Obesity (i.e. excess weight) is one of the most important and preventable health problem that is becoming more prevalent worldwide.
HOW CAN WE DESCRIBE OBESITY?
Obesity, in simplest terms, is the abnormal and excessive fat accumulation in the body that disrupts health. In other words, having fat more than 30% of the body weight for women and more than 25% for men. Obesity, which is especially the biggest health problem of developed countries, is also considered as one of the most important health problems in our country. According to World Health Organization data, one in every three people are obese. Studies determined that one in every four men and almost half of the women in Turkey have obesity.
WHY BARIATRIC SURGERY BECAME THIS POPULAR?
Bariatric surgery is not cosmetic operations intended only for reforming the appearance of the patients, making them feel fitter or enable them to wear what they want. Obesity can cause many diseases such as type 2 diabetes, coronary artery disease, hypertension, coronary failure, gastroesophageal reflux, depression, infertility, menstrual irregularities, impotency, joint diseases, varicose veins, cerebral hemorrhage and paralysis, lack of social harmony. Obesity is a known factor for the development of some cancers like breast, large bowel and prostate.
HOW OBESITY IS IDENTIFIED, WHO ARE CALLED OBESE?
Generally, Body Mass Index (BMI) is used to identify obesity. Body mass index is obtained by dividing the weight in kilograms to the square of height in meters. BMI lower than 18,5 kg/m² is considered as underweight, BMI between 18.5 ? 24,9 kg/m² is considered as normal weight, BMI between 25 ? 29,9 kg/m² is considered as overweight, BMI between 30 ? 39,9 kg/m² is considered obese and BMI over 40 kg/m² is considered as extremely obese (morbid obesity).
Comparison of obese patients with 30 or more BMI against normal individual with BMI between 20-25 revealed that rate of mortality due to various reasons increase by 50-100% for obese patients. Early death risk significantly increases for morbid obesity with BMI over 40 and super morbid obesity with BMI over 50.
HOW OBESITY IS TREATED?
First line treatment of obesity is not surgery. For patients who admit to our center for obesity, our first aim is to have them lose weight through a dietary program prepared by our experienced doctors and dietitians. These programs are consisted of diet, exercise and behavioral change treatments.
WHEN BARIATRIC SURGERY IS RECOMMENDED?
Bariatric surgery is recommended for patients who have 35 or more BMI value and fail to lose weight for 6 months despite expert controlled diet, exercise and medical treatment.
INDICATIONS OF BARIATRIC SURGERY
Patients between 16-60 years of age,
Patients with 40kg/m2 BMI,
Patients with 35-40 kg/m2 BMI but have accompanying diseases such as diabetes, heart, respiratory and joint diseases can be candidates for this surgery.
Before deciding on operation, it must be proven that obesity is not associated with an endocrine disease. Surgery decision should not be made solely on patients? will but as a result of an evaluation conducted by a committee consisting surgeon, anesthesia specialist, endocrinologist, psychiatrist and dietitian.
HOW BARIATRIC SURGERY IS PERFORMED?
There are two main methods in bariatric surgery; reducing the stomach volume and/or preventing the absorption of nutrition in some stages. Use of laparoscopic method in bariatric surgery can provide a more comfortable recovery period for patient in comparison to open surgery. Patients can return their daily lives in a short amount of time with this method and risks like wound site infection and hernia are also reduced.
Although there is no standard for deciding which surgical method will be applied, many factors such as age, gender, BMI, nutritional habits causing excess weight, fat distribution, additional diseases and amount of weight aimed to be lost play a role.
IS SURGERY A DEFINITE SOLUTION?
Surgery is not a definite solution for obesity. Only if the patient comply with the recommended diet, exercise and lifestyle changes can a permanent and definite weight loss will be possible. Therefore, if an individual wants to lose weight permanently, he or she needs to be determined to comply with lifelong nutrition and lifestyle changes. It is important to remember that no surgical method can provide targeted weight loss in people who resume their habits of excessive consumption of food like ice-cream and potato chips that don?t take up a lot of room in the stomach in the evening while watching TV.
As a result, in order for surgery to be successful, patients must comply with the recommendations of doctors and dietitians during the post-op period. This is the only way to have permanent and fast weight loss, and to eliminate all other obesity related diseases.