Obesity, one of the most common diseases of modern life, limits the persons physical abilities and causes psychological problems. More importantly, it plays a role in the development of fatal diseases. For this reason, it is extremely important for the person to maintain their ideal healthy weight and for patients who are at the border or are at high risk of obesity to reach their ideal weight under the supervision of a dietitian and a specialist physician. Many people think that weight gain and obesity are caused by a lack of willpower. However, obesity is a multifactorial process, genetics, environmental factors, lifestyle, psychological factors and many more play an important role in obesity. Obesity, which has been seen as an epidemic disease all over the world in recent years, should be followed closely and its treatment should be carried out immediately, the reason for this is obesity can lead to life-threatening problems if left untreated.
Obesity is excessive fat accumulation that poses a high risk to health. However, obesity with this fat accumulation is not just an aesthetic concern. With an abnormally high body fat content, a person is more likely to develop diabetes, heart disease, cancer, and high blood pressure. Obesity is not a commonly thought state of insufficient willpower. Hereditary factors, psychological and environmental factors are determinative in the development of obesity. A person with a body mass index (BMI) over 25 is considered overweight and a person over 30 is considered obese.
Obesity surgery is the common name given to a set of procedures that help you lose weight. In cases where successful results cannot be achieved after diet changes, exercise and drug therapy, bariatric surgery may be preferred method of choice. The operations performed in obesity surgery are also called bariatric surgery. Bariatric surgery involves different surgery techniques performed with the closed surgery method. The selection of these surgeries is made by a series of tests performed on the patient and these tests are evaluated by the physician and interviewed with the patient following that a common, agreed decision is made which is to be in patient’s best interest.
The causes of obesity, which are recognized internationally, are as follows:
- Poor eating habits
- Excessive calorie intake
- Sedentary lifestyle
- Hormonal factors
- Psychological state of the individual
- Cultural differences
- Alcohol and tobacco consumption
- Inappropriate implementation of low-calorie and restrictive diets at frequent intervals
The most basic of obesity symptoms is excessive accumulation of adipose tissue in the body. There are other symptoms as well. These symptoms are as follows:
- Excessive sweating
- Shortness of breath
- Back and joint pain
- Easy fatigability
- Skin problems
- Sleep apnoea and snoring
- Psychological problems and low self-esteem
The development of technology has enabled bariatric surgery to use various techniques. Thus, surgery and obesity treatment plan can be tailored individually for different patient types. The choice of these surgeries and treatments is also determined by the tests and observations made by the physician, and the decision is made during the interviews with the patient.
Gastric balloon application is one of the simplest methods that helps to lose weight. In this method, the balloon filled with air or liquid is placed with the aid of light anesthesia and this process takes 15-20 minutes on average. With the placement of the gastric balloon, the nutrient capacity of the stomach decreases and the person gets full upon eating much quicker. This method helps accelerate the weight loss process. The gastric balloon stays in the stomach between 6 months and 1 year. At the end of this period, the balloon is removed with a simple endoscopic method within 5-6 minutes. The advantages of this method are that it is a simple application and does not cause permanent changes in the patient. However, if the patient continues the lifestyle routine that may have caused the weight gain in the first place after the balloon is removed, it may cause the lost weight to be regained in a short period of time. For this reason, it is of great importance that after the gastric balloon procedure you follow a regular and balanced diet and exercise regularly.
Sleeve gastrectomy is one of the most frequently performed methods in bariatric surgery around the world, helping the patient lose weight. Within the scope of this method, 80-90% of the stomach is removed and the stomach is made into a tube. This reduces the person's calorie intake. Sleeve gastrectomy takes 1-2 hours with the closed method. After the procedure, the patient stays in the hospital for 2-3 days depending on his or her condition. After the surgery, normal diet can be followed after consuming liquids for 2 weeks and soft foods for 2 weeks. However, you should make sure you chew food thoroughly, consume meals in small portions, exercise and take vitamin supplements after the surgery. You should also avoid sweet and caloric liquid foods such as sodas, juices in order not to quickly regain the weight you lost. Postoperatively, patients lose most of their weight within 1 year, but this rate and duration differs from person to person.
In the Gastric By-Pass (R-YGB) method, which is one of the procedures widely applied in bariatric surgery worldwide, the stomach is basically divided into two parts as large and small parts. The duodenum and part of the small intestine are bypassed and joined by the newly formed small stomach. With Gastric By-Pass, it is aimed to restrict the person's calorie intake and to reduce the absorption of consumed foods. Gastric By-Pass (R-YGB) method is one of the methods with high metabolic efficiency used in solving health problems caused by obesity. As a result of this method, the weight loss experienced by the patient may continue for an average of 1.5 years, but it should be known that this period differs from patient to patient. After the procedure, the patient should be followed up frequently and vitamin supplements should be supplemented.
MINI GASTRIC BYPASSS
Mini Gastric By-Pass is a more easily applicable type of Gastric By-Pass surgery. In this surgery, a long stomach pouch is created and part of the small intestine is combined with the stomach pouch. Mini Gastric By-Pass is a short duration and low-cost application. After the application, patients may require vitamin supplementation in the long run.
Duodenal switch surgery, also known as switch, is a surgical operation that combines both gastric bypass and sleeve gastrectomy. Duodenal switch operation is performed in two steps. The first step is to remove 80% of the stomach and shape the remainder into a thin tube. With this process, the stomach, which has a volume of 1.5-2 litres, takes the form of a tube with a volume of 120 ml. In the second step, two separate ways and a common channel are created by separating the small intestine connected to the stomach to create a by-pass. After the following these steps, the stomach volume decreases and the patient reaches a feeling of satiety by consuming less food. As a result of this method, the path of the nutrients in the small intestine is shortened, and as a result, the amount of calories remaining from the food is reduced because the nutrients are less absorbed.
Gastric botox, one of the non-surgical obesity treatment methods, is the endoscopic method of applying botox to certain points of the stomach of patients whose body mass index is between 25 and 35 and who cannot lose weight after trying the conventional methods such as lifestyle changes. After the botox application to the stomach without surgical intervention, the feeling of hunger decreases, while the feeling of satiety is felt for a longer time. Weight loss is achieved with proper diet and exercise. It is the preferred method of choice in patients who are not overweight enough for bariatric surgery (BMI between 25-35) and cannot lose weight despite all efforts. Bariatric surgery is recommended for those with a body mass index over 35.
Obesity surgery is not suitable for everyone who wants to lose weight. The person must be overweight enough to threaten his or her health and must meet some conditions for surgery. These conditions are as follows:
- While the age limit for bariatric surgery was between 18-56, this limit has been reduced to 12 years. However, in pediatric obese patients, surgery is not performed unless the situation is serious enough.
- In obese patients over the age of 60, the health problems of the patient are taken into consideration.
- The patient must have tried to lose weight with exercise and diet changes before the operation and must have been unsuccessful.
- Obesity and the emergence of diseases such as type 2 diabetes, hypertension and cardiovascular in the person also necessitates treatment.
- The person should not have any drug and alcohol addiction.
- The person's body mass index should be over 35-40.
The patient should not have any health problems that prevent the operation and hormone levels should be within normal range
Bariatric surgery is not suitable for patients with advanced stages of cancer, patients with chronic psychological problems, patients with hypertension and pregnant patients.
The patient is examined thoroughly by the physicians in the preoperative period. Then the patient is informed. The patient admitted for treatment is also evaluated by the departments of pulmonology, cardiology, psychiatry, endocrinology, anesthesiology and metabolic diseases. In the last stage before the operation, various laboratory tests, gastric endoscopy and abdominal ultrasonography are performed on the patient.
Patients undergoing obesity (bariatric surgery) applications in experienced centers and experienced hands usually experience no side effects considering right patient and right surgical technique selection.
In the post-operative period, you should visit your doctor, psychiatrist and dietitian regularly.
POSTOPERATIVE WIGHT LOSS
Losing weight after bariatric surgery is directly related to the habits you gain and maintain. General weight loss continues for 1 year. However, after bariatric surgery, you should create a new nutritional routine, pay attention to a protein-based diet and try to exercise regularly. In this process, it is important that you do not cut off contact with your doctor and dietitian.
WHEN CAN I START EXERCISING AFTER THE SURGERY?
You can start exercising whenever you feel like it after bariatric surgery. However, you should not force yourself too much in the beginning. A brisk walk, which will take a maximum of 40 minutes, is sufficient for the beginning. From the 15th day after the surgery, you can swim, run, and start doing sports such as yoga or Pilates. You can also do strenuous exercises that require weights after the completion of the 2nd month. Otherwise, you may experience joint and heart rhythm problems.
WHEN CAN I GET PREGNANT AFTER THE BARIATRIC SURGERY?
If you have had sleeve gastrectomy, you can get pregnant at the end of the first year. However, if you have had a more complex operation other than sleeve gastrectomy, it is appropriate to get pregnant from the 18th month. The time required to become a father is 1 year for men after obesity surgery. If earlier, obesity can be epigenetically passed from father to child.
WILL I LOSE MY HAIR AFTER BARIATRIC SURGERY?
Normally, hair loss does not occur after bariatric surgery. However, since the amount of fat under the hairy skin decreases, skin thinning may occur and your hair follicles may become weak and fall out. In order to prevent this situation, you can use vitamin supplements such as copper, selenium, zinc and biotin by consulting your doctor.