Obesity

Bad eating habits, excessive caloric intake and an inactive life are among the major causes of obesity.

What are the causes of obesity?
Bad eating habits, excessive caloric intake and an inactive life are among the major causes of obesity. However, the factors that trigger obesity remain unclear, while it is known that there are several factors playing a role in a person developing obesity such as familial predisposition as well as neurological, physiological, environmental, biochemical, cultural and psychological factors.

What are the health problems caused by obesity? 
Obesity brings along many health problems and risks in that it creates an adverse impact on body systems such as the endocrine, cardiovascular, respiratory, gastrointestinal, skin, genitourinary and/or musculoskeletal system as well as the individual’s psychosocial status.

Especially morbid obesity is associated with serious health problems that can have fatal consequences. The first of these serious health problems is hypertension which can be the cause of heart disease, kidney disease, stroke and arterial occlusion. Another one is high blood cholesterol and diabetes. Being the potential cause of kidney failure, loss of vision, heart attack and loss of limbs, the prevalence of diabetes in people with an obesity problem is 10 times higher than normal. Along with these, obesity can also be the cause of respiratory problems such as hypoventilation syndrome and sleep apnea. Some other health problems triggered by obesity are reflux, urinary incontinence, degenerative arthritis and ulcers. Some studies have shown that obese men are more likely to develop esophageal, prostate and colon cancer and obese women to develop ovarian, breast and uterine cancer.

How is obesity diagnosed?
Usually, obesity is diagnosed using the “body mass index” based on the World Health Organization’s obesity classification. Body mass index (BMI) is a person's weight in kilograms divided by the square of height in meters (BMI=kg/m2). Adults with a BMI above 30 are classified as obese and those above 25 are classified as overweight. In children, body mass index (BMI)-for-age percentile charts are used based on their age and gender. Accordingly, children with a percentile of >90 are classified as obese and those with >85 are classified as overweight.

What are the methods to treat obesity? 
The key to fight obesity is its prevention before it occurs. And since obesity in childhood paves the way for obesity in adulthood, it is a must that initial steps to prevent obesity are taken from childhood on. For that, we must raise the families’ and children’s awareness of balanced diet and active lifestyle.

Treatment of obesity is a challenging process that calls for a long-term devotion. The manifold factors triggering the occurrence of obesity make it complicated and difficult to treat. Treatment must be applied with a multidisciplinary approach involving a team of physicians, dieticians, psychologists and physiotherapists. The methods employed in obesity treatment are medical nutrition, i.e., diet therapy, exercise therapy, behavioral change therapy, pharmacological treatment and surgical therapy.

Who is a candidate for obesity surgery? 
Whether a person is eligible for bariatric surgery is decided based on a detailed evaluation of various data on a case-to-case basis. The key to achieve good results from surgical therapy is to opt for the right surgical method for the right patient. The method of obesity surgery is decided according to the patient’s body mass index as well as presence of any additional diseases, the patient’s eating habits and age. According to international criteria, in order for a person to qualify for obesity surgery the person’s BMI must be over 40 kg/m2 or over 35 kg/m2 accompanied by additional risk factors such as hypertension, type 2 diabetes, dyslipidemia, sleep apnea or severe arthrosis.

What are the surgical methods used in treatment of obesity?
Sleeve Gastrectomy
Sleeve gastrectomy, colloquially known as tube stomach surgery, is also called as vertical gastrectomy. The purpose of the operation is to remove the gastric fundus and corpus, which store foods, and reduce the volume of the stomach to 60-120 ml. In postoperative period, patients lose weight in two ways. In the first way, weight loss occurs as a result of the reduced gastric volume and mobility. In the second way, patients lose weight since “ghrelin” levels, namely hunger hormone, decline sharply after the stomach portion with endocrine cells where this hormone is secreted is removed during the operation.

Gastric Bypass Surgery
Gastric bypass surgery is the most common surgical treatment of obesity all around the world. In postoperative period, patients lose weight in two ways. In the first way, foods bypass the stomach and enter the small intestine through the created small pouch connected to the small intestine. Also, the gastric volume is reduced and patients eat less and they take fewer calories as the intestinal absorption changes. Low amount of food and less absorption bring about weight loss.

In the second way; in postoperative period, incretin hormones become active, while anti-incretin hormones become inactive. Thus, both weight loss occurs and diabetes is managed.

The other methods used in bariatric surgery are gastric balloon and gastric band. As the gastric band is an older method and there are few indications of gastric balloon, they are less commonly applied.

What are the benefits of obesity surgery?
Since obesity surgery is performed with minimally invasive methods (tiny incisions) and laparoscopic methods, the risk of complications is minimized. Thus, obesity surgery associated with sustainable and successful outcomes in treatment of morbid obesity has become increasingly popular. Obese patients lose weight as a result of bariatric surgery and common comorbidities either regress or completely disappear. Researches indicate that laparoscopic gastric bypass surgery and laparoscopic sleeve gastrectomy are the most effective treatment methods for the elimination of metabolic problems and achieving weight loss in morbidly obese patients.