We call people "obese" if the amount of fat in their body has increased enough to adversely affect their health. Here, the body mass index (BMI) value, which we can simply define as the weight-height ratio, guides us (BMI: kg/m²). Accordingly, patients with a body mass index over 40 are called "morbidly obese". The following application regarding the equivalents of BMI values can be examined.
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<25: Healthy Weight
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25 -29.9: Overweight
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30 -39.9 : Obese
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>40 : Morbid Obese
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>50 : Super Morbid Obese
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>60: Super Super Morbid Obese
INCREASING WITH OBESITY WHAT ARE THE DISEASES?
Obesity causes many diseases, especially diabetes and cardiovascular diseases. Recent research has included some types of cancer among the diseases that increase with obesity. According to some studies, the average life expectancy of morbidly obese people is 10-20 years less than the normal population. Below you can see some of the diseases that increase with obesity:
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Type II diabetes
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High blood pressure and other heart diseases
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Gallbladder pathologies (Especially stone diseases)
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Joint diseases (Especially knee joint diseases)
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Polycystic ovary syndrome and related infertility in women
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Asthma and sleep apnea
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Urinary system diseases
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Gastroesophageal reflux disease
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Low testosterone and related erectile dysfunction in men
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Gout
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Malignancies (Uterine cancer, Breast cancer, Colon cancer, Prostate cancer)
So obesity causes an increase in all causes of mortality!!!
WHY SHOULD MORBID OBESITY BE TREATED?
Morbid Obesity must first be treated in order to correct the diseases it causes (examples given above). In addition, the psychosocial problems it causes and the consequences it brings. The high financial burden also creates a necessity for morbid obesity treatment. What should be emphasized here is that morbid obesity is a disease.
Morbid obesity is a disease that needs to be fought!!!
CAN MORBID OBESITY BE TREATED WITH NON-SURGICAL METHODS?
There are many non-surgical methods for the treatment of morbid obesity, such as diet, exercise, behavioral regulations, various medications and hormones. is used. However, although weight loss is achieved with these methods, almost all patients become obese again. The classic statements of our patients who apply to us are as follows: "Sir, I lost 30 kilos in 6 months with diet and exercise, but I gained 40 kilos back in the next 4 months." Of course, the amount of weight and durations here vary from patient to patient, but the expression is always similar.
When the world literature is examined, it is seen that the comments about non-surgical methods are always similar:
*With medical treatment, only % While 10% of the weight loss occurs, 95% of the patients return to their pre-diet weight.
*Atkinson et al. Am J ClinNutr, 1994
**Non-surgical treatments applied to morbidly obese patients have a very low chance of success.
**Am J ClinNutr, 1992
***Patients' Although acceptable weight loss is achieved with non-surgical approaches in most cases, the biggest handicap is the failure to maintain the reduced body weight.
***GastrointestinalSurgeryFor Severe Obesity, NIH Consensus Statement, March 1991
So it is very difficult to achieve permanent weight loss with non-surgical methods!!!
WHO ARE CANDIDATES FOR MORBID OBESITY SURGERY?
Surgical option has come to the fore in the treatment of morbid obesity because it causes premature deaths due to comorbidities and has become very common. Surgical treatment of morbid obesity is called "Bariatric Surgery". With bariatric surgery, long-term permanent weight loss is achieved, many co-morbid diseases are prevented and survival is increased by reducing the metabolic effects of obesity.
The treatment of morbid obesity is surgery!!!
The following conditions are met. Patients who meet this condition should not benefit from surgery These are the patients we expect to be candidates for surgical treatment:
Patients with a BMI>40 kg/m²
Those with a BMI of 35-40 kg/m² and a disease that is expected to improve with weight loss:
-Type II diabetes
-Cardio-respiratory diseases (High blood pressure, sleep apnea, high cholesterol, etc.)
-Serious joint diseases
-Psychological diseases
Those who have tried conservative methods such as diet and exercise for at least 6 months
Patients between the ages of 18-65
Those who do not have gland disease in their endocrinological control
Those who do not have alcohol or substance addiction
Patients with stable psychological status
WHAT ARE THE SURGICAL METHODS APPLIED FOR MORBID OBESITY?
Obesity surgery aims to achieve "sustainable weight loss". This is the advantage of surgery over other methods. Bariatric surgery provides more than 50% reduction in excess weight. At this point, what our patients need to know is this: Surgical treatment is the first step of a process that will include long-term follow-up and evaluations. In other words, surgery forms one part of the multidisciplinary approach in the treatment of morbid obesity. The results of surgical treatment are better in educated patients who are well motivated, follow our recommendations, do not neglect their check-ups. We've mentioned it before. The patient's compliance with the diet during medical treatment can form an opinion about the patient's compliance after surgical treatment. In other words, the results obtained with surgery are better in patients who have previously tried non-surgical methods but have not achieved permanent benefit.
Patients who will undergo surgery; It is necessary to be clearly informed about the expected benefit from the surgery, the risks and long-term consequences of the surgery, and the need for lifelong nutrition and biochemical follow-up. As we mentioned at the beginning, there are basically two types of obesity surgery: Restrictive, that is, volume-reducing methods, and malabsorption, that is, the circuit of a part of the digestive system. methods are excluded.
Today, many techniques such as laparoscopic adjustable gastric band (LAGB), vertical band gastroplasty (VBG) and jejunoileal bypass (JIB) are used due to the complications they cause and often requiring revision surgery (new obesity surgery). D event is not implemented. Sleevegastrectomy and mini gastric bypass are the most popular obesity surgeries of recent times.
All bariatric surgeries should be performed with laparoscopic (closed) techniques. Except for very special cases, open surgery has no place in obesity surgery!!!
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