Obesity Definition and Surgical Treatment

Obesity means fat accumulation in the body which is more than standards and impair the health. For the calculation of obesity, body mass index calculation is used on the height and weight of the person. Body mass index (BMI) is obtained by dividing the weight in kilograms by the square of the height in meters. According to the results, if the body mass index is over 30, the person is defined as obese and if the body mass index is over 40, the persona is defined as morbidly obese.


Diabetes is a chronic disease that can last for a whole life when the pancreas cannot produce enough insulin or cannot use the insulin produced in the body effectively. It is observed that insulin cells slowly decrease since from the diagnosis. In healthy metabolisms, nutrients break down in our intestines to turn into glucose (sugar), move from the intestines to the blood and begin to increase the sugar content in the blood. At this point, the sugar is transferred into the cell with the help of insulin hormone produced by the pancreas. If insulin hormone is not a sufficient level in the body or if it cannot function properly, glucose in the blood cannot be transferred to cells and glucose rate in the blood continues to increase. As a result, diabetes develops.

Is obesity a disease?

Obesity is no longer a cosmetic problem caused by eating too much or lack of self-control over the body. Many international organizations, especially the World Health Organization, regard obesity as a chronic and progressive disease resulting from different environmental, genetic and psychological causes. Obesity is caused by excessive accumulation of fat in the body. It is necessary for pursuing a healthy life without gaining weight that the energy taken from the foods in a day should be equal to the energy that we spend in a day. If we receive more energy than we consume, this unburnt excess energy is stored in the body as fats and causes weight gain, which leads to obesity if continues for a long time.  


How is obesity diagnosed?

The total weight of our bodies is composed of muscles, bones and fat tissues and other elements. In males, 15-18% of body weight and 20-25% in women are formed by fat tissue. If this rate goes beyond 25% in men and 30% in women, obesity is seen. Many different methods for the diagnosis of obesity can be used to calculate the body fat, but these methods are both expensive and time consuming. Instead, a practical calculation method called ‘Body Mass Index’ (BMI) is used all over the world. According to this calculation, a classification is made, and the possible health risks are determined for each group and the treatment is scheduled.


What happens if obesity is not treated?

Obesity is not a cosmetic problem on its own, it is a chronic disease that affects many organs and systems. Due to the negative effects on the endocrine system; menstrual irregularities, infertility and polycystic ovary syndrome in women, and infertility and erectile dysfunction in men (impotence) may be seen. Besides, insulin resistance and type 2 diabetes, heart diseases, hypertension and high cholesterol, pancreatitis and gall bladder problems can be observed due to the increase in the amount of fatty acid circulating in the blood. Sleep problems (sleep apnea syndrome, snoring), dyspnea, joint disorders and waist problems can occur due to physical stress caused by weight.
The most frightening danger is that cancer development risk is seen as more common in overweight and obese people. According to a study conducted in the United States, the risk of cancer in smokers is 33%, while this rate is 20% in overweight and obese. The most common cancers are breast, uterus, cervical, colon, esophagus, pancreas and prostate cancers. In addition, negative psychological effects affect almost all obese patients.


How is our health affected by weight loss?

Many scientific studies have been conducted around the world to evaluate the positive effects of weight loss. In the light of these;

  • Vücut yağında 1 kg’lık azalma olması, sistolik kan basıncında (büyük tansiyonda) 2 mmHg, diyastolik kan basıncında (küçük tansiyonda) 1 mmHg düşme sağlamaktadır.
  • Her 10 kg kilo kaybı, total kolesterolde %10’luk bir düşüşe neden olmaktadır.
  • Kronik metabolik hastalıklar açısından yüksek riskli kişiler diyet ve egzersizle orta düzeyde kilo verdiğinde, 3-4 yıl içinde diyabet hastası olma riskleri %40-60 azalmaktadır.
  • Bir gün içinde alınan enerji miktarı %1 oranında kısıtlandığında, vücut ağırlığında 0.28 kg azalma olmaktadır.

How is our health affected by weight loss?

Many scientific studies have been conducted around the world to evaluate the positive effects of weight loss. In the light of these;
• A 1 kg loss in body fat results in 2 mmHg decrease in systolic blood pressure (high blood pressure) and 1 mmHg decrease in diastolic blood pressure (small blood pressure).
• Each 10 kg weight loss causes a 10% decrease in total cholesterol.
• High-risk patients in terms of chronic metabolic diseases have 40-60% decreased diabetes risk in 3-4 years when they lose moderate weight with diet and exercise.
• When the daily energy intake is restricted by 1%, 0,28 kg decrease occurs in body weight.
Who should be operated for the treatment of obesity?
Operation can be considered for the treatment of obesity in patients whose BMI value is > 40 kg / m² or between 35 and 40 kg / m² and those who have metabolic diseases such as diabetes, hypertension and sleep apnea syndrome, having tried lifestyle changes (diet and exercise) in an effective way before but have not been successful.
Example: Is a person who is 165 cm tall and weighing 120 kg candidate for operation?
Body Mass Index = Weight (kg) / Height (m)²
Body Mass Index = 120 kg / 1,65 m x 1,65 m
Body Mass Index = 120 kg / 2,72 m²
According to the BMI calculation, this patient is classified as Morbid Obese; additionally, is s/he has effectively tried losing weight with diet and exercise before but has not been able to be successful, s/he is also a candidate for bariatric surgery application.


What is the advantage of surgery?

Obesity surgery is to provide much more positive, permanent and effective metabolic results by losing excessive weight in a short time than obtained by changes in lifestyle, diet, exercise and medical treatments. Death rate and being permanently disabled after the operations have been reduced until to a similar level with other surgeries such as gallbladder or uterine operation which are performed commonly. In scientific studies made on effectivity and reliability of obesity surgery, operated and non-operated morbid obese patients were compared, and it has been seen that non-operated patients have much higher risks for death depending on heart diseases and other all reasons.


What is important for the success of obesity surgeries?

Surgical success depends on the correct patient selection at first. That is because it is very important to decide which patient should be operated and which operation type should be applied to which patient. All these decisions should be taken not only by the surgeon; but it should also be decided together with the obesity treatment team. This team should include experienced specialists interested in endocrinology, psychiatry, cardiology, chest diseases, anesthesiology-reanimation, general surgery and nutrition departments. The basic principle is to choose correct patient, do proper preparation and have a successful result. If any problem is detected as a result of the examination of the team, it may cause postponing or completely canceling the surgical intervention.

The key to lifelong success is that patients who are going to undergo surgery are conscious and aware of the process. The most important issue that should be remembered that these surgeries are only a tool and they cannot treat all obesity-related diseases by themselves. During the weight loss process after surgery, the patient should definitely follow the diet and exercise program in order to protect muscle mass and lose weight from fat tissue and he should continue doctor controls regularly even in the long term. In order to preserve the weight loss for a whole life, the patient should first be aware of the reasons which lead him to obesity and change his life style completely in a way to avoid from these hidden dangers.


What should be done for preparation of the surgery?

One of the important factors affecting short and long-term success after surgery is good patient preparation. Before the operation, it is evaluated whether there is a metabolic disorder such as hypertension, sleep apnea syndrome, diabetes which is caused by obesity or there are thyroid gland diseases, Cushing syndrome etc. In addition, it is investigated whether there is a gastritis, ulcer or reflux complaint in the stomach and operation is started after identified problems are medically treated. By abdomen ultrasound, it is investigated whether there is a stone or sludge problem in the gallbladder. If there are such problems, the gallbladder is also removed during the operation.


How long are the preparation, operation and hospitalization?

Although the intensive care duration and hospitalization period change depending on patient’s diseases and general condition after the operation, it is around 1 week – 10 days. It is preferred that our patients coming from other cities and countries stay in Istanbul in order to observe them for 4-5 days after the operation. During this period, both surgical controls are done, and training is given about postoperative life style and nutrition habits.


How often is doctor control necessary?

Although doctor controls are determined by the doctor and the patient depending on the additional diseases of the patient, its frequency is decreased over time.