What is obesity and morbid obesity? Who can be considered obese?
Obesity, in its simplest form, is the accumulation of abnormal and excessive fat in the body to the extent that it impairs health.
We can define it as obesity or overweight. Morbid obesity, as a medical term, is obesity at a level that can lead to obesity-related diseases, causing medical
problems as a result of the risks it poses to the person, and ultimately shortening life expectancy.
>Morbid obesity can be translated into Turkish as excessive and diseased obesity. It is estimated that one-fourth of men and nearly half of women in Turkey have obesity problems.
The most commonly used measure in classifying obesity is the body mass index. Body mass
index is obtained by dividing the weight in kilograms by the square of the height in meters
. For example, the body mass index of a person who is 1.70 m tall and weighs 65 kg is calculated as 65 ÷
(1.7 2 ) = 22.5 kg/m 2.
In medical classification, the body mass index is 18.5. Those below kg/m² are underweight, those between 18.5 - 25 kg/m²
Those between 25 - 30 kg/m² are overweight, those between 30 - 40 kg/m²
Those between 40 kg/m² and above are called obese, and those above 40 kg/m² are called morbid obese.
Where in the body the fat tissue is collected is also very important. It is accepted that the fat accumulated around the belly is more dangerous than the fat accumulated in the hips and hips. For this reason,
apple type obese patients have a higher risk of developing heart diseases, especially
compared to pear type obese patients.
2. What are the health problems caused by obesity?
In addition to the psychological problems that obesity causes, such as not being able to actively participate in social and professional life and distortion of body image, there are many health problems it causes.
Although it is very difficult to count all of these, the main ones are metabolic syndrome and insulin
resistance, type 2 diabetes, high cholesterol and lipid levels, coronary artery disease, hypertension, heart
insufficiency, sleep apnea, sleep disorders, respiratory disorders, gastroesophageal reflux,
polycystic ovary syndrome and winter menstrual irregularities, bone and joint problems, especially osteoarthritis, varicose veins, brain hemorrhage and paralysis, and gallbladder stones. Additionally,
Some cancers, such as breast, colon and prostate cancer, are more common
in obese people. We know that no matter which method is used to lose weight in obese patients, there is a significant decrease in these diseases.
3. How should we fight obesity?
Obesity has become a very common public health problem today. Its rate is increasing, especially in western societies. For example, it is thought that approximately 300 thousand people die annually in the United States due to diseases caused by obesity, and obesity is the second most common "preventable" cause of death after smoking.
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Obesity is a public health problem with social and cultural causes. Increasing consumption of foods containing high carbohydrates (sugar) and fast-food type nutrition is an important reason.
Sports do not take much part in our daily lives, such as cycling or walking in transportation
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Many factors, such as the lack of widespread use of methods, increase obesity.
Therefore, we are talking about a public health problem with socio-cultural reasons.
Regular physical and sportive activities since childhood. Participation and development of healthy
eating habits and opportunities are the most important
factors in the fight against obesity.
However, there is an important point that should be noted. Once morbid obesity occurs, it cannot be treated with diet and exercise alone. Scientific studies reveal that even if morbidly obese patients
can lose weight with diet and exercise, unfortunately, the majority of them cannot lose weight permanently
and the lost weight is regained. Currently,
there is no drug treatment proven to be effective in the treatment of morbid obesity
.
There are changes in lifestyle and eating habits, in other words, appropriate diet and Obesity in this significant proportion of morbidly obese patients who cannot lose weight despite exercise Surgical
treatment of the site is on the agenda.
4. Who are the suitable candidates for obesity surgery?
Which patients will benefit from morbid obesity surgeries and who should and should not undergo these surgeries have been scientifically clearly demonstrated. Patients with a body
mass index over 40 kg/m2 constitute the most suitable patient group. Apart from this,
those with a body mass index between 35-40 kg/m2 and diseases caused by obesity also benefit significantly from obesity surgery. In order to perform morbid obesity surgeries, which are serious surgical procedures, we also require patients to have tried dieting before. Of course, the characteristics that we surgeons want are for the patient who is a candidate for surgery
to be in good spiritual condition, to be in a social and spiritual state of well-being to comply with the rules after the surgery
and to be motivated for this surgery.
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There is one point that should be particularly noted. Unless there is a special condition such as type 2 diabetes
obesity surgeries should not be performed on people with a body mass index below 35 kg/m2
. It should be known that these surgeries are not plastic surgeries, but rather serious surgical procedures that carry risks and some of which are irreversible. Our patients must be sure that their special
situation is evaluated correctly with scientific criteria.
5. What types of surgeries are used in the treatment of morbid obesity?
We can divide the surgeries performed in the surgical treatment of morbid obesity (Bariatric surgeries) into two main
types: 1) Restrictive surgeries, 2) Both restrictive and Surgeries that prevent the absorption of nutrients
. While restrictive surgeries aim to reduce the amount of food consumed by the patient
, malabsorption surgeries aim to lose weight by reducing the absorption of consumed nutrients
. All of these surgeries are performed by the laparoscopic (closed) method.
There is also a non-surgical method of treating obesity, the gastric balloon method, which is passed through the esophagus and placed in the stomach by endoscopy. However, with this method, weight loss surgery
It is less than the other methods, and when the balloon is removed, patients almost always return to their old
weight.
The most commonly used restrictive surgeries today are laparoscopic, also known as gastric banding
It is a sleeve gastrectomy surgery known as gastric band and sleeve gastrectomy surgery.
In laparoscopic gastric band surgery, an inflatable adjustable prosthesis is placed around the stomach
and this is done with the help of a chamber placed under the skin on the abdominal wall. The pressure of the prosthesis
is adjusted. The aim of this surgery is to reduce the volume that the stomach can hold. The use of a foreign object
and the fact that the patient sometimes requires frequent visits to the doctor to have the band swelling adjusted
are important disadvantages. Depending on the tape used, side effects and complications, some of which may be life-threatening, may occur. I personally do not use this
method.
Laparoscopic gastric sleeve surgery has recently gained popularity among surgeons. The purpose of this
surgery is to remove the large part of the stomach, which we call the fundus and corpus, and turn the entire stomach into a thin tube. Thus, the patient becomes able to consume much less
nutrients than before the surgery. One of the most important advantages is the decrease in the levels of hunger hormone (Ghrelin) secreted from the removed part of the stomach. With the decrease in the hunger hormone
, the patient begins to feel full much earlier after the surgery. This is an important factor that contributes to decreased food intake after sleeve gastrectomy surgery. Another important advantage of laparoscopic sleeve gastrectomy surgery is that it does not disrupt the anatomical continuity of the stomach - duodenum - small intestine. Moreover, it allows the addition of malabsorptive surgeries later, if necessary, in extremely obese patients.
The most commonly used malabsorptive surgery is gastric bypass surgery. Apart from this,
biliopancreatic diversion and duodenal switch surgeries are also performed.
The basic logic of all surgeries that prevent absorption is to restrict food consumption,
and the food consumed. preventing the absorption of substances To reduce the amount of active use of the small intestine, that is, food passing through and being absorbed. These
surgeries can have various different applications. All malabsorptive surgeries
change the anatomy by disrupting the continuity of the stomach - duodenum - small intestine and
are technically complex surgeries.
Whether the patient requires obesity surgery or not And which surgery is the most suitable option should be examined and decided in detail by a General Surgeon and an Endocrinologist who specialize in these surgeries. In long-term follow-up of morbidly obese patients who undergo bariatric surgery, the problems caused by obesity are significantly eliminated
. Figure 1 shows the rates of improvement in obesity-related health problems in patients.
6. What is metabolic surgery, or more commonly known as diabetes surgery, and
Which patients can it be applied to?
Recently, morbid obesity surgeries have been used to treat the disorder we call metabolic syndrome and type
2. Scientific evidence has begun to accumulate that it is beneficial in diabetes. However, this does not mean that every diabetic patient will benefit from these surgeries. These surgeries have no benefit in cases of insulin-dependent type 1 diabetes that begins in childhood.
The most important cause of type 2 diabetes and metabolic syndrome is obesity. Diabetic morbidly obese
patients benefit greatly from obesity surgery. Blood sugar control improves, the need for oral
diabetes medication and sometimes insulin decreases. In fact, some patients recover completely from type
2 diabetes. However, it should be known that these surgeries are not a "Diabetes surgery" In addition to the procedures performed for diabetes, some other surgeries (such as ileum
transposition, transit bipartition surgery) play a role in the treatment of diabetes. However, the long-term results of these surgeries are not scientifically clear yet. These patients should be evaluated before surgery is recommended.
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