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Bariatric Surgery

Bariatric Surgery (Sleeve Gastrectomy)

Bariatric Surgery; Morbid obesity means “being overweight at a disease level” in Turkish.

The word ‘obese’ has been derived from the Latin word ‘obedere’. Obedere means someone who eat too much in Latin.The World Health Organization describes obesity as “the accumulation of excess fat on the body in a way that will distract health”.

Obesity is a disease that leads to very serious health problems and that may unfortunately shorten the life span. Scientific data shows that morbidly obese individuals live approximately 15 years less than normal-weight people.

Various parameters such as the body fat percentage and the type of body fat have been used for obesity classification. For the present, however, the body mass index (BMI) calculation of the World Health Organization (WHO) is used for the identification and classification of obesity, and almost became a common language all over the world.

It is a value that everyone can calculate with a simple operation. Individuals with a BMI greater than 30 are considered as obese.

In particular, the type of body fat, that is the fat around the waist circumference (apple type fatness-male type) and the fat around the hip circumference (pear type fatness-woman type), have an important place in defining obesity.

Although it has not gained an evidence value scientifically, there is a strong evidence suggesting that the excess fat around the abdominal circumference does not only progress with the subcutaneous fat but also with the fat of the internal organs, and with risky diseases such as diabetes and atherosclerosis, called the metabolic syndrome (Huxley R, Mendis S, Zheleznyakov E, et al.

Body mass index, waist circumference and waist: hip ratio as predictors of cardiovascular risk–a review of the literature. Eur J Clin Nutr 2010;64:16–22.). In other words, the ratio of waist circumference to hip circumference becomes important.

This value should be below 1. In terms of the risk of metabolic syndrome, the waist circumference should be 102 cm in males and 88 cm in females.

What is the reason of obesity (sleeve gastrectomy)?

Increased energy received from food + decreased energy spent by exercise = OBESITY Everyone has a certain basal metabolic rate. In other words, the cells in the human body spend a certain amount of energy to maintain their normal function.

We need this energy for our heart to beat, to breathe, briefly to survive. This energy is approximately 25-35 kcal/kg. For instance, the cells of a person with a weight of 70 kg consume about 2000 calories to function normally. Except that, we need extra energy for our normal physical activities.

We supply this energy from foods. This equation is necessary to be in a balance. If the amount of energy we receive from foods increases and the energy we consume with exercise decreases, the body stores the excess energy as fat and begin a process towards obesity.

Another important issue is the genetic basis of obesity. The advancements in genetic technology have focused on some genes. The gene that has been emphasized mostly is the ‘Ob’ gene that produces leptin.

The changes in the Ob gene reduce the production of leptin and this reduction results in an uncontrolled appetite increase. The scientific data shows that there may be a strong genetic basis. Children, whose mother or father is obese, are 30% likely to be obese, while this rate is 50-70% in children whose mother and father are both obese.

Apart from that, some endocrinological (hormonal) and psychiatric (eating disorders) diseases can be the cause of obesity. Endocrinological (disorders of the adrenal glands or thyroid glands) and psychiatric causes should absolutely be questioned in patients consulting doctor for obesity.

The data presented at the SAGES meeting in the United States in 2013 revealed another interesting cause of obesity. Unfortunately, obesity has been shown to have increased in countries where smoking cessation campaigns were held. The frequency of obesity is gradually increasing all over the world.

The numbers predicted by the World Health Organization are alarming. Obesity, which was below 10% in the 1960s, has reached 30% in 2000s, and half of the world’s population is expected to be obese if it increases with this acceleration.

In our country, the prevalence of obesity is not lower than the western countries and reaches 30% especially in females. In the TOHTA study, in which approximately 25000 people were screened, the prevalence of obesity was found to be 35.4% in people over 20 years of age. In the TURDEP-1 study, in which 24788 people were screened in 1998, the prevalence of obesity was found to be 30% in females, 13% in males, and 23.3% in general.

The TURDEP-2 study, which was repeated exactly 12 years after the TURDEP 1 study, revealed alarming results and it was observed that the prevalence of obesity, which was 22.3% in 1998, increased up to 31.2% in 2010.

In conclusion, 2 out of every 3 people are either overweight or obese in Turkey. In a short period of 12 years, the prevalence of diabetes increased by 90% and the prevalence of obesity increased by 44%.

Why should obesity be treated (sleeve gastrectomy surgery)?

“Obesity is the second preventable cause of death following smoking.” World Health Organization ” Obesity should not be considered only as an aesthetic problem.” Obesity is a condition that affects the entire body system to a large extent, from joint diseases to cancers.

The most important systems affected by obesity are the endocrine and cardiovascular system. The most important risk factor in the adult type of diabetes, that is the second type of diabetes (Type 2 DM), is obesity. Increased amount of body fat gives a resistance to the insulin hormone which is released from the pancreatic gland and is the most important regulator of glucose metabolism.

In other words, insulin slowly loses its activity in tissues. In addition, the excess amount of free fatty acids cause a toxic effect in insulin-secreting cells (beta cells) of the pancreas. The treatment of obesity without depletion of insulin reserves in the pancreatic glands is very important from this point of view.

The cardiovascular system (heart / vessel) is the second important system adversely affected by obesity. Increased serum fat ratios (triglycerides and cholesterol) provide a basis for atherosclerosis. Hypertension, heart attack and stroke risks arise when atherosclerosis reaches a serious extent.

The risk of heart attack is 2 times more in obese individuals than in normal-weight people. The scientific studies have shown that 70% to 90% of all hypertension patients were obese. One of the most common complaints that obese people experience is sleep apnea.

Sleep apnea is a disease that may cause breathing to stop completely during sleep. 40% of morbidly obese individuals have sleep apnea. Weight loss seems to be the only permanent treatment for sleep apnea. It has been shown by the medical literature that obesity was a risk factor for some types of cancer.

It has been reported that there was an increase especially in prostate and colon (large intestine) cancers in males. Whereas in females, breast cancer developing especially due to hormonal changes shows an increase. The increase in cholesterol, the main source of oestrogen, appears to be the reason.

Obesity is indicated by the World Health Organization as the second preventable cause of death following smoking. Obesity is shown to be the cause of three hundred thousand deaths each year in the United States. Given the whole world, the obesity-related death is much more common than the hunger-related death.