Obesity is a disease that results from the energy intake from food exceeding the energy spent and is characterized by abnormal fat increase in the body, which impairs health. Obesity is considered when body fat tissue exceeds 25% in adult men and 30% in adult women. HOW TO DETECT OBESITY 1. Body Mass Index: It is the most used method in the world. It is calculated using the person's height and weight values. Body Mass Index(BMI)=Weight(kg)/Height²(m²) BMI? 18.5 Underweight BMI= 1.8-24.9 Normal BMI= 25-29.9 Overweight BMI= 30-40 OBESITY BMI= 40-50 MORBID OBESITY BMI? 50 SUPER OBESITY EXAMPLE: Is a 32-year-old man, 160 cm tall and weighing 108 kg, obese? BMI=108 kg/(1.6)²m² =108/2.56=42.1kg/m²= MORBID OBESITY 2. Waist circumference (cm ) / Hip circumference (cm) Ratio is 0.85 in Women and 1.0 in Men If it is too much, there is obesity. 3. Waist Circumference Measurement (cm): Risky High Risk MALE? 94 ? 102 WOMEN? 80 ? 88 WHAT ARE THE FACTORS CAUSING OBESITY? 1.Iatrogenic causes: •Drugs and hormones •Hypothalamic surgery 2. Diet-related obesity: •Eating disorder in infancy •Frequent eating •High fat meals •Binge eating 3.Neuroendocrinobesity •Hypothalamic syndrome •Cushing syndrome •Hypothyroidism •Hypogonadism • Polycystic ovary syndrome •GH (Growth hormone) deficiency •Pseudohypoparathyroidism •Night eating syndrome 4.Social and behaviorally dependent: •Socio-economic factors •Psychological factors •Seasonal eating disorders 5.Genetic obesity: •Autosomal recessive •Autosomal dominant •Chromosomal abnormalities 6. Sedentary life 7. Inactivity after surgery 8. Old age WHAT ARE THE RISKS OF OBESITY? METABOLIC EFFECTS Hypertension Diabetes Mellitus Type 2 (non-insulin dependent diabetes) Hypercholesterolemia Hypertriglyceridemia Fatty liver Gallbladder tachycardia Pancreatitis Infertility Sleep apnea Clotting disorders MECHANICAL AND ANATOMICAL EFFECTS Obstructive sleep apnea Gastroesophageal reflux disease (GERD) Asthma Urinary incontinence Venous stasis Deep vein thrombosis (DVT) Fungal infections of the skin Decubitus ulcers DEGENERATIVE EFFECTS Cardiovascular diseases Sugar Complications related to the disease Vertebral disc disease Non-alcoholic liver disease (NASH) INCREASES THE RISK OF CANCER Breast cancer Ovarian cancer Uterus (Endometrium) cancer Prostate cancer Large intestine and rectum (Colorectal) cancers Kidney (Renalcell) cancers Lymph cancers (NHL) Food Esophagus cancer Stomach cancer Pancreatic cancer PSYCHOLOGICAL EFFECTS Anxiety disorder Depression Eating disorders WHAT IS DONE IN OBESITY TREATMENT? Treatment should be planned according to the cause. If there is a metabolic cause that causes obesity, it must be treated first. Diet therapy, exercise therapy, drug therapy, psychological support and other treatment methods appropriate to the patient should be planned. •Diet Treatment: The patient's total calorie intake should be reduced, not the amount of fat in the diet. Otherwise, you cannot be successful in the diet. Approximately 50% of the diet should consist of carbohydrates, 30% proteins and the remaining 20% fats. The success rate of the diet for patients in the morbidly obese class is around 1%. •Behavioral therapy: The basis of most non-clinical weight loss programs is behavioral therapy. The first behavior to change is eating. Efforts are made to slow down the eating rate. Efforts are then made to change the antecedents of eating from relatively distant ones to more proximal ones. The third step is to reinforce these behaviors. •Exercise: Regular physical activity in adults, lean body weight The increase causes a decrease in fatty tissue. This is why there is not much change in body weight in the first period of exercise programs. After about three months, lean body weight stabilizes and weight loss accelerates. According to studies on determining the duration and frequency of exercise intensity to increase fat oxidation in obese people; Exercises that last more than 30 minutes, provide 65% maximal oxygen consumption capacity, and are performed at least five days a week are the most efficient. The performance achieved through exercise is not permanent. The level of gain begins to decrease within two weeks at most. This explains the necessity of continuing the exercises throughout life •Medication: Drugs used in the treatment of obesity are divided into 3 main groups: 1. Drugs that reduce food intake 2. Drugs that change metabolism 3. Drugs that increase thermogenesis Mild or moderate Drug treatment is not suitable for those who are overweight. Drug therapy may be considered in patients with BMI >30 kg/m2. SURGICAL TREATMENT OF OBESITY Surgical treatment is used in the following cases: •Surgical treatment: Before resorting to surgical methods, the patient should undergo detailed analysis and it should be established that obesity is not caused by any genetic, endocrine, neurological (such as hypothalamic dysfunction) pathology or drug use. Otherwise, cause-specific treatment should be preferred. o With a body mass index over 40 o In individuals between the ages of 18-60 o If obesity has existed for at least 3 years o If there are no hormonal diseases In those who have not been able to lose weight for at least 1 year despite medication and diet treatment; o In those who are not addicted to alcohol or drugs. o If the patient understands the method to be applied and is able to adapt after the surgery. o In those who have an acceptable risk of surgery.
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