Obesity and Obesity Surgery
Obesity, simply put, is defined as an increase in body fat tissue to a degree that impairs overall health. Although obesity is often perceived as a cosmetic problem, it is actually a serious health issue. Poor dietary habits, genetic disorders, a sedentary lifestyle, excessive food consumption, and hormonal factors can all contribute to obesity. Furthermore, obesity can lead to significant health problems such as heart disease, diabetes, sexual dysfunction, musculoskeletal disorders, and sleep apnea.
What is Obesity?
Obesity is a complex disorder caused by an excessive increase in body fat tissue, leading to health problems. Obesity is calculated using the Body Mass Index (BMI), which is based on height and weight: The World Health Organization considers a BMI above 30 as obese, above 40 as morbidly obese, and above 50 as super obese. Personalized Obesity Surgery: For suitable obese patients, obesity can be treated more easily with personalized treatment methods.
With our advanced technology and expert academic staff, we offer the most suitable treatment plan for each individual. Personalized treatment options are determined by considering the patient's gender, age, test and examination results, and whether they have any obesity-related health problems.
What Diseases Does Obesity Cause?
Obesity causes many health problems, including negative effects on body systems (endocrine system, cardiovascular system, respiratory system, gastrointestinal system, skin, genitourinary system, musculoskeletal system), psychosocial well-being, and infertility due to its impact on sperm quality. Polycystic ovary syndrome (PCOS), seen in women, is also more frequently associated with obesity.
Hypertension is six times more common in obese individuals than in lean men and women. Hypertension following obesity reaches very high levels, especially in cases of abdominal obesity, where the waist circumference exceeds 80 cm in women and 94 cm in men.
Obesity simultaneously increases the risk of heart disease, diabetes, and high cholesterol, thus creating the necessary environment for the development of hypertension.
What is Obesity (Bariatric) Surgery?
Obesity surgery is the name given to all surgical interventions performed to eliminate morbid obesity, and in medicine it is called "bariatric surgery". Bariatric surgery is currently the most effective method for maintaining weight loss in morbidly obese patients. Bariatric surgery comes into play when a patient cannot lose the desired weight through diet, physical exercise, behavioral modification, and medication.
Bariatric surgery can be considered a chance for patients struggling with advanced obesity to overcome this disease. The most important goals of bariatric surgery are sustainable weight loss, improved quality of life, reduced complication rates, cost-effectiveness, and low mortality rates. To achieve these goals, before surgery, the patient must undergo a thorough evaluation of their eating habits, nutritional and clinical condition by the bariatric surgery team, a psychological evaluation to identify eating disorders, and lifelong follow-up with a team that includes a dietitian.
What methods are used in obesity surgery?
Restrictive methods
These procedures reduce the volume or capacity of the stomach, thus limiting calorie intake by promoting early satiety. Examples include laparoscopic adjustable gastric banding (LAGB), vertical band gastroplasty (VBG), laparoscopic sleeve gastrectomy (LSG), and gastric balloon.
Gastric Sleeve Surgery
This is a surgical obesity treatment method applied to individuals with additional diseases such as knee and heart problems, or to patients with a body mass index of 40 or higher who do not have any underlying diseases. Simply put, during the surgery, 85% of the stomach's volume is removed using various medical instruments, and the stomach is sleeved. The main purpose of the surgery is to restrict the amount of food the stomach can hold. Gastric sleeve surgery alone is not a weight-loss method. In the post-operative period, patients must follow a new diet program and, if possible, an exercise program. If patients adhere to the diet and exercise program, they can lose 65-80% of their excess weight within the first year.
Gastric Balloon
A gastric balloon is a non-surgical weight loss method for overweight patients. In this method, a balloon is sent into the stomach endoscopically and inflated with various special fluids to reach a certain volume in the stomach. This ensures an early feeling of fullness and restricts the patient's food intake. Patients who undergo gastric balloon surgery cannot lose weight solely through the effect of the gastric balloon. As with other procedures, patients should follow an appropriate diet and exercise program.
Gastric balloon placement is performed under sedation in the endoscopy unit, with the assistance of an anesthesiologist. Patients feel nothing during the procedure. After the procedure, the patient is monitored by a doctor for 3-4 hours before being discharged.
Absorption-impairing techniques
These reduce calorie intake by decreasing nutrient flow and bypassing the absorptive area. These include biliopancreatic diversion (BPD) and jejunoileal bypass.
Combined methods
These are methods that both restrict food intake and reduce absorption. These include Roux-en-Y gastric bypass (RYGB) and duodenal switch (DS). **In the fight against obesity, it is possible to achieve successful results with endoscopic methods in addition to surgery. Patients who are concerned about the risks of surgical methods may prefer gastric balloon and endoscopic sleeve gastrectomy procedures.
Gastric Bypass
There are many methods used in obesity surgery. Among these methods, the most commonly performed is Gastric Bypass surgery. Gastric Bypass surgery is used in the treatment of diseases related to obesity. The most preferred and applied disease is Type 2 diabetes.
Gastric bypass surgery is a procedure that both restricts food intake and inhibits absorption. After surgery, the patient's stomach volume will decrease, reducing their appetite. This allows the patient to lose weight more easily.
Common Misconceptions in Obesity Surgery
Surgery is useless at this point'
The patient's age or excess weight, or more generally, whether they meet the necessary criteria for this surgery, is a matter that can only be determined by a specialist physician. Thanks to technological advancements in the medical field, the experience and opinions of our physicians will be the sole determining factor in enlightening you on this matter.
Obesity surgeries are very risky'
Obesity surgeries don't carry any more risk than any other surgery. However, performing these surgeries by surgeons without sufficient experience in this field, in hospitals lacking adequate equipment, can unfortunately result in death. Obesity surgeries must be performed by a team of expert, experienced professionals in a fully equipped center with the necessary technology.
There's nothing else to do after the surgery.'
In overcoming obesity, another aspect as important as surgical treatment is the patient's transition to a post-operative dietary regimen under the supervision of a specialist physician. The patient also needs to adapt emotionally and psychologically to this new diet. While surgery reduces appetite, the reduction in stomach size increases the feeling of fullness. Thus, the patient does not have difficulty correcting their old eating habits.
I won't gain weight again after the surgery.'
We mentioned that surgery alone is not sufficient. 20% of patients regain weight after obesity surgery, and some even return to their previous weight, requiring further surgery. Therefore, the idea that weight gain will be avoided after surgery is incorrect. To prevent this, patients must pay close attention to their diet after the operation.
Eating won't be as enjoyable as it used to be.'
The idea that individuals will experience difficult times and completely lose their enjoyment of food after obesity surgery is a misconception. Patients will experience reduced attachment to food and decreased appetite, and as less food is consumed, the stomach will shrink, leading to a faster and more pronounced feeling of fullness. This makes it possible to maintain adequate and balanced nutrition without the difficulty of dieting. The surgeries do not have any negative impact on the taste and pleasure individuals derive from food.
Why Medipol Mega University Hospital?
At Medipol Mega University Hospital, patients with multiple health problems are evaluated and provided with the most appropriate medical assistance. The aim is to provide the best support for weight loss with the assistance of endocrinology, dietetics, general surgery, and, when necessary, psychiatry, pulmonology, and cardiology. Our intensive care services are provided in single rooms with the most advanced technology. These surgeries can be performed with minimal surgical trauma using robotic systems.
A multidisciplinary approach by a team of experts will create an obesity profile, and surgical intervention will be performed according to your suitability. For this purpose, we recommend surgery to patients who have been obese for the last 5 years and have been struggling with obesity for the last 2 years. In addition, we recommend obesity surgery to obese patients with a body mass index (BMI) of 35 and above who have additional diseases such as hypertension, diabetes, high cholesterol, and sleep apnea, or to obese patients with a BMI of 40 and above who have no underlying diseases.
For detailed information, please visit our International Patient Services page.
The Role of the Dietitian in Obesity Surgery
The long-term and successful outcome of bariatric surgery depends on lifelong nutritional and lifestyle changes in the patient. Monitoring the nutritional status of patients after surgery by a dietitian is crucial for increasing the success of bariatric surgery. The dietitian's role is to assess the nutritional status of patients before and after surgery according to the ASMBS guidelines and to provide dietary counseling for nutritional support in the post-operative period. Research in this area shows that patients who maintain dietitian follow-up after surgery have a better post-operative success rate, experience a greater reduction in body mass index, consume fewer calories, and are more successful in changing their eating behavior. Furthermore, it has been noted that patients who participate in support groups and similar motivational meetings lose more weight than those who do not. Benefits that patients can gain from support groups include social support, sharing experiences, taking responsibility, and receiving tips that reinforce their diet.
Postoperative Nutrition
The newly created stomach pouch has a capacity of approximately 150 ml of food. To allow the stomach pouch to heal, liquid-soft and pureed foods should be consumed for four weeks. Dietary and lifestyle changes are essential for weight loss. However, it is important to avoid causing stomach upset and vitamin and mineral deficiencies. The post-operative eating pattern follows a four-stage process, and transitions between stages must absolutely be made with the doctor's approval.
Phase 1: Clear liquid foods. Approximately 3 days after surgery, clear liquid foods (tea, water, compote, apple juice, broth, etc.) are introduced. Once the patient tolerates these foods, soup, yogurt, biscuits, and white cheese are added on the 5th and 6th days. The patient should consume these foods in small amounts at frequent intervals.
Phase 2: Liquid, soft, and blended foods. Liquid, soft, and blended foods should be continued for 4 weeks post-surgery. Soft fruits (apricots, peaches, strawberries, watermelon, etc.) can be consumed readily. Hard fruits should be blended. To avoid protein deficiency, the patient should consume 70 grams of protein per day.
Phase 3: Semi-solid foods. Four weeks after surgery, the patient is introduced to semi-solid foods. By this time, the stomach pouch has healed, and soft and semi-solid foods can be easily tolerated. Meals should focus primarily on protein-rich foods, avoiding those high in fat and sugar and difficult to digest.
Phase 4: Low-fat, solid foods. Restrictions are lifted approximately 3 months after surgery. All solid foods, red meat, raw vegetables, and raw fruit can be eaten, provided they are chewed thoroughly. Sugar and sweets, creamy soups, sauces, butter, fried foods, and high-fat foods like fast food should be avoided.
Things to do in the pre-operative period
- General health and nutritional status should be assessed.
- A post-operative diet plan should be explained.
- To minimize the risks of surgical procedures, comorbidities should be treated in the best possible way.
- The patient's commitment and motivation to the follow-up program should be assessed.
- The patient should be guaranteed to receive all necessary information regarding the need for lifelong follow-up and the risks and outcomes of surgical options. The patient should be made to understand the potential consequences of surgery.
- The patient should be accurately informed about the risks involved in surgery, and lifelong behavioral changes should be made.
- They must accept the monitoring and tracking programs.
- The patient's clinical condition and bariatric surgery plan should be evaluated.
- Sleep apnea syndrome and lung respiratory function
- Metabolic and endocrine disorders
- Helicobacter pylori gastritis
- Body composition (densitometric assessment)
- Bone density
- Indirect calorimetry
Success and Failure After Obesity Surgery
A successful bariatric surgery can be defined as the patient losing 50-70% of their excess weight and establishing and maintaining new, regular eating habits after the operation.
If the patient also supports this new eating habit with physical activity, it will prevent regaining the lost weight and ensure the continued success of the surgery. Postoperative failure can be defined as the inability to reach the set goals and the regaining of the lost weight to its previous level over time. After a successful operation, the patient's transition to a new lifestyle, eliminating previous eating disorders, and maintaining consistency in this regard is also critically important for maintaining the weight lost.
Who are candidates for obesity surgery?
Patients aged 18-60 with a body mass index (BMI) of 40 kg/m2 or higher, and those with a BMI of 35-40 kg/m2 accompanied by at least two of the following conditions: metabolic disorders such as type 2 diabetes, cardiorespiratory disease (hypertension), sleep apnea syndrome, serious joint disease (osteoarthritis), polycystic ovary syndrome (PCOS), or serious psychological problems related to obesity, are candidates for surgery.
Before deciding on surgical treatment, the patient must have had obesity for at least 5 years, have attempted to lose weight for 5 years without success, and must not have any hormonal disorders. Furthermore, the patient must not be an alcoholic or drug addict. The patient must fully understand the surgical procedure and be able to adapt to the post-operative period.
How Long is the Recovery Period?
Because the method used in obesity surgery does not involve a large abdominal incision, post-operative pain is minimal. Patients are helped to stand up and walk after the operation. Based on observation of the patient's health, they are discharged on a date deemed appropriate by the doctor. The patient resumes their active life shortly after the operation. If necessary check-ups with the doctor are not neglected, the weight loss process will continue healthily.
How Much Weight Loss Will Occur?
After obesity surgery, the amount of food consumed decreases significantly because the patient does not feel as hungry or have the capacity to eat as before. Nevertheless, it is recommended to avoid sugary foods, drinks, and alcohol. While regular check-ups are an important element in preventing possible complications, it is predicted that individuals who adhere to all these conditions can lose at least 50-60% of their excess weight in approximately 12 months.
Exercise After Obesity Surgery
After obesity surgery, patients should definitely consult their doctor about which exercises they can do and start exercising at the most appropriate time recommended by the doctor. Patients who have undergone obesity surgery cannot lose the desired weight solely through the effects of the surgery. As with other methods, patients need to follow an appropriate diet program and exercise routine.