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.
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.
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!
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.
For the individuals who suffer from obesity but are below the surgical limits of the indications for weight loss surgery, for those who do not preffer weight loss surgery but have the indications for it, and for the overweight individuals (BMI between 25 and 30) there are some non surgical endoscopic weight loss procedures! Non surgical endoscopic weight loss procedures are:
1- Stomach Balloon ( Gastric Balloon)
2- Stomach Botulinum Toxin Injection
3- Endoscopic Gatsric Plication
Before answering the question about what weight loss surgery is, the most important thing to do should giving an answer to the question "What is obesity"? Obesity, in the most general sense, means having more fatty tissue than it should be in the human body. Obesity is a disease that has become almost a global epidemic today and is increasing rapidly. Behind obesity are environmental factors such as sedentary lifestyle, abstinence from natural foods, consumption of high-calorie processed foods, consumption of high-calorie, sugary or high-fat foods and some genetic factors. Generally, obesity disease is diagnosed by calculating the Body Mass Index.
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 a weight loss surgery a wide chech up must be performed to exclude some hormonal and genetic factors.
How is Obesity Level Calculated?
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.
What is "Obesity Surgery" or so called "Weight Loss Surgery"?
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.
What are the Methods Applied in Weight Loss Surgery?
Today, 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.
Life After Obesity Surgery
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.
Which Patients Can Apply for Weight Loss Surgery?
Obesity 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.
What is Sleeve Gastrectomy Surgery ?
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 today;
- exercise and special diet programs
- adopting new healthier feeding habits
- Stomach balloon
- Stomach botulinum toxin injection
- Surgical methods
can be applied.
Today, 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.
How Long Does Sleeve Gasrectomy Surgery Take?
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.
Is the whole stomach removed in Sleeve Gastrectomy surgery?
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.
Important Points Before Gastric Sleeve Surgery
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