Obesity Surgery

Obesity is one of  the most important health problems of developed and developing countries today.  Obesity is, in general, an excessive increase in the ratio of lean mass to fat mass in the body, which exceeds the desired level of body weight according to the resultant height.
As it is known; Nourishment is an indispensable need of life that starts in the womb and continues until the end of life.
It is the ability of people to grow and develop, to take healthy and productive food items that are necessary for a long time to live and use in the body in a sufficient and balanced amount.
Eat one’s fill, supress hunger is not eating or drinking everything you want.
In everyday life, individuals (Pregnant, nursing, infant, school child, young, old, worker, athlete, cardiovascular, sugar, hypertension disorder, respiratory tract disorders and so on.)need daily energy, which varies according to age, sex, work, genetic and physiological characteristics and disease state.
In order to maintain a healthy life, the energy received and the energy consumed must be balanced.In adult males, 15-18% of body weight and in adult females 20-25% of body weight constitute fat tissue. İf this rate is greater than 25% for males and 30% for females, obesity occurs.
If the daily energy received is greater than energy consumed, the unspent energy is stored int the body as fat and cause obesity.
In parallel, along with facilitating life,  developments in today’s technology have significantly restricted daily movements. Obviously, obesity is accepted as a disease affecting the quality and quality of life negatively. And it occurs when the energy consumed by foods (calories) is higher than the wasted energy and the excess energy stored as fat in the body (20% or more)
Obesity is also defined by the World Health Organization (WHO) as an accumulation of excess fat in the body to the extent that it can impair health.
Causes of obesity
– Lack of physical activity, inactivity.
– Nutritional habits; eating fatty foods, eating too much.
– Some medicines and hormones
– Hormonal diseases
– Increase with age
– More frequent in women than in men (kilograms taken at pregnancy)
– Increase as the number of pregnancy increases
– After marriage
– Smoking cessation
– Alcohol
 Result of obesity
• The risk of Chronic heart disease increases.
• May cause asthma.
• The risk of atherosclerosis increases.
• The risk of hypertension increases three-fold compared to non-obese.
• The risk of developing type 2 diabetes is increasing.
• It can cause depression and gout.
• Obesity increases fatal stroke risk.
• Osteoarthritis may develop in the foot and knee joints.
• Libido and potency may decrease.
• In men, the risk of colon, rectum and prostate Ca is increased.
• Reflux esophagitis and hiatus are more common.
Calculation Obesity
The most commonly used measure for obesity is Body Mass Index (BMI) and waist circumference measurement. BMI, Body weight (kg) divided by the square of height (m²). This value is independent of age and gender. However, the use of BMI should not be used for children, pregnant women and highly muscular persons since it does not give accurate results. Health authorities have divided the BMI values into normal overweight, overweight and obese groups.
Below 18.5 kg / m²’nin altında olanlar Thin
Between 18.5-24.9 kg / m²
Normal weight
Between 25-29.9 kg / m²  Over weight
Between 30-39.9 kg / m²
Obese (fat)
More than 40 kg / m² Advanced (morbid) obese
Incidence of obesity
Obesity is among the most important health problems of developed and developing countries today. The obesity rate in the USA and European countries is 30-35%. As well as in other countries of the world, in our country the frequency of obesity is increasing day by day. According to the “Turkey Nutrition and Health Research-2010” study report, the incidence of obesity (BMI ≥30) in Turkey was found to be 20.5% for males, 41.0% for females and 30.3% for both.3% of them are morbid obese (BMI ≥ 40). Obesity tendency is alarming especially in children. The annual increase in childhood obesity is growing.
It is reported that the prevalence of childhood obesity is 10 times higher than the values in 1970s. According to World Health Organization data, in developing or developing countries, about 20% of children are overweight and one third of them are obese.
As Obesity becomes increasingly widespread and becomes a public health problem, fighting efforts have been started all over the world.
Treatment of Obesity
Diet
Diet plays a key role in the treatment of obesity. Obesity with diet therapy: BMI should be targeted at 18.5-24.9 kg / m2. In order to reduce energy intake in dietary therapy, the daily calorie intake should be reduced of 500-1000 Kcal. Then the daily calorie is limited to 1500-1600 kcal. The weight loss diets should be compatible with adequate and balanced nutrition guidelines.
The aim is to give the right nutrition habit to the individual and to maintain this habit.
Remember to limit your fat and calorie intake and also exercise in order to preserve your life-long kiln after weight loss.
Avoid the following high-fat foods and sugary drinks except in small quantities
• Mayonnaise
• sour cream
• Cream cheese
• Cake, pie
• Refined (white) bread
• Nuts (oil)
• Avocado (oil)
• Full fat milk
• Butter, margarine
• Peanut butter (oil)
• Full fat cheese
• Ready salad dressings
• Potato salad
• Pasta, rice pilaf
• Ice- Cream
• Tail fat
• Fried foods
• Bacon, sausage,
• Crisps
• Donat
•All oils (olive oil, sunflower oil, etc. – use without overdrive)
• Beverages with sugar
• Sauces
• Muffin
• Crackers, biscuits
• Alcohol (including beer)
Exercise
Exercise is an important method in the prevention and treatment of obesity that helps other treatment approaches. Exercise is a must for the success of other methods. Physical activity reduces fat tissue and fat in the abdomen, as well as prevent muscle mass deficits that can be seen when dieting.
Exercise therapy supports dietary therapy and may prevent individuals from gaining back weight after the diet.
In obese individuals, the most important issues is to prevent  risk of injuries when exercising. That’why the exercise program is kept in minimum while increasing energy expenditure. The recommended exercise program should be specific to the individual, fun, applicable, and compatible with the individual’s daily life habits.
Medication
DDrugs to be used in obesity treatment are not suitable for mild to moderate obesity.
It is very important that the drugs used are determined to be reliable in terms of health, have an appropriate effect on the etiology causing obesity, have no significant side effects in the short and long term and should not be addicted and should be used for medical advice and controlIn order for obesity treatment to be successful, the patient must agree to continue with diet therapy and exercise therapy as well as drug treatment and regularly come to checkups
 Stomach balloon
The stomach balloon is a medical prosthesis in the form of a balloon made of a synthetic material called silicone.The purpose of producing the stomach balloon is to reduce the stomach volume by creating a volume when inflated in the stomach (400-500 ml). So people with a stomach balloon usually feel much less satiety if they eat a lot less. Because the stomach balloon is made entirely of artificial plastic material, it does not melt in the stomach. However, after a certain period of stay it is need to be removed from stomach. For most of the stomach balloons, this is usually about 6 months. However, different brands of different stomach balloons can stay in close to 12 months. Stomach balloon application is the easiest attenuation method. It is very difficult to suppress the feeling of hunger and reach the feeling of satiety with the portions recommended in the diet. The stomach balloon provides a feeling of early satiety with a small amount of food.
Surgical Treatment
Surgery is the other option in obesity treatment if diet, exercise, and drug therapy are failed.
If the patient’s BMI exceeds 40 kg / m2 for 5 months or longer, it is an important indication for obesity surgeon.Surgery is also indicated in patients with a BMI of 35-39,9 and severe medical problems associated with obesity such as type 2 diabetes, hypertension or sleep apnea. In some cases, patients with VKI 30-35 and severe health problems due to obesity may also be candidates for obesity surgery. The increasing number of obesity worldwide and the failure of other treatment methods have increased the importance of surgical treatment methods. The number of surgical procedures is increasing every year.
Surgical Treatment Options
Gastric bandage
A band of silicone (clamp) should be attached to the upper part of the miter just below the food borne (esophagus), which is the practice, to create about 15-20 cc volume. A simpler explanation is that the hourglass is brought into shape.This surgery is a restricting (restricting food intake) surgery. The weight loss is based on the principle that excess food can not be obtained by reducing the volume of stomach. When the small stomach is filled up with the clamp, it is not possible to get more food.
Sleeve gastrectomy (Tube stomach, Stomach reduction)
In this method, 2/3 of the stomach is laparoscopically removed Normally stomach volume is 800-1000 ml.After sleeve gastrectomy, the stomach volume shrinks by 250-300 ml. This means that the patient can eat only ¼ of before surgery. Another effect of sleeve astrectomy is reduced post-operative hunger. The starvation hormone (Ghrelin) is secreted from the largely removed part of the body. Therefore, postoperative Ghrelin hormone level is decreased and appetite is decreasing.
Gastric plication
The stomach volume is reduced by 70% by placing one or two stitches on the midline.
Patients therefore succumb when they are taking up 1/3 of their foods. Unless sleeve gastrectomey, ın gastric plication the part of stomach is not been removed, it is only folded into itself. This is a process that can be recycled. Complications risks are less than other conditions.
Gastric Bypass
It is about 50-60 ml from the bottom of the junction with the food pipe. The stomach is stapled with the volume remaining and divided into 2 separate pieces. Then a new mouth is created between the small intestine and this newly created stomach lumen so that about 100 cm of the small intestine is out of digestion. By this way The food get by stomach  is very limited and also The absorption surface of the small intestine is reduced by about 30% . When you fill the small slice of food you get a feeling of rapid saturation.
Mid-Degree (10%) Weight Loss Benefits include:
• 20% reduction in all-cause mortality
• 30% reduction in death due to diabetes
• 50% reduction in fasting blood sugar
• 20% reduction in deaths due to cardiovascular disease
• Significant improvement in quality of life
• Significant improvement in depression
By giving 60-70% of the excess weight, obesity-related illnesses improve by 60-85%
• Asthma
• Hypertension
• Reflux disease
• High cholesterol
• Osteoarthritis in knee and foot joint
• Sleep apnea
• Type 2 diabetes
• Depression
Treatment of obesity like obesity is also quite complicated. All patients should have a treatment appropriate to each patient, rather than a single treatment. This is possible with the work of a multidisciplinary team.

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