Obesity Surgery

OBESITY

 Obesity, mainly caused by modern lifestyles and changing eating habits, presents a serious health threat. Everyday, newer and newer approaches are required to avoid and treat obesity, which is a common disease now. Generally, various diseases accompany obesity making it a quite costly public health issue for many countries.

 

Obesity is generally defined as excessive fat accumulation. The most commonly used measure of body fat is Body Mass Index (BMI). BMI is calculated by dividing a person’s weight in kilograms by the square of his or her height in meters.

 

Body Mass Index (BMI) = weight (kg) / height2 (m2)

BMI <18.5                 Below normal weight

BMI >= 18.5 – 24.9   Normal weight

BMI >= 25 – 29.9      Overweight

BMI >30                    Obesity

                        30- 34.9          Class 1 Obesity

                        35- 39.9          Class 2 Obesity

                        40 and above  Class 3 Obesity (Morbid Obesity)  

BMI > 50                  Super Obesity

 

A fat cell is an endocrine cell, in other words, a hormonal system cell, and a fat tissue is an endocrine organ. This tissue releases several substances that affect the body. An increase in fat tissues, or obesity, increases the amount of fat acids in circulation, as well as inflammatory reactions. This causes insulin resistance, which forms the basis for diabetes.     

Nutrition is a quite complex process, which involves smell, taste and temperature of the food, cognitive and emotional stimulations, and metabolic mechanisms, which send signals to the brain to start and stop eating. In recent years, it has been discovered that some substances give signals to the brain to eat more.

Due to malnutrition and changing lifestyle habits, the obesity rates increased rapidly all over the world after 1960s, and the efforts to stop the increase are still falling short today. In Turkey, the rate of overweight is stated as more than 50%. In other words, one in two people are either overweight or obese. With this rate, our country stands close to the top among the European countries. The situation is even worse in the US. 69% of the population is above normal weight, which means that two people out of three are at the risk of this disease, obesity. When the food distribution is considered, the burden of the disease is quite heavy globally.

It would not be wrong to say that obesity is a disease since various hormones, including hunger hormones, and mechanisms are in play regarding the problem. According to American statistics, more than 112 000 obesity-related deaths happen per year. The big picture of obesity lays the foundation for more than 30 chronic diseases, which are type 2 diabetes, high cholesterol, high blood pressure, gallstones, cardiovascular diseases, fatty liver syndrome, sleep apnea, acid reflux, urinary incontinence, coronary failure, joint diseases, asthma and other respiratory diseases, birth defects, and even several kinds of cancer.    

Sadly, overweight patients frequently face discrimination and bullying. Obesity must be admitted as a disease and the negative perceptions among the public should be corrected.

The main reason of obesity is excessive food or calorie intake. Unfortunately, consumption of fast food, which containes too much fat and calories, and sodas is very popular among children. Also, carbohydrate-based nutrition, and products imposed by the industry, such as fructose syrup, threaten especially younger people. 

 

WHAT ARE TREATMENT OPTIONS?

Professional weight-loss programs generally involve low-calorie diets, increased physical activity and behaviour change techniques. However, lifestyle changes alone are not efficient and lasting enough.

The medication used for weight loss does not have an important role as a medical cure for obesity in the long run. The medication, which curbs appetite, may help lose weight in the beginning, however, it was observed that most patients who applied weight loss programs without surgical intervention regained the weight lost within 5 years.    

 

SURGICAL TREATMENT

Weight loss surgery, also called bariatric or metabolic surgery, has been applied for almost 50 years as a treatment for people who are very obese. when treatments and diets do not work. The outcomes of our laparoscopic (closed) weight loss surgeries are quite satisfying.

 

WHO CANNOT GET WEIGHT LOSS SURGERY?

  • Those who are psychologically unstable and have severe eating disorder
  • Alcohol addicts
  • Those who have serious systemic diseases, such as liver cirrhosis, serious respiratory system diseases, diseases which increase the risk for bleeding and infection, and serious heart diseases
  • Patients over 65 years of age
  • Those who have unsuitable BMI 

 

TYPES OF WEIGHT LOSS SURGERY
Two of the most frequently performed surgeries are laparoscopic gastric bypass and sleeve gastrectomy.

Sleeve Gastrectomy
Sleeve gastrectomy can be defined as a restrictive method, and basically involves reducing the stomach. This procedure is perfomed laparoscopically by opening small holes without making big incisions in the abdomen while the patient is under anaesthesia.   

The stomach is reduced by removing a large portion including the part, which releases hunger hormones. The result is a tube like structure with a volume of 100 -150 ml. This is the closest method to human physiology.

Gastric Bypass
Gastric bypass is based on decreasing the size of the stomach to reduce the food intake and shortening the way that the food travels in the small intestine, in other words the way of absorption. This surgery limits both the amount of the food taken and its absorption.

This procedure reduces the stomach approximately to 20-40 ml. to decrease the food intake. As a result of the surgery, the food bypasses a large part of the stomach, duodenum, and jejunum, so the absorption of the food, especially the food high in calories and sugar is prevented.

Once taken, the food comes to the small stomach through oesephagus and passes directly to the small intestine. In other words, the food bypasses the parts of the digestive system responsible for absorption, namely the big stomach, duodenum, and jejunum, and directly passes to the small intestine.

 

Gastric Plication
This surgery involves sewing one of more folds in the stomach to reduce the size of the stomach without removing any portion of the stomach or intestines. Therefore, the operation is reversible unlike sleeve gastrectomy or gastric bypass. However, it is not as effective as sleeve gastrectomy or gastric bypass for weight loss. People who do not have an extremely BMI and do not want incisions to their stomach should prefer this surgery.

 

METABOLIC SURGERY (FOR DIABETES)

Loop Bipartition Surgery (Sleeve Gastrectomy with Loop Bipartition)
This is a kind of surgery performed as a treatment for obesity-related uncontrolled type 2 diabetes. This surgery involves creating a large gastric “sleeve” or “tube” first, and then anastomosing a portion of the small intestine to a point close to the exit of the newly formed stomach. Hence, food and drink pass through both the normal and the short way. Thus, blood sugar is taken under control and the patient loses weight.

 

Roux en Y Transit Bipartition (Sleeve Gastrectomy with Roux en Y Bipartition)
This surgery involves creating a large gastric “sleeve” or “tube,” and removing a portion of the small intestine. Then the end close to the large intestine is anastomosed to the exit of the newly formed stomach. The upper end is anastomosed to a point close the large intestine. Thus, blood sugar is taken under control and the patient loses weight.

 

Duodenal Switch
Duodenal switch, or biliopancreatic diversion, is a weight loss surgery, which reduces the volume of the stomach to restrict the food intake and absorption to a large extent. This procedure can be a surgical option for the super obese patients with a BMI above 50, and for those who have already undergone sleeve gastrectomy but regained the weight lost. It can also be suggested for patients with uncontrolled diabetes.

 

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