OBESITY

What does Obesity mean?

Obesity is a serious disease caused by complex genetic and environmental factors, with significant morbidity and mortality. Shortly, obesity is defined as the accumulation of fat in the body which cause diseases. In obesity, adipose cells (fat cells) store an excessive amount of triglyceride. This is reflected in the increase of adipose tissue and the patient's excess weight.

What factors affect obesity?

There are personal, genetic and cultural factors that affect obesity. Genetic factors represent 60% of cases. Cultural factors refer to 30%. Just 10% of cases is cause by personal factors.

Obesity development is more likely (reach 80%) in people whose both parents are overweight, if one parent is overweight prevalence decreases (40%), obesity possibility decrease to 10% when parents have standard body weight

How obesity affects our health?

Obesity increases risk of cardiovascular diseases, 2 type diabetes, hypertension, dyslipidemia, respiratory diseases and cancer (breast, colon, etc.). Also; gastrointestinal disorders, gall bladder disease and biliary tract disease are more common in overweight patients

How to diagnose obesity?

Obesity is defined as being more than 20% above recommended body weight. It is calculated on the basis of the ideal weight, determined in population-based studies. Usually obese patients body weight exceeds 100% of the ideal weight.

Several methods of anthropometric measurements or calculations have been developed to determine obesity.

The most important are: body mass index (BMI) and waist circumference measurement. The most widely used diagnostic method of obesity is the body mass index, obtained by dividing the weight to height squared (kg / m2).

What is BMI value for obesity?

BMI

<18.5 Underweight

18.5-24,9 Normal weight

25-29.9 Overweight

> 30 Obesity

30-34,9 Grade I

35-39,9 Grade II

>40 Morbid obesity

>50 Defined as the Super Obesity.

The super obese patients are more than 225% above ideal weight.

Classification according to waist circumference;

Men> 102 cm

In women> 88 cm is considered to be abdominal obesity

What is the prevalence of obesity in the country and in the world?

Obesity is an epidemic of our time. Due to its increasing frequency in the world obesity has become a growing public health problem. According to the statistics of the World Health Organization (WHO), the prevalence of obesity reaches alarming rate in both developed and developing countries. Nowadays obesity has reached the degree of public health problem, surpassing the problem of malnutrition and infectious diseases. Studies have shown 30-40% of cases of obesity among women, 20-25% among men. It is known that 25% of Turkey's population is obese and there is twice as many women as men.

What does bariatric surgery mean?

Bariatric surgery is surgical way to treat obesity. There is lots of surgical techniques, used to treat obesity and help patients to loss weight, all of them referred to bariatric surgery.

What should be consider choosing method of surgery?

Choosing method of surgery for obese patient following criteria should be considered

• Patients Body Mass Index (BMI) rate

• The presence of concomitant disease (diabetes, pressure, cardiovascular disease, lung disease, muscle and joint disorders)

• Eating habits of the patient, eating culture

• Patients expectations for the treatment

• Patients request

Is obesity a disease that require surgical treatment?

In the case of the morbid obesity, when obesity has reached the disease stage, surgery is the only option. Researches have shown that other methods of treatment are unfortunately unsuccessful. In 97% of cases obese patients regain kilograms lost through diet, lifestyle changes, exercise or medical treatment. For this reason surgical treatment is strongly recommend for patients with BMI over 30 and comorbidities (diabetes, hypertension, cardiovascular diseases, diseases of the muscles and joints) and patients without comorbidities but with a BMI about 40.

Which patients are inoperable?

• Patients who are unable to endure the anaesthesia because of degree of comorbidities.

• Patients with psychiatric disorders

• Patients with drug addiction

• Surgical procedures are not performed to some patients with genetic obesity syndrome.

What methods of bariatric surgery are used?

Bariatric surgery techniques are divided into 3 groups.

1. Restrictive methods

2. Restrictive and malabsorptive

3. Methods reducing absorption (Malabsorptive)

The group of restrictive methods included gastric band surgery, sleeve gastrectomy.

The gastric balloon is another restrictive method performed by endoscopic, non- surgical, installation of gastric balloon.

Among the combined methods reducing volume of stomach and absorption (restrictive and malabsorptive) the most important is gastric bypass surgery. Gastric bypass techniques include Roux-N-Y, sleeve gastrectomy, duodenal switch or mini-bypass surgeries.

Among the methods reducing absorption (Malabsorptive) the most popular is biliopancreatic diversion, used in patients with super obesity, eating disorders and habits of eating big among of food.