What is Obesity?
Obesity, or popularly known as “overweight”; often wrong – unhealthy diet and inactivity – is a life-threatening disease that occurs as a result of excessive accumulation of fat in the body due to lack of physical activity. Besides these factors; Many genetic, environmental, neurological, hormonal and psychological factors cause obesity.
Obesity; It sets the stage for serious problems such as first Metabolic Syndrome and then Diabetes, Hypertension, Heart Diseases and must be treated.
Obesity and diseases triggered by obesity threaten modern society as an epidemic that we cannot prevent.
Treatment of concomitant diseases such as Type 2 Diabetes, Hypertension, Fatty Liver, Dyslipidemia has expanded the purpose of surgical treatments in obese individuals and the metabolic positive results of the treatment have become as important as losing weight.
Despite the benefits of trying treatment plans equipped with lifestyle changes, planned nutrition programs and exercise prescriptions before Bariatric / Metabolic Surgery, the most effective and permanent treatment option for Morbid Obese individuals; It is an Obesity Surgery.
Obesity is not a problem that cannot be overcome. Just put yourself in safe hands.
How is Body Mass Index Calculated?
In obesity, Body Mass Index- BMI (Body Mass Index-BMI) calculation is based. Body mass index (BMI); It is obtained by dividing your body weight by the square of your height.
Weight / height 2 Example: For a 130 kg 170 cm person, BMI is calculated as 130 / (1.7 * 1.7) = 44.9 kg / m 2.
If the body mass index of the individual is above 40, it is called “obese”.
Body mass index is at 35; Patients with additional diseases such as insulin resistance, hypertension, and hyperlipidemia are also eligible for bariatric surgery.
HOW IS OBESITY TREATED?
Dietary Treatment of Obesity
Obesity and Medical Nutrition Therapy
Obesity is a chronic disease that results from the fact that the energy taken into the body by nutrients is more than the energy consumed and is associated with an increase in body fat mass compared to lean body mass.
Obesity is an important health problem that causes various disorders and even deaths by affecting all organs and systems of the body, especially the cardiovascular and endocrine systems.
It has been stated in recent publications that obesity, which is accepted as one of the 10 most risky diseases by the World Health Organization (WHO), is closely related to cancer.
Obesity is also known to pose a risk for various diseases such as cardiovascular diseases, hypertension, Type 2 diabetes, metabolic syndrome, dyslipidemia, some hormone-dependent cancers and obstructive sleep apnea syndrome.
Obesity treatment purpose; to reduce the morbidity and mortality risks related to obesity, to give the individual an adequate and balanced nutrition habit and to increase the quality of life.
Even small weight loss of obese individuals (5-10% of the initial weight) contributes to health improvement in the short term or may reduce the severity of comorbid diseases that may be caused by obesity.
Purpose in the nutritional treatment of obesity; By creating an energy deficit, there should be a decrease in fat stores without loss of mass in muscles and vital organs, and the loss of vitamins, minerals and electrolytes should be prevented. Although there are many methods in providing weight loss, the main principle of treatment is; The energy expended is less than the energy taken. Realistic weight loss should be targeted while establishing the diet.
As a realistic target, it should be aimed to lose 5-10% of excess weight in the first 6 months of the slimming program. This requires energy restriction to provide 0.5-1 kg loss per week.
Medical Nutrition Treatment of Obesity:
Energy: The basic principle in determining the daily energy amount in nutrition programs recommended for slimming is that the energy taken is less than the energy spent. The daily energy intake of the individual can be provided by a reduction of 500-1000 kcal from the daily energy required to provide 0.5-1 kg weight loss per week.
Protein: 12-15% of the energy determined daily should come from proteins and more quality protein sources should be used. About 30-40% of the total protein should be obtained from animal sources to meet the vitamin B12 requirement. Adequate intake of proteins; It is important because of providing a feeling of satiety, protecting lean body mass and positive effects on tissue formation.
Fat: In line with healthy nutrition recommendations, it is recommended that 25-30% of the daily energy amount comes from fat. Providing this ratio in the diet is important in terms of taste, feeling of satiety and long-term application of the diet. In addition, in order to increase the absorption of fat-soluble vitamins (A, D, E, K), the fat content of the diet should not be reduced too much, it should be ensured that the part of the energy provided from fat does not fall below 20%.
The types of oil to be used during cooking are also important. The ratio of energy from saturated fatty acid should be less than 10%, polyunsaturated fatty acid 7-8%, monounsaturated fatty acid 10-15%. The amount of cholesterol in the diet should be below 300 mg / day.
Carbohydrate: 55-60% of dietary energy should be provided from carbohydrates. The consumption of simple carbohydrates such as sugar should be reduced (≤10 of the daily energy), dry legumes (chickpeas, lentils, dry beans, etc.), whole grain products, bulgur, etc. Consumption of foods containing complex carbohydrates should be increased. It has been reported that carbohydrates, especially oligosaccharides and polysaccharides with high fiber content, control energy intake by creating a feeling of satiety and can reduce the risk of obesity development.
Vitamins and minerals: Vitamin and mineral deficiencies (B group vitamins, iron, calcium, etc.) can be seen in slimming diets parallel to the low energy content. There is no shortage of vitamins and minerals in diets that are not very low in energy and are balanced in terms of nutrients.
Fiber: It is widely believed that increasing dietary fiber is effective in preventing obesity and weight gain, as in many chronic diseases. Pulp; Due to the long chewing time, it is important in the implementation of the nutrition program for many reasons such as prolonging the eating time, providing a feeling of satiety by slowing the gastric emptying rate, preventing constipation by increasing bowel movements and stool volume, and not increasing the insulin level too much. The amount of pulp to be taken daily for adults is 25-35 grams. Vegetables, fruits, legumes, whole grain flour and whole wheat products are recommended natural fiber sources.
Alcohol: Not recommended in slimming diets. If alcohol is consumed, the calorie value should be calculated and subtracted from the daily energy need. Examples of drinks containing about 30 grams (200 kcal) of alcohol are 60 ml of raki, 270 ml of wine, 750 ml of beer, 75 ml of whiskey, 80 ml of vodka or 90 ml of gin.
Liquid: When taken before and after meals, 2-3 liters of fluid should be consumed daily due to its role in increasing stomach fullness and eliminating metabolic wastes. Especially 1-1.5 liters (8–10-glasses) of this liquid should be met from water. Drinking water is very important in preventing constipation. Constipation negatively affects the weight loss of the individual.
Salt: Salt should be restricted in the nutrition program applied to obese individuals with edema and hypertension due to heart failure or other reasons. If these problems are not present, salt intake should not exceed 5 grams (1 dessert spoon) per day.
Meal order: Although the nutrition program varies according to the person, it should be arranged as 4-6 meals a day. Feeding at frequent intervals prevents overeating, delays hunger and reduces nutrient intake at the next meal.
General Recommendations in Medical Nutrition of Obesity:
- Eat less and often. Eating at least 5-6 meals a day will help you lose weight by speeding up your metabolism.
- Be sure to start the day with breakfast.
- Eat your meals slowly and in a calm environment as much as possible, chew well.
- Do not be busy with anything while eating.
- Take care to consume enough water throughout the day to keep your urine light colored.
- Choose low-calorie but healthy foods instead of high-fat, sugary foods.
- Consume at least 5-8 servings of vegetables and fruits a day. Thus, you will be able to stay full for a longer time by eating both vitamins and minerals and rich in pulp.
- Prefer brown bread more often than white bread.
- Use less oil while cooking. They provide more than twice as many calories as fats, carbohydrates, and proteins.
- Use vegetable oils.
- Instead of frying, choose healthier methods such as boiling, grilling, and baking.
- Buy low-fat milk and dairy products.
- Do not consider dietary products as unlimited foods, most of them have quite a lot of calories.
- You definitely increased your physical activity. Like walking at least 3-4 times a week, walking nearby, using the stairs, dancing.
- Be sure to go shopping full and do not buy foods that will harm your diet.
Treatment of Obesity with Endocrinology and Internal Diseases
Obesity is one of the most common diseases of our age.
Obesity; It is the condition of having more fat than the amount of fat that should normally be in the body.
How to Measure Body Fat?
Fat ratio in the body; waist circumference is determined by applications such as weighing, anthropometric methods and the dxa method.
Obesity is growing day by day in our country as well as in the world. Approximately; 50% of women and 1/3 of men are obese. Obesity is an insidious disease; In the long term, it causes the development of diseases that increase the risk of death in the chronic period. For example; It causes adverse effects on all organs together with diabetes, high blood pressure, and arteriosclerosis. It disrupts the ventilation of the lungs and has a negative effect on the intestinal system.
How Obesity Is Treated?
In obese individuals, first, by checking whether there are hormonal disorders seen with a probability of 15%, the patients are evaluated.
If there is a hormonal disorder as a result of the tests, the first application is for the treatment of that disease.
If there is a disease, appropriate methods that provide weight loss are started to be applied after treatment. If there is no disease, diet therapy and exercise are arranged first. Appropriate weight loss medications are started to be administered to patients who cannot lose weight with diet exercise.
What Are Obesity Treatment Methods?
Diet, exercise and drug treatments are available.
Nowadays, there are many more drugs and treatment methods available. There are different groups of drugs:
- Insulin Resistance (Effective on Liver and Adipose Tissue),
- Drugs Effective on Fat Absorption
- There are some psychiatric drugs that act on the Gastrointestinal System and give a feeling of satiety, stop and slow the emptying time of the stomach.
As a result; These methods are used by blending them according to the comorbid diseases of the patient.
Adipose tissue, like other organ systems, produces more than a thousand hormones. The development of insulin resistance reveals the causes of diseases such as impaired functioning of the liver, negative effects on the brain and muscle tissue. When the adipose tissue increases, these peripheral effects occur as a result of the imbalance in the hormones produced.
Obesity related surgical procedures generally take place in two parts:
Bariatric surgical applications for obesity reduce stomach volume. With this application, patients are full early. They should take plenty of fluids and stay away from solid foods. Patients who have this surgery should not consume liquid foods with plenty of carbohydrates.
- Short Circuit Operations at Intestines Level (Absorption Disruptive Treatment Methods)
Absorption from the intestines of the patient is reduced, changes and short circuits are made in some hormones secreted from the intestines, resulting in the patient’s weight loss.
There are also operations where these two surgeries are performed together. Stomach-reducing surgical operations are relatively less complicated than other operations. More successful results are obtained in operations where the intestinal segment is shortened. More successful results are obtained in the long term. Especially in patients with diabetes, short segment intestine is formed; It can be seen that the treatment of diabetes is alleviated and even the diabetes is improved. Due to the different characteristics and ailments of the patients after the surgery, the results may differ between the patients. Different results can be obtained in individuals depending on the degree of diabetes and the amount of adipose tissue.
Who Can Have Obesity Surgery?
- Individuals with a Body Mass Index of over 40 and a lot of adipose tissue are suitable for obesity surgery.
- Patients with a Body Mass Index over 35 and having dangerous diseases, ie; Cardiovascular diseases, patients receiving intensive diabetes treatment, patients using insulin therapy over 100 units a day, and patients with lung problems, when they cannot get rid of adipose tissue, are considered to be in the risky group in the future. In this case, obesity surgery procedures can be applied.
What are the Surgical Treatments in Obesity?
Obesity and diseases triggered by obesity threaten modern society as an epidemic that we cannot prevent. Treatment of concomitant diseases such as type 2 diabetes, hypertension, fatty liver, dyslipidemia has expanded the purpose of surgical treatments in obese individuals and the metabolic positive results of the treatment have gained importance as much as losing weight.
Obesity surgery, which is the most effective and permanent treatment option in morbid obese individuals, should be supported by the teams working on this subject with treatment plans equipped with lifestyle changes, planned nutrition programs and exercise prescriptions.
“Bariatric Surgery” is used for surgical interventions applied for therapeutic purposes to people who fail to lose weight with the treatment and diet programs applied, have a Body Mass Index (BMI) higher than 40 or BMI
higher than 35, and have some chronic diseases and therefore have serious health problems. or it is called “Obesity Surgery”.
Obesity Surgery – Bariatric Surgery, which has an important place in the treatment of obesity, patients can return to their normal weight and the incidence of obesity-related diseases in these people also decreases.
Thanks to the Obesity Surgery performed with the closed surgery method (laparoscopic), the healing process of the patients is shortened.
Bariatric Surgeries provide 80% weight loss in the first year, when supported with necessary lifestyle changes.
Who Is Eligible for Obesity Surgery?
Individuals with a Body Mass Index above 40 kg / m2 or BMI above 35 kg / m2 and with at least one concomitant disease are considered surgical candidates.
Individuals with metabolic diseases such as type 2 diabetes, hypertension, fatty liver, or significant irregularity in blood fats can be analyzed according to BMI groups and become surgical candidates.
Musculoskeletal and joint problems, functional and psychiatric problems and sleep apnea are also important problems that can accompany obesity and cause people to be defined as morbid obese.
Type 2 diabetic patients whose body mass index is in the range of 30-35 kg / m2 and whose disease cannot be controlled with standard antidiabetic treatments are also among the indications for metabolic surgery, provided that the decision of the endourologist is made.
What is Obesity Surgery?
Obesity Surgery; It is a surgical procedure that offers a life style in which individuals who cannot lose weight by changing their lifestyle, diet, programmed sports and drugs can return to their ideal weight with appropriate surgical intervention, control their risks against chronic problems such as diabetes, cardiovascular diseases, and start enjoying life by making peace with their body.
Is Obesity Surgery Performed at All Ages?
How are the Obesity Surgery Methods Decided?
Gastric bypass surgery is preferred in patients with type 2 diabetes who use high doses of insulin, those with severe reflux or those with sugar-sweet addiction, while sleeve gastrectomy has become the most used method for other patients.
What is the Role of Endoscopic Methods in Obesity Surgery?
In patients with obesity and need to lose weight, but who are not candidates for surgery, gastric balloon application supported by well-planned nutrition, exercise and lifestyle changes is a very useful method and the risks are significantly lower than surgery. However, care should be taken to prevent regain weight gain in the period after the balloon is released.
Endoscopic narrowing of the stomach with stitches used inside the stomach has begun to come to the fore. The coming years are likely to be a period in which combinations of medical and endoscopic treatments are used more frequently.
Is Obesity Surgery Risky?
When performed in well-equipped centers by experienced surgeons, important complications are 2% and life-threatening is around .01%.
What are the Surgical Operations Performed in Obesity Treatment?
Stomach Balloon Application
Tube Stomach Surgery
Treatment of obesity and metabolic diseases is a lifelong challenge. Both the patient and the team organizing the treatment should be ready for this. The important benefits to be achieved due to the restriction of the amount of food to be taken due to anatomical changes and hormonal changes in the intestines; It is very important that regular supplements are made under medical control so that they are not damaged by the lack of protein, vitamins, minerals, calcium and similar elements that may develop.
For effective and permanent weight loss and long-term control of diabetes, programs in which regular exercise habits are gained in the postoperative period and that muscle mass is preserved and supported are required.
A team that can organize surgeons, endocrinologists, internal medicine specialists, nutritionists, psychiatrists / psychologists and exercise programs before and after the operation will be the greatest assurance of the patients in this life-long struggle.