calculation; In addition, if he has tried to lose weight effectively with diet and exercise but has not been successful, he is a candidate for bariatric surgery.
What is the advantage of surgery?
Obesity surgery, by providing a large amount of weight loss in a short time, leads to much more positive, permanent and effective metabolic results than the changes made in lifestyle, diet, exercise and drug treatments. decreased to a level similar to that of other frequently performed surgeries such as hysterectomy. In scientific studies on the efficacy and safety of bariatric surgery, morbidly obese patients who were operated on and those who were not operated on were compared, and it was seen that the risk of death due to both heart diseases and all causes in those who were not operated was much higher than those who were operated on.
What does success in obesity surgeries depend on?
Surgical success primarily depends on choosing the right patient. Because it is very important which patient will be operated on and which type of surgery will be applied to which patient. All these decisions should be made by the obesity treatment team, not only by the surgeon. This team should consist of experienced experts from the departments of endocrinology, psychiatry, cardiology, chest diseases, anesthesiology-reanimation, general surgery and nutrition. The basic principle is correct patient selection, good preparation and successful outcome. Determining a problem in any matter as a result of the team's evaluations may cause the postponement or cancellation of the surgical intervention to be applied to the patient.
The key to lifelong success is that the patients who will undergo the surgery go through the process consciously and consciously. The most important thing to remember is that this surgery In order to preserve muscle mass and lose weight from adipose tissue, the patient must strictly follow the diet and exercise program recommended to him during the post-surgery weight loss process, and continue his doctor's follow-ups regularly in the long term. In order to maintain the lost weight for life, the patient must first be aware of the reasons that lead him to obesity and radically change his next lifestyle to avoid these hidden dangers.
What should be done to prepare for the surgery?
One of the important factors affecting the success in the short and long term after the operation is good patient preparation. Before the operation, it is evaluated whether there is a metabolic disorder such as thyroid gland diseases that cause weight gain, Cushing's syndrome or obesity due to hypertension, sleep apnea syndrome, diabetes. In addition, endoscopy is used to investigate whether there is gastritis, ulcer and reflux in the stomach. After the problems are treated medically, the operation is performed. With abdominal ultrasound, the presence of problems such as stones and mud in the gallbladder of the patient is investigated. If it is, the gallbladder is also removed during the operation.
How long is the preparation, operation and hospital stay?
The length of stay in the intensive care unit and hospital depends on the age of each patient. Although it varies depending on the diseases it has and the general condition after the operation, it is around 1 week-10 days on average. It is preferred that our patients coming from outside the province or abroad stay in Istanbul in order to observe closely in the 4-5 days after the operation. During this period, both surgical controls are carried out and training is provided on lifestyle and nutrition after the operation. Although it is determined by the doctor and the patient depending on the condition, its frequency decreases as time passes.
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