Obesity can be defined as "having more fat tissue in our body than needed". Obesity often presents not only as an esthetic consideration but also as a systemic health problem. Especially in the "central obesity" in wihich the excessive fat tissue is distributed mainly around the waist, serious diseases like type 2 diabetes, hypertension, sleep apnea and dyslipidemia may accompany obesity. All these diseases together are named as the "Metabolic Syndrome". Weight Loss Surgery and Metabolic Surgery are the most effective treatments of Obesity and related Metabolic Syndrome.
Metabolic syndrome is a group of systemic diseases which are seen togehter. Components of Metabolic Syndrome are central obesity, insulin resistance or Type 2 Diabetes, Hypertension, Dyslipidemia and Polcystic Ovary Disease. Weight loss surgery provides an effective treatment of Metabolic Syndrome.
Obesity generally develops due to an imbalance between the calories obtained and calories burned. If we exclude some rare genetic and hormonal disorders, we can say that obesity is almost always due to consuming high calorie products together with low exercise or sedentary life style. Some hormonal diseases of the thyroid glands, surrenal glands and some genetic disorders like Prader Willy Syndrome are the other rare causes of obesity. Before deciding about weight loss surgery a wide check up should be performed to exclude hormonal and genetic causes!
Candidates for wight loss surgery: Patients with body mass index between 35 kg/m2 and 40 kg/m2 plus a systemic disease like type 2 diabetes, hypertension or sleep apnea and patients with body mass index of 40kg/m2 or more are considered as candidates for weight loss surgery. Weight loss surgery is accepted as the most effective treatment of obesity and obesity related diseases.
Weight Loss Surgery types may be clasified mainly in two groups; restrictive and malabsorptive operations.
1- Restrictive Weight Loss Procedures as an obesity treatment: These are the procedures like gastric sleeve surgery and gastric band operation. In the restrictive weight loss procedure the route of the food with in the digestive system is not diverted, thus there is no malabsorption. Only the diameter of the stomach is restricted that is why they are called restrictive weight loss procedures. In restrictive weight loss procedures there will be no nutrient malabsorption. The main weight loss effect of the restrictive procedures is the limitation in the calories consumed. Differently from gastric band procedure, gastric sleeve operation leads to a lowered appetite state due to the removal of the special part of the stomach called "FUNDUS" during the operation. Gastric sleeve suregry recentl is one of the most commonly perofrmed operation in the world. The numbers of gastric band operation is oppositely decreasing fastly due to high rate of early and late postoperative complications.
2- Malabsorptive weight loss operations are called so because after the operation the route of the ingested nutrients will change in the digestive tract. In any malabsorptive operation there will be more or less nutrient and calorie malabsorption. Therefore life long witamin and some micro nutrients should be supplemented to he daily diet to avoid micro-nutrient deficiencies. Malabsorptive weight loss operations are; Mini gastric bypass, Roux en-Y gastric bypass, SADI-S operation, Duodenal switch, Transit bipartition and Ileal interposition.
Factors causing obesity problems can be listed as follows;
- Restricted movement
- Genetic factors
- Malnutrition, Consumption of ready and unhealthy foods
- Alcohol consumptionAdopting a lifestyle away from exercise and sports
- Hormonal reasons
* Before deciding for weight loss surgery a wide check up must be performed to exclude some hormonal and genetic factors.
Obesity level is decided by calculating the Body Mass Index.
If you divide your weight (kg) by the square of your height in meters, you will find your Body Mass Index.
Example; In order to find the body mass index of an individual with 110 kg and 1.70 m, the calculation is 110 kg / 1.70m x1.70 m, that is: 110 / 2.89 m2 = 38 kg / m2.
So the Body Mass Index is 38.
- From the point of view of obesity diagnosis, those with a Body Mass Index between 25-30 kg/m2 are Overweight,
- individuals with Body Mass Index between 30-35kg7m2 are at Stage 1 Obesity,
- those with a Body Mass Index between 35-40 are at Stage 2 Obesity,
- patients with a Body Mass Index of 40 and above are at Stage 3 Obesity or Morbidly Obesity level.
- Patients with a body mass index over 50 are diagnosed as a Super Morbidly Obesity Patients.
In general, the patient group with a body mass index over 35 plus systemic diseases such as Sleep Apnea, Type 2 Diabetes, and Hypertension may consider obesity surgery or so called weight loss surgery if they are unable to lose weight with diet and physical exercises.
The best answer to the question of "What is Obesity Surgery" would be "The group of methods that solve obesity disease surgically". To explain this situation, we can say the following: Obesity Surgery is not only the name given to one operation, but the general name given to all of more than one surgical procedure.
Obesity Surgery methods are varied, these are:
- Gastric Sleeve Surgery (Stomach Reduction Surgery),
- Gastric Bypass (Gastric Bypass),
- Duodenal Switch and a few more operations.
The first operation that comes to mind when it comes to Obesity Surgery is gastric sleeve (Stomach Reduction-Sleeve Gastrectomy) surgery. This is not unfair, because Gastric Sleeve Surgery is a relatively short operation compared to other surgeries, performed with the principle of restriction and appetite reduction without causing malabsorption. The average takes 1 hour, the hospital stay is 2-3 days, and the time to return to work is short since it is performed by laparoscopic method.
However, Obesity Surgery is not limited to Gastric Sleeve Surgery, the type of surgery to be chosen should be decided by the obesity surgeon together with the patient according to the needs of the patient.
Bu öğeye bir yanıt ekleyinObesity surgery or weight loss surgery is a treatment method that should be managed very well both during the operation and the recovery process after surgery. In addition to the maximum protection of the general health of the patient, the patient should also be supported psychologically.
For this reason, it is recommended that people who apply for bariatric surgery should receive the necessary support from their immediate surroundings in this process.
In addition to these, significant changes in lifestyle and eating habits are required after surgery.
- Alcohol and smoking should not be consumed
- Fresh vegetables and foods should be preferred instead of frozen and packaged foods.
- Stress factors should be avoided.
- Exercise programs should not be interrupted.
- An active lifestyle should be adopted.
Obesity surgery can be applied to patients whose body mass index is above a certain level..
Obesity surgery, which is applied with many different methods, is a very comprehensive surgical field. Operations applied in obesity surgery can be listed as follows; Gastric sleeve surgery is a method applied to patients with a body mass index over 40. It is based on the discipline of removing a part of the stomach and the Ghrelin gland that secretes hunger hormone. Today, this surgery is performed by laparoscopic methods. Another procedure is the Gastric bypass which is a restrictive plus malabsorptive bariatric surgical procedure. Gastric Bypass was the most commonly peroformed bariatric surhery in tha last years but it has been replaced by Gastric Sleeve operation in recent years, while gastric by pass is preserved for obesity patient with more severe co-morbidities.
A brand new life begins for the patient after bariatric surgery. With psychological support and under the guidance of nutrition and dietitian, weight is lost will be very quick and healthily. In this process a diet with a high rate of protein and low rate of carbonhydrate should be established. At the same time, a regular exercise program should be created.
Sleeve gastrectomy procedure which is one of the weight loss surgery procedures, is defined also as gastric sleeve surgery among the public. In this surgical procedure stomach volume is reduced by 75-80%. With this reduction in volume, stomach is much earlier fulled with lesser food. This causes a distension in the stomach wall which leads to a signal of satisfaction that is transimited to the brain by "Vagus" nerve. Another result of the gastric sleeve operation is decreased level of appetite. While reduction of the stomach volume, also the part called "Fundus" is removed. This fundic removal leads to a very low level of appetite lasting from 6 to 12 months which is very helpful in the weight loss process and new healty life style adoption period of the patient. Obesity is a serious problem of today's modern man. Obesity is a problem that endangers the total health status of the person, causes cardiovascular or systemic diseases or shortens the life span rather than aesthetic concerns. Restriction of movement in living spaces, lack of time to spare for sports and exercise, and consumption of ready and unhealthy foods as well as stress factors are among the factors that cause obesity problem.
In the treatment of obesity problem;
- exercise and special diet programs
- adopting new healthier feeding habits
- Stomach balloon
- Stomach botulinum toksin
- Surgical methods
can be applied.
Obesity surgery procedures such as gastric sleeve surgery and gastric bypass are benefitted in the treatment of obese patients with a BMI rate of 40 or more or BMI of over 35 plus systemic diseases. As a result of both technical facilities and rich scientific studies, there are many effective surgical solutions for obesity today.
The procedure time in sleeve gastrectomy is approximately 50-60 minutes. This this weight loss surgery is performed under general anesthesia and by laparoscopic method. About 80% of the stomach is removed during the procedure. Gastric sleeve surgery should be performed by a team of experts and experienced in healthcare facilities. Gastric sleeve surgery; It covers a very detailed process with before and after. Gastric sleeve surgery applied by laparoscopic method is a very safe and effective obesity treatment today.
When obesity develops due to excessive food intake and low calorie consumption, the need for weight loss surgery arises when excess weight cannot be controlled by exercise and diet. Sleeve Gasrectomy surgery is one of the most common bariatric operations. Sleeve gastrectomy surgery is also known as stomach reduction surgery. For this reason, most of the stomach is removed during sleeve gastrectomy surgery. At the same time, the area called Fundus, located at the top of the stomach, is taken during this procedure. Fundus is taken because the hunger hormone called Ghrelin is secreted in this region. Ghrelin is the main hormone that determines our hunger level, that is, our hunger hormone. In Sleeve Gastrectomy surgery, it is not a matter of taking the entire stomach, in this surgery, the stomach is reduced by approximately 3/4.
Excessive food intake will be prevented since the stomach volume becomes smaller after sleeve gastrectomy. After this surgery, the person is satiated much faster with much less food. At the same time, the person will have a balanced diet because he is not hungry. Thus, after the surgery, the patient enters a rapid weight loss process, especially during the recovery period. Many patients wonder whether there will be surgical scars in the abdominal area after the operation after gastric reduction, ie sleeve gastrectomy. In gastric reduction operations performed by laparoscopic method, the incision scars are minimal in the abdominal region and these scars can heal almost invisibly over time.
There are some points that the obesity patient should pay attention to and apply during the weight loss surgery preparation stage before sleeve gastrectomy.
These can be listed as follows;
- In the days before surgery, nutrition should be light. In addition to abundant water consumption, it is also recommended to prefer watery foods. The amount of weight you can give before the surgery will facilitate the work of the surgical team and reduce the risks of the surgery, be sure to get information from your physician for the pre-operative diet.
- If you have diabetes, it is important to have your diabetes in other words your blood sugar level under control before surgery.
- Diseases such as asthma or COPD need to be controlled before surgery and to make sure that you do not have an attack.
- Smoking and alcohol should be quitted at least 1 month before the operation.
- It will make your job easier after you have been informed about the lung exercise methods we will use after the surgery.
- Patients using blood thinners may need to change their medication or take a break under the doctor's supervision, please provide detailed information to your doctor about all the medications you use.
- It is highly recommended to have all tests performed for covid infection before surgery to prevent an extra risk due to the current Covid pandemic.
- You will have some pain after the operation and this pain will decrease or disappear significantly on the second day.
What is expected from you is that you move and walk in the early hours after surgery. Early mobilization eliminates many surgery risks. You should definitely get information from your doctor about the pain of surgery and the importance of early mobilization.
- The fact that every question you have in mind is answered before the surgery will speed up the postoperative recovery and reduce your anxiety level.
Do not hesitate to ask your doctor!
Although obesity surgery or weight loss surgery is a very effective weight loss method, it is not a miracle. In order for the surgery to have maximum effect and to stay at the ideal weight for many years, you must make changes in your eating habits and exercise habits and gains new life style. After obesity surgery, whether this is a stomach reduction surgery or gastric bypass, the habit of exercise should definitely be gained, because regular exercise maximizes the effect of obesity surgery and makes the person feel perfect.
Benefits of Exercising :
BENEFIT 1: Lets you lose weight properly! It is known from studies that people who exercise or exercise regularly after obesity surgery lose at least 7-8 kilos more weight. An important point here is to lose weight properly during this weight loss process. Exercising allows you to lose weight from your fat, not your protein, which is a factor that increases the importance of regular exercise. Regular exercise is a very important activity that prevents protein loss in the rapid weight loss process.
BENEFIT 2: "It helps you feel great" Exercising will make you feel more energetic and great than ever before. Most of our patients consider obesity surgery not only to lose weight, but to be more active and energetic in their daily lives, to play with their children more comfortably, to run more comfortably and even to ride a bike more comfortably. From this point of view, exercising will enable you to reach these goals much more easily. Regular exercise will increase your muscle mass, strengthen your shell and bones and even your immune system. Another very interesting finding in the researches is that regular sports have very positive effects on our psychological state and mood. Regular exercise reduces anxiety and depression while increasing academic success. As WORLD OBESITY CENTER, we definitely recommend exercise after Gastric Sleeve Surgery, Gastric Bypass surgery and Diabetes Surgery.
BENEFIT 3: "It positively affects mental health" Exercise causes the release of the hormone "Endorphin". This hormone plays a key role in the recovery of anxiety and depression.
While many of our patients get rid of weight problems with obesity surgery, they may have difficulty in overcoming the psychological difficulties they had in their overweight times even after surgery. In this process, sports will be their biggest helpers. In addition, exercise will increase the amount of blood flowing to the brain, which is another positive effect of exercise on brain health.
In short; Exercising or exercising will improve your brain activity, increase your IQ and slow down the decline in your age-related brain activity.
How Should I Exercise? You should definitely get the opinion of your physicians about the time to start sports after obesity surgery. Basically, 3 sports types should be aimed when planning sports after surgery.
1- Cardio exercises: Cardio exercises, also known as aerobic exercises, are basically exercises that will help you spend lots of energy and move around, such as walking, running, skipping rope, cycling, swimming. The benefit of these exercises is that they provide fast fat burning while making the person feel incredibly fit, energetic and healthy. While walking and brisk walks are recommended as cardio exercises in the first month immediately after the operation, we recommend other cardio exercises after the 1st month for our patients who provide the necessary adjustment process for sufficient fluid consumption.
2- Muscle strengthening exercises: Muscle strengthening exercises are sports activities that aim to protect and increase our muscle mass. Basically, these are studies about lifting weights. We recommend muscle strengthening exercises starting from the 2nd month after obesity surgery. The most important point here is to start working with low weights and increase the amount of weight over time without showing any haste and impatience. It should not be forgotten that working with too much weight can cause muscle breakdown. When these exercises are performed under the supervision of a physician, they will cause a serious increase in muscle mass.
3- Flexibility exercises: The main purpose of the exercises that give flexibility is to prevent injuries and injuries. These exercises are basically stretching exercises. Stretching and stretching exercises should be done before and after each aerobic or strengthening. Stretching and stretching exercises should be done until a slight burning sensation is felt in the muscles and then stopped. rapid weight loss obesity treatment
Revision literally means revising or correcting something. The term revision weight loss surgery means to correct a previous surgery for different reasons or to convert it to another operation.
Why those who have obesity surgery may need revision surgery?
First of all, the reasons for revision obesity surgery can be listed as follows:
- Excessive weight loss
- Weight gain
- Severe vitamin deficiencies
- Eating disorders due to anatomical problems such as torsion (chronic vomiting)
- Persistent chronic diarrhea that cannot be relieved with medication.
>More details here!
What is Stomach botulinum toksin (Stomach Injection) for Obesity? Stomach botulinum toksin is not a type of weight loss surgery but is anon surgical weight loss procedure! Stomach botulinum toksin is not much different from botulinum toksin applied to the face or other parts of the body for aesthetic purposes. Botulinum toksin applied in both processes is the same substance. However, the dose of botulinum toksin used in stomach botulinum toksin is much higher than facial botulinum toksin due to the large surface area of the stomach and strong muscle tissue. Technically, both botulinum toksin techniques aim to achieve immobility in the muscle to which they are applied. The immobility provided by the injection of facial botulinum toksin provides the healing of wrinkles on the face, while the reduction in stomach movements provided by stomach injection, that is, stomach botulinum toksin.
The decrease in gastric contractions causes the foods in the stomach to leave the stomach much later, naturally, the foods that stay in the stomach for a long time provide a feeling of satiety for a longer time. In addition, when applied to the special part of the stomach, it provides a decrease in appetite. In other words, after stomach injection or stomach botulinum toksin, our patient will feel satiety for a longer time and less hunger.
Stomach botulinum toksin is generally a more appropriate procedure to be selected in overweight and those with mild obesity problems, because the expected weight loss will be 10-15 kg in the method that works for 4-6 months.
We are already evaluating our patients with more serious obesity problems in terms of bariatric surgery.
Stomach botulinum toksin is rising as a good, safe and risk-free alternative for our patients who cannot get the necessary results from diet and sports, want to get faster results or want to get fast results without a serious diet or are afraid of surgery.
Another area of use of stomach botulinum toksin is that people with weight gain after obesity surgery look like oalack. Since revisions of obesity surgeries are more laborious, stomach botulinum toksin can be considered as a remedy before revision.
Stomach botulinum toksin will also be more effective when used with gastric balloon, it will also prevent severe stomach pains that can be seen in some patients after the balloon since it prevents stomach muscle contractions, and it will make the balloon process much more comfortable.
Scientific publications about stomach botulinum toksin for obesity treatment are gradually increasing.
In fact, since 2008, scientific articles have informed us that stomach botulinum toksin will rapidly become widespread.
In the research of Mark Topazian et al., In the journal "Obes Surg", a leading scientific medical journal in the field of obesity, it was reported that botulinum toksin applied to the stomach muscle caused a feeling of satiety and weight loss in patients and no side effects were observed. In addition, they found that food remained in the stomach much longer after stomach botulinum toksin.
In the World Journal of Gastrointestinal Endoscopy Journal, Dr. Andrew Ukleja et al. Reported in 2015 that the botulinum toksin procedure applied to the stomach due to another stomach condition is safe, effective and has no side effects. In 2012, a very good research in Chinese Scientists was published in Hepatogastroenterology journal, Dr. According to the research of Li L. and his team, Stomach botulinum toksin delays gastric emptying, provides weight loss and reduces appetite, which is the appetite hormone Ghrelin.
Publications on Stomach botulinum toksin are increasing rapidly, and those interested in the subject can easily access the necessary medical databases.
According to scientific results, it seems that the application of stomach botulinum toksin, which is a non-surgical obesity treatment, will become more common. The feedback we received from our patients and the post-procedure comfort and satisfaction levels confirm this.
After Stomach botulinum toksin, we definitely consider dietician support as necessary, we know that no obesity treatment is permanent unless the necessary behavioral and dietary changes are provided, even this is valid for surgical treatments of obesity.
Therefore, as the World Obesity Center, we provide dietician and psychological consultancy services to our patients who have had Gastric botulinum toksin procedure. Please not that stomach botulinum toksin is not a type of weight loss surgery, it is non surgical technic.
We, as the World Obesity Center, started to receive the first results of botulinum toxin injection, that is, stomach botulinum toksin, which has been followed by obesity physicians for about 2 years and spread from the mouth to the ear as a stomach injection among the public. Although the use of botulinum toksin for obesity treatment is very new in the world, botulinum toksin application to the stomach for the treatment of achalasia or gastroparesis diseases has been used for almost 30 years.
The new information is that botulinum toksin injection into the stomach can be used in the treatment of obesity. In this respect, stomach botulinum toksin is not actually new, on the contrary, it is an old and very reliable technique with a new usage area.
We wanted to explain the use and effect of stomach botulinum toksin in obesity treatment and all other aspects for you with scientific aspects. Will stomach botulinum toksin be an alternative method for weight loss surgery is another question that we still do not know the answer clearly but for now we can say that stomach botulinum toksin is good and easy treatment option for overweight and early stage obesity patients.
Stomach botulinum toksin is not a weight loss surgery procedure. It is a non surgical method.
Of course, stomach botulinum toksin has many differences from facial botulinum toksin.
For example, while facial botulinum toksin is made for aesthetic purposes, stomach botulinum toksin has positive results in terms of both aesthetics and health thanks to the weight it gives. While facial botulinum toksin is a very painful procedure, it is not painful at all because it is applied directly to the stomach under anesthesia without any cut or hole on the skin by endoscopy, the patient does not feel any discomfort. Stomach botulinum toksin is applied in a short time like Facial botulinum toksin.
Stomach botulinum toksin, which is a non-surgical, non-balloon obesity treatment, is applied in 20 minutes by endoscopy. Afterwards, the patient is rested for 1 hour in order to eliminate the effect of anesthesia. One hour after stomach botulinum toksin application, the patient can go home and start feeding again, and the next day, he can start his normal work and daily life. We observed in our patients that right after the stomach botulinum toksin application, that is, the stomach injection, patients feel a slight numbness in their stomach and feel anorexia, the numbness felt in the stomach passes the next day. We did not receive any nausea or vomiting pain complaints from our patients.
Gastric Balloon (Stomach Ballon) is a silicone balloon placed in the stomach with the help of endoscopy, which is applied to individuals with obesity problems and to patients who are overweight but do not have an indication for obesity surgery, that is, who are not suitable for surgery. People who are suitable for gastric balloon are individuals with a body mass index between 26 and 35, however, people with a very high body mass index such as 50 or 60 can choose the gastric balloon procedure to reduce their weight a little until the planned bariatric surgery procedure and to make the surgery more safe.
Finally, although it is suitable for surgery, gastric balloon is an option for patients who refrain from obesity surgery for various reasons. Although the gastric balloon procedure is painless, stomach cramps may be observed for a few days after the gastric balloon is attached, some physicians prefer to hospitalize patients in the first night and give intravenous cramp-preventing drugs. Since the gastric balloon will basically occupy a volume of about 500-700 ml in the stomach, it allows early satiety by leaving less room for meals in the stomach and thus restricts calorie intake.
The meal portions of people who wear a gastric balloon should be small and low in carbohydrates rich in fiber and protein, people who consume large portions may experience nausea or even vomiting.
Since the gastric balloon also creates tension in the stomach wall, the nerve called the vagus sends the signal to the brain that the stomach is full, which also provides a feeling of satiety.
A weight loss of 15-25% of total body weight is planned with Stomach balloons. Gastric balloons can be of many types, all of them have different duration and properties in the stomach
Based on the substance they are inflated, gastric balloons are divided into two as air gastric balloon and gastric balloon with liquid. While airy gastric balloons are more comfortable in terms of cramping and vomiting complaints, which can be seen especially in the first days, gastric balloons inflated with liquid are more successful in terms of clay efficiency in the long term.
According to the duration of their stay in the stomach, gastric balloons are generally divided into 6-month and 12-month gastric balloons. As the gastric balloon stays in the stomach longer, it can be expected to lose more weight. As the inflation technique, there are gastric balloons inflated only once and gastric balloons that can be inflated multiple times.
Recently, gastric balloons that do not require endoscopy and are placed in the stomach by swallowing have also been on the market.
The procedure of inserting a gastric balloon generally takes 20 minutes, the gastric balloon procedure placed in the stomach by endoscopy is painless, but some people may experience cramping, nausea and even vomiting for a few days in the hours following the insertion process, these complaints can be controlled with medications, usually after the first week. However, a minority group may not tolerate these complaints and may choose to have the balloon removed at an early stage.
Since deep sedation and anesthesia are generally applied for the gastric balloon insertion procedure, the patient does not feel pain and discomfort during the procedure. Gastroscopy (gastroscopy = gastric endoscopy) for the gastric balloon can also provide the opportunity to diagnose other diseases that may exist in the esophagus, stomach and small intestine.
It is necessary to be in the overweight or obesity group to wear a gastric balloon, today the gastric balloon is considered a weight loss treatment, it should not be considered as an aesthetic method, so those with a body mass index of 26 and above can wear a gastric balloon, however, these people could not lose weight with diet and exercise. must be. Gastric balloon is a treatment that should always be considered together with diet and exercise, that is, it is necessary for the person to make the necessary changes in eating and lifestyle habits in order for the balloon to maximize its effect, your physician or dietician will help you in this regard.
The gastric balloon is removed by endoscopy just as it is inserted, and the removal process takes about 20 minutes, no pain is expected during or after the removal process. Unlike being worn, people who will have a gastric balloon removed should start a liquid diet a few days before the procedure, so that the particles in the stomach will be removed and the procedure will be safer. You can have a meal shortly after the removal and there will be no need for hospitalization. The patient can be discharged after the effect of anesthesia disappears.
The gastric balloon is attached with an endoscope, so it is not an operation. In the absence of surgery, it does not carry the risks of a surgical procedure, however, the risks that exist in every endoscopic procedure are also valid for the gastric balloon. Before the gastric balloon is inserted, it should be made sure that the stomach is absolutely empty, and the recommendations of the doctor who will attach the balloon should be followed strictly.