In the event that the daily energy intake is excessive, the unused energy is stored in the body as fat and causes obesity. Obviously obesity, it is accepted as a disease that affect the quality of life and the duration negatively, as the energy (calorie) taken by the food is higher than the consumed energy and the excess energy is 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 endanger health.
How to measure OBESITY AND CLASSIFICATION
Basically, obesity can be measured using the BMI (body mass index). BMI is a numerical result of dividing the body weight by length and obesity is classified as this result.
According to the classification determined by the World Health Organization (WHO)
In short, a classification
BMI below 18.5 is considered as having sufficient weight
BMI 18.5 – 24.9 normal weight
BMI of 25.0 – 29.9 excess weight
BMI 30.0 – 39.9 overweight
BMI over 40.5% morbidly (seriously) overweight
WHY ARE WE OBESE?
Obesity is often seen in people who live in a high-calorie diet and are physically active or have little exercise. Apart from this, genetically predisposed, hormonal disorders, psychological problems and the following antipsychotic drugs are also among the causes of obesity.
Although there is a belief among people that obesity is associated with a lower rate of metabolism, this is in fact a rare cause.
Studies have shown that inheritance or genetic factors play a role in the formation of obesity by 25-40%. Obesity in the children of obese people is 2-3 times more than obese. If both parents are obese, 80% of the children develop adult obesity.
AM I OVERWEIGHT?
BMI value of a person with a height of 170 cm and a weight of 120 kg: 1,7 * 1,7 = 2,89 120 / 2,89 = 41,5 is a morbidly obese patient and requires absolute treatment. The World Health Organization has adopted obesity for all persons with a BMI value of 30 and above
IS THE OBESITY DISEASE TO BE TREATED?
Obesity treatment is a necessary, long and continuous process that requires the individual’s determination and effective participation. The fact that many factors are effective in the etiology of obesity, makes prevention and treatment of this disease extremely difficult and complicated. For this reason, a multidisciplinary approach and a team of doctors, dietitians, psychologists, physiotherapists are needed in the treatment of obesity. Selecting only one of the following treatment modalities is a false option and successful results are obtained when the combination of obesity treatment options is used.
The aim of obesity treatment is to decrease obesity related morbidity and mortality risks by aiming to lose a realistic body weight, to provide adequate and balanced nutrition habits and to increase quality of life. The 6-month reduction in body weight provides important benefits in preventing obesity-induced health problems. The methods used in obesity treatment are divided into 5 groups. These methods include;
Obesity with nutritional therapy:
- It is aimed to reduce body weight to the level that should be according to the paint (BMI = 18.5 – 24.9 kg / m2). It should not be forgotten that medical nutrition (diet) treatment is specific to the individual. Initially determined targets may be the ideal weight that the individual should have, or just over ideal weight.
- The weight loss diets to be applied should be consistent with adequate and balanced nutrition guidelines. The aim is to give the right nutrition habit to the individual and to maintain this habit.
- When the body weight reaches the required level (BMI = 18.5 – 24.9 kg / m2), the weight gain should be prevented and the lost weight should be maintained.
While the effect of exercise therapy on weight loss is still controversial, it is certainly accepted that physical activity prevents fat mass and fat loss in the abdominal area and muscle mass losses that can be seen when dieting. With exercise therapy, the weight gain of the individual in support of medical nutrition therapy can be prevented, and attenuation and weight gain are prevented.
Adults are advised to exercise moderately for 30 minutes on average each day. This level of activity allows a daily energy consumption of 840kJ (200kcal). Obese people are intended to be physically active every day. Energy expenditure depends on the body weight and activity intensity of the person.
The basic principles of exercise are as follows:
- Type of exercise; Walking, Increase in daily life activities, Resistance exercises
- Exercise duration; Every day or at least 5 days a week
- Time of exercise; 40-60 min / once a day, for 20-30 minutes / twice a day
- Intensity of exercise; 50-70% of the maximal oxygen consumption
In obese individuals, the most important issues to be taken into account when performing the exercise program to keep the risk of injury to a minimum, while increasing energy consumption. Recommended exercise program should be specific to the individual, fun, applicable and compatible with everyday lifestyle of an individual.
Behavior modification therapy under the control of body weight is a form of treatment to effect a change or reduction of negative habits related to diet and physical activity, which prevents excessive increase in body weight and becomes a pattern of a healthy person by increasing the life of the positive habits. The steps of treatment are to reverse bad habits.
- Stimulation of control
- Alternative behavior development
- Reinforcement, self-rewarding
- Cognitive (perceptually) restructuring
- Social support
Drugs to be used in the treatment of obesity are not suitable for individuals with mild to moderate weight gain. It is of utmost importance 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 do not become addictive and should be used for medical advice and control.
In order for obesity treatment to be successful, the patient must agree to continue medical treatment and exercise therapy as well as drug treatment and regularly come to checkups.
The surgical approach to obesity is basically two-step:
The goal in bariatric surgery is to reduce the energy taken in the body. For this purpose, gastric bypass operations (both gastrointestinal and gastric volume reduction), gastric volume reduction operations are performed after the excess kilos.
It is the removal of existing fat tissue localized in various parts of the body. This treatment is aesthetic.
WHAT IS OBESITY SURGERY?
Obesity surgeon is the most effective and fastest and most effective way to lose weight in the world at the moment. It should be remembered that obesity is a disease that requires multidisciplinary approach. The main factor in this treatment is patient adaptation for a permanent treatment of the patient.
WHICH PATIENTS ARE FOR OBESITY SURGERY
Patients with a BMI index of 40 or over and other treatments with no success have been recommended. However, the BMI index is 35 and it is also recommended for people with additional illnesses.
We should keep in consideration that the first 24 months after the operation planning a pregnancy is not recommended.
OBESITY SURGICAL TECHNIQUES REASON
First of all, all of the obesity surgical techniques are laparoscopic (closed) methods. In some cases, open surgery is passed.
Obesity surgeon can be divided into 2 parts.
- Volume reduction surgery
In this group, stomach, tube stomach, stomach folding and
- Absorbing operations
WHY SURGICAL TREATMENT:
Surgical treatment is the most effective and safe method in the treatment of obesity. Because surgical treatment
- patient motivation
- reminds how hard it is to make a decision but how accurate it is
- provides fast and effective weight loss in the early period
- fast and effective weight loss also increases confidence and self-confidence, which in turn allows weight loss to continue
- it is important to remember that obesity is a treatable disease
- helps to reduce the medications used for the improvement of diabetes, hypertension, elevation of cholesterol, joint problems, respiratory problems, etc.
- 30% of diabetic patients who use insulin usually get rid of insulin the day after gastric bypass surgery and 70% of these patients are completely free of insulin requirement within 6 months.
- As a result, surgical treatment for morbid obesity is proceeding with certain steps towards becoming the gold standard.
SURGICAL TREATMENT OPTIONS:
We can split these surgical options in two:
- RESTRICED SURGERY
- RESTRICTING AND ABSORBING SURGERY
- Stomach cuff (gastric silicone band)
- Tube stomach (sleeve gastrectomy)
- Stomach folding (gastric plication)