Definition of Obesity and Surgical Treatment
Obesity is defined as the excessive accumulation of fat tissue affecting the health. Body mass index calculation is used for the assessment of obesity. The formula for body mass index (BMI) is weight in kilograms divided by height in meters squared. BMI greater than 30 and 40 is considered as obesity and morbid obesity, respectively.
Diabetes mellitus is a chronic and lifetime disease that is caused by impaired insulin production in the pancreas and/or impaired utilization of the produced insulin by the cells. Starting from the diagnosis, a gradual decrease in the insulin-secreting cells is observed. In a healthy person, nutrients are converted to glucose (sugar) in the intestines, absorbed into the bloodstream and start to increase the sugar level in the blood. At that point, sugar is transferred into the cells with the help of insulin produced in the pancreas. If there is not enough insulin or it cannot properly exhibit its function, sugar cannot penetrate the cells and the glucose level increases in the blood. Thus, diabetes mellitus is developed.
Is obesity a disease?
Obesity has been thought to be a cosmetic problem related to excessive eating and impaired self-control for many years but this belief is changed now. Several international institutes including the World Health Organization consider obesity as a chronic and progressive disorder caused by different environmental, genetic, and psychological factors. Obesity develops as a result of excessive fat accumulation in the body. To maintain our healthy life without gaining weight, the energy obtained from the food intake in one day should be equal to the energy spent on the same day. If we take more than we spend, the surplus of energy is converted to fat and stored in the body, which leads to weight gain and obesity in the long term.
How is obesity diagnosed?
Our total body weight consists mainly of muscles, bones, fat tissues and some other components. In males, 15-18% of the total body weight is fat tissue, while the same rate is 20-25% in females. The increase in this percentage over 25% and 30% in males and females, respectively is called obesity. Although the body fat percentage can be accurately calculated with several methods for the diagnosis of obesity, these methods are expensive and time-consuming. Therefore, a practical calculation method called “Body Mass Index” (BMI) is used worldwide. The classification and treatment plans are done according to this calculation.
What happens if obesity is not treated?
Obesity is not just only a cosmetic problem, it is rather a chronic disorder affecting several organs and systems. It may cause irregular menstruation, infertility and polycystic ovarian syndrome in females and infertility and erectile dysfunction in males due to its effects on the endocrine system. In addition, insulin resistance, type 2 diabetes mellitus, heart diseases, hypertension and hypercholesterolemia, pancreatitis and gallbladder disorders may emerge because of the increased fatty acid levels in the blood. As a result of the physical stress caused by body weight, the patient may complain from sleep problems (sleep apnea syndrome, snoring), dyspnea, joint disorders, and backbone problems.
The most threatening danger is the increased risk of cancer. According to a study conducted in the USA, the risk of cancer is 33% among smokers, while the same risk is 20% among overweight individuals. The most common cancers observed in obesity are breast, uterus, cervix, colon, esophagus, pancreas, and prostate cancers. Furthermore, its negative impact on the psychological condition affects all obese patients.
How is our health affected by weight loss?
Several scientific studies conducted worldwide have shown the benefits of weight loss. In light of these studies,
- We can suggest the following benefits of weight loss; A 1-kg loss in the body fat provides a 2mmHg decrease in the systolic and 1mmHg decrease in the diastolic blood pressure.
- Each 10-kg weight loss means a 10% decrease in the cholesterol level.
- Regarding the chronic metabolic diseases, the risk of development of diabetes mellitus is decreased by about 40-60% within 3-4 years if individuals with high risk achieve a moderate weight loss with diet and exercise.
- A 1% restriction of the daily energy intake decreases the bodyweight about 0.28kg.
Who are suitable for obesity surgery?
Obesity surgery can be considered in patients, who have a BMI>40kg/m2 or between 35-40kg/m2 concomitant with metabolic diseases like diabetes, hypertension and sleep apnea syndrome and tried lifestyle changes (diet and exercise) without success.
Example: Is a person with a height of 165cm and a weight of 120kg a candidate for surgery?
Body Mass Index=Weight (kg) / Height (m²)
Body Mass Index=120kg / 1.65mx1.65m
Body Mass Index = 120 kg / 2.72 m²
Body Mass Index = 44.11 kg /m²
This patient has to be classified as “morbidly obese” and they can be considered as a candidate for bariatric surgery if they have previously tried to lose weight with diet and exercise without success.
What are the benefits of surgery?
Obesity surgery provides more permanent and effective metabolic outcomes compared to the outcomes obtained with lifestyle changes, diet, exercise, and medical treatment due to the significant weight loss in a short time. The postoperative morbidity and mortality rates become comparable to the common surgeries like gallbladder surgery or uterus surgery depending on the increased experience of the surgery teams. In scientific studies focused on the efficacy and safety of obesity surgery, the operated and not operated morbidly obese patients are compared and the investigators found out that the mortality risk related to cardiac factors and all factors was higher in the not operated groups.
What affects the success of obesity surgery?
The success of surgery depends primarily on the selection of suitable patients. Because it is important which patient will be operated and which type of surgery will be preferred. All these decisions should not be made only by the surgeon but by the obesity treatment team. This team should consist of physicians experienced in the endocrinology, psychiatry, cardiology, pneumology, anesthesiology-reanimation, general surgery, and nutrition. The main principles are the selection of suitable patients, good preparation, and successful outcome. If the team detects any problem after the assessment, surgery can be delayed or canceled.
The key to lifelong success iin patients, who will undergo surgery, is high awareness and conscious behavior through the entire life. The most important issue that should be always kept in mind is that these surgeries are just a tool and cannot treat alone all obesity-related diseases. After surgery, during the weight-loss period, the patient should follow the recommended diet and exercise programs to preserve the muscle mass and lose only the fat tissue and long-term control visits. To maintain the bodyweight following the weight loss, the patient should first recognize the reasons leading to obesity and change the lifestyle to avoid these hidden dangers.
What should be done to prepare for surgery?
One of the important factors affecting the short- and long-term success of surgery is good patient preparation. Before surgery, the presence of any metabolic disorder like thyroid gland disorders, Cushing’s syndrome, or obesity-mediated hypertension, sleep apnea syndrome and diabetes should be assessed. In addition, the stomach is examined with endoscopy for gastritis, ulcer, and reflux and surgery is scheduled after the treatment of the detected problems. The abdominal ultrasonography is used for problems like biliary sludge and stones. If these problems are detected, the gallbladder is also removed during surgery.
How long last the preparation, surgery, and hospitalization?
The total hospitalization in the intensive unit and hospital is approx. 7-10 days depending on the patient’s age, co-morbidities, and general condition after surgery. In patients coming from other cities or countries, we prefer that they stay in Istanbul so that we can monitor them in the first 4-5 days after surgery. During this period, surgical controls are done and the patient is informed about the lifestyle and nutritional issues.
How often will be the follow-up control visits after surgery?
Although the frequency of the follow-up visits is determined according to the co-morbidities by the physician and the patient, it will drop in time.