WHAT IS OBESITY?
Obesity is the accumulation of abnormal amounts of fat in the body. Obesity occurs as a result of a combination of excessive food intake, lack of physical activity, sedentary lifestyle and genetic factors. In addition to these, some hormonal diseases also cause obesity. Obesity is graded by body mass index. If the body mass index is over 30, we are talking about obesity and patients are candidates for obesity surgery.
OBESITY CAUSES?
There are many causes of obesity, but the most common cause is overeating. People gain weight when they consume more calories than they burn. Other causes of obesity include genetics, certain medical conditions, and certain medications.
People who are obese often have a harder time losing weight because they have a slower metabolism. This means they burn calories more slowly than people who are not obese. Genetics can also play a role in obesity. If your parents or grandparents were overweight, you may be more likely to be obese.
Certain medical conditions can also cause obesity. These include hypothyroidism, Cushing’s syndrome, and polycystic ovary syndrome. Medications that can cause weight gain include steroids, birth control pills, and some antidepressants. And of course, if you are obese, you are at risk of developing other health problems. These include heart disease, stroke, type 2 diabetes, and certain types of cancer. Obesity can also lead to joint problems, sleep apnea, and social and emotional problems.
If you are obese, you should talk to your doctor about ways to lose weight. Even losing a small amount of weight can help reduce your risk of developing other health problems. Or maybe you can consider bariatric surgery to completely solve this problem.
WHAT IS OBESITY SURGERY?
TYPES OF OBESITY SURGERY
There are many types of obesity surgery, each with its own advantages and disadvantages. The most common types are;
- Sleeve gastrectomy
- Mini gastric bypass
- Gastric bypass
WHO IS SUITABLE FOR OBESITY SURGERY?
There are many factors that contribute to a person’s suitability for bariatric surgery. The most important factor is a person’s body mass index (BMI). A BMI of 35 or more is considered morbidly obese. Other factors that contribute to a person’s suitability for bariatric surgery include a person’s age, health history, and motivation to lose weight. Bariatric surgery is not for everyone. It is a serious procedure that should only be considered after all other weight loss options have been exhausted.
SURGICAL TREATMENT OF MORBID OBESITY
The development of laparoscopic surgical instruments and techniques, on the other hand, strengthened the idea of treating morbidly obese patients with laparoscopic (closed) surgical techniques, and finally, in 1983, the first closed bariatric surgery was performed. In 1993, the first gastric band was introduced to the market, and in 1995, the first series of patients with a gastric band was published in France. Gastric bypass operations became a routinely used surgery in the United States in 1998.
The probability of many diseases increases significantly due to obesity. The most well-known of these diseases are high blood pressure and cardiovascular diseases. Many scientific studies have proven that there is a direct relationship between increased weight and increased blood pressure. When the increase in blood fats due to obesity is added to this, the frequency of arteriosclerosis, vascular occlusions in various body parts, and heart diseases increases significantly.
SLEEVE GASTRECTOMY
Sleeve gastrectomy is performed by surgically removing a large portion of the stomach. It is performed laparoscopically, meaning that the abdominal wall is not cut, but rather by entering through small incisions with special tools. In this way, our body is not exposed to too much stress, and recovery and return to daily life after sleeve gastrectomy are quite fast.
GASTRIC BYPASS SURGERY
It was the most preferred method in America until 5 years ago. With the widespread use of sleeve gastrectomy, it became the second preferred method. In this method, the stomach is divided into two just below the entrance to the esophagus, creating a small stomach pouch. Unlike the stomach reduction surgery, no part of the stomach is removed in this surgery. The newly created small stomach is combined with the small intestine; allowing food to bypass the large stomach and the first part of the small intestine. In this way, it is aimed to be full with less food and to absorb less of the food consumed.
WHO CAN HAVE SLEEVE GASTRIC SURGERY?
Sleeve gastrectomy surgery is a method usually applied to people who have advanced obesity problems and cannot achieve permanent weight loss with methods such as diet and sports. The most common way to determine the degree of obesity is to use a figure called the “body mass index”, which is obtained by dividing our weight by our height. For example, the BMI of a person who is 2 meters tall and weighs 160 kg is:
- Height squared 2×2=4,
- Weight/height squared is determined as 160/4= 40.
Normal BMI rates vary according to age. 19-25 is considered a healthy range. BMI values: Over 25 is considered overweight, over 30 is considered 1st degree obesity, over 35 is considered 2nd degree obesity, and over 40 is considered 3rd degree obesity. Those over 35 are considered suitable for surgical treatment if they have comorbidities, and those over 40 are considered suitable for surgical treatment even if they do not have comorbidities. BMI alone can be misleading in those with a lot of muscle mass. The situation is controversial in those between 30 and 35 who have comorbidities related to obesity. The “American Society for Metabolic and Bariatric Surgery”, one of the authoritative associations on this subject, recommends that the surgical approach in grade 1 obesity be evaluated by experienced surgeons for each patient.
The answer to the question of who can have stomach reduction surgery in terms of age range; The age range for stomach reduction surgery is given as 18-65. In case of psychiatric illness, stomach reduction surgery can be performed on people whose illness is under control, provided that the approval of a psychiatrist is obtained.
RISKS OF SLEEVE GASTRIC SURGERY
Those who want to have surgery are most concerned about the risks of stomach reduction surgery. 10 years ago, the complication rates after sleeve gastrectomy surgeries were reported as approximately 2-5% and the mortality rate as 2 per thousand. Today, these rates have decreased to less than 1 per thousand in developed centers. Thanks to obesity surgery, developing technology and the increasing experience of surgeons over time, the risks of stomach reduction surgery have decreased and become safer.
The most important complication is leakage. If appropriate treatment techniques are applied, leakage can be treated in a shorter time and without the need for re-surgery. Again, having the surgery done in a suitable hospital and by choosing an experienced team both minimizes the risk of leakage and significantly increases your chances of being treated and recovering if it occurs.
Embolism is again among the risks of stomach reduction surgery that are much talked about and are not only related to obesity surgery, but can be seen after all other surgeries and can be life-threatening when large. Here again, the most important issue is to take precautions to minimize the risk of embolism. First of all, using blood thinners, using a device that is wrapped around the legs during surgery and supports blood circulation with intermittent air compression will minimize the risk of embolism. Early walking of the patient after surgery will also be one of the measures that will reduce the risk of embolism.
Bleeding, which is among the risks of gastric sleeve surgery, is a situation that can be encountered, although it is not very common. It usually stops on its own, sometimes it may be necessary to give blood. Rarely, the patient may need to be taken into surgery again. It is not life-threatening most of the time.
AFTER SLEEVE GASTRIC SURGERY
Stomach reduction surgery, which should be performed by a specialist surgeon, requires the patient to stay in the hospital for a few days depending on the condition. After discharge from the hospital, after a few days of rest without doing heavy work at home, work and social life can be resumed. After the surgery, the patient’s appetite will decrease incomparably. Patients who start with liquids and then continue with pureed foods after the stomach reduction surgery can switch to solid food in the 6th week. Patients lose weight effectively in the first six months with the nutrition plan after the stomach reduction surgery. In the future, the nutrition after the stomach reduction surgery should be planned with the help of a dietician. In patients who return to their pre-operative diet, it is possible to gain weight without the stomach expanding again. If this condition cannot be controlled with diet, the stomach reduction surgery can be repeated or a second revision surgery such as “bypass”, which also reduces the absorption of the food taken, can be performed.
NUTRITION AFTER SLEEVE GASTRIC SURGERY
The early period of nutrition after bariatric surgery starts with clear and viscous liquids. In the liquid period after gastric sleeve surgery, a transition from clear liquid to dark liquid is achieved from the first day of food intake. This period covers the first 2 weeks. The 3rd and 4th weeks continue as puree and soft solids. The nutrition plan after gastric sleeve surgery is organized as a transition to normal nutrition for the first month.
Protein sources are the group that is desired to be consumed the most in nutrition after gastric sleeve surgery. Therefore, importance is given to their consumption in the liquid period. In the hospital, fluid intake is started with water and 100% apple juice. In the following days, it is continued as clear unsweetened tea, meat/chicken broth. After discharge, fluids of the same clarity as in the hospital should be consumed for the first 7 days at home. The fluids you will continue at home in addition to the first days; ayran, light milk or lactose-free milk, strained soups that do not contain legumes, flour, tomato paste, 100% fruit juices and sugar-free compotes that you can start from the 5th day. Thick liquids can be started in the 2nd week of the liquid period after stomach reduction surgery. Dairy products can be consumed without diluting from the 7th day. Protein powder should be consumed to meet the protein need in sufficient amounts after stomach reduction surgery. During this period, soft solids such as soft-boiled eggs, soft cheese, poached eggs, omelets are tried by evaluating the tolerance of the people to the food. Soups that do not contain solid meat and chicken pieces (can be seasoned from the 10th day) can be preferred by blending.
The puree period after stomach reduction surgery covers the 3rd and 4th weeks. Low-fat, blended foods should be consumed during this period. Vegetable purees enriched with meat and chicken broth should be preferred while continuing protein powder. In addition, meat and chicken pieces should not be blended. From the meat group, only fish meat can be consumed softly from the 21st day onwards. The foods that should not be consumed in the early period after bariatric surgery are divided into two as those that negatively affect the healing process of the stomach and those that are difficult to digest. For example, acidic-carbonated beverages, Turkish coffee and caffeinated coffees, oil and oily foods, table sugar and sugary foods, hot sauce or spices, and hard-to-digest solid foods such as meat, chicken, legumes, and raw vegetables should not be consumed. Changes in taste sensation can be controlled with recipes after bariatric surgery. At this point, it is very important to cooperate with your dietician.
HOW DOES A PATIENT'S LIFE CHANGE AFTER STOMACH REDUCTION SURGERY?
The purpose of stomach reduction surgery is to reduce the volume of the stomach. Due to the reduced stomach volume, a feeling of early satiety occurs and thus the amount of food that can be taken during the day is significantly reduced. Food consumption decreases by approximately ¾ after stomach reduction surgery. If the diet is not followed carefully after stomach reduction surgery, weight gain may occur even if the stomach does not expand again. In order not to allow this, it is essential that the patient is regularly followed up by a professional team after the surgery. Success is possible with proper surgery as well as appropriate follow-up after stomach reduction surgery.
FREQUENTLY ASKED QUESTIONS ABOUT OBESITY SURGERY
If you’re considering bariatric surgery, you’re probably wondering what to expect. Here are some frequently asked questions about the surgery and recovery process.
,HOW LONG DOES THE SURGERY TAKE?
The surgery itself is usually only about an hour long. However, you’ll need to stay in the hospital for a few days to recover.
WHAT ARE THE RISKS OF THE SURGERY?
As with any surgery, there are risks. These include bleeding, infection, and blood clots. However, the risks are generally very low.
HOW MUCH WEIGHT WILL I LOSE?
Most people lose about 50-75% of their excess weight. However, this can vary depending on the type of surgery you had and your individual situation.
WHAT ARE THE SIDE EFFECTS OF THE SURGERY?
The most common side effects are nausea and vomiting. This is usually temporary and goes away within a few days. Other side effects may include diarrhea, constipation, and hair loss.
IS THERE AN AGE LIMIT FOR OBESITY SURGERY?
There is no age limit for obesity surgery. Obesity surgery can be performed on people of all ages, from children to the elderly. However, it is generally performed on patients between the ages of 18-60 unless necessary. The decision to undergo surgery depends on many factors, such as the severity of obesity, the presence of other health problems, and the person’s ability to adapt to post-operative care.
RISKS OF OBESITY SURGERY
As with any surgery, there are many risks in obesity surgery. These risks include, but are not limited to, infection, bleeding, blood clots, and pulmonary embolism. There is also a risk of perforation of the stomach or intestines during surgery. Since obesity surgery can cause changes in the way the body absorbs nutrients, it is also associated with the risk of malnutrition.
The risks of obesity surgery also vary depending on the type of surgery performed. For example, gastric bypass surgery carries a higher risk of malnutrition than gastric sleeve surgery. In addition, gastric bypass surgery is associated with a higher risk of complications such as bleeding and infection than gastric sleeve surgery.
It is important to discuss the risks of bariatric surgery with your doctor before having the surgery. In addition, you should follow your doctor’s instructions carefully after surgery to minimize the risks.
WILL I GAIN WEIGHT AFTER OBESITY SURGERY?
A common question asked by those considering bariatric surgery is will I regain weight after surgery? The best answer to this question is that it depends.
A number of factors will affect whether you regain weight after bariatric surgery, including the type of surgery you had, how well you stick to your post-operative diet and exercise plan, and your overall health.
Generally speaking, however, most people who undergo bariatric surgery do not regain the weight they lost. Many people maintain significant weight loss over the long term. Of course, weight loss is not the only benefit of bariatric surgery. The surgery can also help improve or resolve a number of health problems, including type 2 diabetes, sleep apnea, and high blood pressure.
If you are considering bariatric surgery, it is important to talk to your doctor about all the potential risks and benefits.