Obesity and Metabolic Surgery
Obesity, one of the most significant diseases of our time that requires attention, brings along numerous health threats if left untreated. Diseases such as cardiovascular diseases, diabetes, joint disorders, liver and gallbladder problems, sleep apnea syndrome, hypertension, stroke, and various cancers such as uterine, breast, prostate, and colorectal cancers are often attributed to excess body fat, i.e., obesity, posing a threat to health.
What is Obesity and Morbid Obesity?
The term obesity refers to being excessively overweight, while the term morbid signifies a condition that causes discomfort or illness. The concept of morbid obesity, which is rapidly increasing in prevalence worldwide, refers to a severe obesity condition accompanied by diseases resulting from excessive body fat, posing a risk of mortality
What are the Causes of Obesity?
Incorrect eating habits, excessive calorie intake, and a sedentary lifestyle can be listed as the primary causes of obesity. However, the factors that trigger obesity cannot be precisely identified. Additionally, familial predisposition, neurological, physiological, environmental, biochemical, cultural, and psychological factors play a role in the emergence of obesity.
What Health Problems Does Obesity Cause?
Obesity negatively affects various body systems and psychosocial conditions, leading to many health problems and risks in endocrine, cardiovascular, respiratory, gastrointestinal, skin, genitourinary, musculoskeletal systems. Especially morbid obesity brings serious health problems that can lead to loss of life. The first of these serious health problems is hypertension, which can cause heart and kidney disease, stroke, and artery blockages. Another is the increase in blood cholesterol levels and diabetes. Diabetes, which can cause kidney failure, vision loss, heart attack, and limb loss, is 10 times more common in individuals with obesity problems. In addition, obesity can contribute to respiratory problems such as decreased ventilation syndrome and sleep apnea. Other health problems triggered by obesity include reflux, urinary incontinence, degenerative arthritis, and ulcers. Some studies indicate that the likelihood of esophageal, prostate, and colorectal cancer is higher in obese men, while ovarian, breast, and uterine cancer are more prevalent in obese women.
How is Obesity Diagnosed?
The diagnosis of obesity is generally based on the World Health Organization's classification of obesity, using the "body mass index" (BMI). Body mass index (BMI) is calculated by dividing a person's weight in kilograms by the square of their height in meters (BMI=kg/m2). Adults with a body mass index of 30 or above are classified as obese, while those with a BMI of 25 or above fall into the overweight category. For children, body mass index percentile curves prepared according to age and gender are used. Accordingly, children above the 90th percentile are defined as obese, and those above the 85th percentile are classified as overweight.
Methods Used in the Treatment of Obesity
The most crucial point in combating obesity is prevention before it arises. Since obesity in childhood lays the foundation for adult obesity, the initial steps for preventing obesity should be taken during childhood. To achieve this, families and children should be educated on balanced nutrition and regular exercise.
Obesity treatment is a mandatory, continuous, and long-term process. The complexity and challenges of obesity treatment arise from various factors that trigger its onset. The treatment process should be conducted with a team consisting of a physician, dietitian, psychologist, and physiotherapists, employing a multidisciplinary approach. The methods used in obesity treatment include medical nutrition or dietary therapy, exercise therapy, behavior modification therapy, pharmacological therapy, and surgical therapy.
Who Can Undergo Obesity Surgery?
The decision of whether an individual is suitable for obesity surgery is made based on a detailed evaluation of various data specific to each patient. The key to achieving successful results from surgical treatment lies in selecting the appropriate surgical method for the right patient. The choice of the method for obesity surgery depends on the patient's body mass index, additional health conditions, eating habits, and age. According to international criteria, for a person to be eligible for obesity surgery, their body mass index should be greater than 40 kg/m2 or greater than 35 kg/m2 with additional risk factors such as hypertension, type 2 diabetes, dyslipidemia, sleep apnea, and severe arthrosis.
Surgical Methods Used in the Treatment of Obesity
Sleeve Gastrectomy (Gastric Sleeve) Surgery
Commonly known as gastric sleeve surgery, sleeve gastrectomy is also referred to as longitudinal gastrectomy. The goal of the operation is to reduce the volume of the stomach to 60-120 ml by removing the sections of the stomach responsible for storing food, namely the fundus and corpus. Two types of weight loss are observed after the surgery. The first is weight loss due to the reduction in stomach volume and movements. The second is achieved by removing the part of the stomach where endocrine cells producing the hunger hormone called "ghrelin" are located during the operation, resulting in a significant decrease in this hormone.
Surgery Widely used worldwide for obesity surgery, gastric bypass surgery is commonly referred to as gastric bypass. After the operation, weight loss occurs in two ways. First, the connection between the small stomach created during the surgery and the small intestine allows ingested food to bypass the large stomach and go directly to the small intestine. Additionally, patients with reduced stomach volumes feel the need to eat less, and changes in absorption in the intestines result in fewer calorie intake. The reduction in food intake and altered absorption contribute to weight loss. Second, after the surgery, incretin-effective hormones become active, while anti-incretin-effective hormones become inactive. This results in both weight loss and the control of diabetes.
Other methods used in bariatric surgery include gastric balloon and gastric band. Gastric banding is an older method, and gastric balloons are less commonly used due to their limited indications.
What are the Benefits of Obesity Surgery?
The ability to perform obesity surgery with minimal invasiveness, using small incisions or laparoscopic methods, has minimized the risks of complications associated with the operation. As a result, the frequency of implementing obesity surgery, which allows sustainable and successful results in the treatment of morbid obesity, is increasing day by day. The weight loss achieved through bariatric surgery often leads to regression or complete elimination of comorbidities commonly seen in obese patients. Research indicates that laparoscopic gastric bypass surgery and laparoscopic sleeve gastrectomy are the most effective treatment methods for resolving metabolic issues and achieving weight loss in patients with morbid obesity.