Obesity is simply defined as an increase in fatty tissue in the body that impairs general health. Although obesity is perceived as a cosmetic problem among the public, it is actually a serious health problem. Wrong eating habits, genetic disorders, sedentary life, excessive food consumption and hormonal factors can cause obesity. Also obesity; It causes important diseases such as heart diseases, diabetes, sexual dysfunctions, musculoskeletal diseases and sleep apnea.

What is Obesity?

Obesity is a complicated disorder that causes the person to experience health problems as a result of excessive excess fat tissue in the body. Body Mass Index (BMI) calculation based on height and weight is used to calculate obesity: over 30 is considered obese, over 40 is morbidly obese, and over 50 is considered super obese by the World Health Organization. . Personalized Obesity Surgery: Obesity can be treated more easily in suitable obesity patients with personalized treatment methods.

With our advanced technology and expert academic staff, the most appropriate treatment plan is offered to the person. The patient; Personalized treatment options are determined by taking into account gender, age, results of analysis and examinations, and whether there is any obesity-related disease.

What Diseases Does Obesity Cause?

Obesity; In addition to its negative effects on the psychosocial status of body systems (endocrine system, cardiovascular system, respiratory system, gastrointestinal system, skin, genitourinary system, musculoskeletal system), it causes many health problems, including infertility, by affecting sperm quality. Polycystic ovary syndrome, seen in women, is also a condition more commonly associated with obesity.

Hypertension occurs 6 times more frequently in obese patients than in thin men and women. Hypertension following obesity reaches very high levels, especially in cases of abdominal obesity, that is, waist circumference over 80 cm in women and 94 cm in men.

Obesity; It simultaneously increases the risk of heart diseases, diabetes and high cholesterol, thus creating the necessary environment for the development of hypertension.

What is Obesity (Bariatric) Surgery?

Obesity surgery; It is the name given to all surgical interventions performed to eliminate morbid obesity and is called “bariatric surgery” in medicine. Nowadays, bariatric surgery appears to be the most effective method for maintaining weight loss in morbidly obese patients. Patient; Bariatric surgery comes into play when the patient cannot lose the expected weight with diet, physical exercise, behavior modification and medications.

Bariatric surgery can be considered as a chance to get rid of this disease for patients who struggle to survive with advanced obesity. The most important goals of bariatric surgery are; The aim is to achieve sustainable weight loss, improve the quality of life, reduce the complication rate, cost effectiveness and low mortality rate. In order to achieve these goals, before the patient is taken into surgery, the bariatric surgery team must: Their eating habits, nutritional and clinical status should be evaluated very well, they should undergo a psychological evaluation to detect eating behavior disorders, and they should be followed for a lifetime with a team that includes a dietitian. What are the methods used in obesity surgery?

Restrictive methods

It reduces the volume or capacity of the stomach and therefore limits calorie intake by ensuring early satiety. These; laparoscopic adjustable gastric band (LAGB), vertical banded gastroplasty (VBG), laparoscopic sleeve gastrectomy (sleeve gastrectomy = LSG) and gastric balloon.

Gastric Sleeve Surgery

It is a surgical obesity treatment method applied to people with additional diseases such as knee and heart problems or to patients with a body mass index of 40 and above even though they have no disease. Simply put, during the surgery, 85% of the stomach volume is removed with various medical instruments and the stomach is tubularized. The main purpose of the surgery is; It is the restriction of the volume of food that the stomach can take. Gastric sleeve surgery alone is not a weight loss method. In the postoperative period, they must follow a new diet program and exercise program as much as they can. If patients comply with the diet and exercise program, they can lose 65% – 80% of their excess weight within the first year.

Gastric Balloon

Gastric balloon; It is a non-surgical weight loss method for overweight patients. In this method, a balloon sent into the stomach endoscopically is inflated with various special liquids to reach a certain volume in the stomach. In this way, the feeling of satiety is achieved early and the patient’s food intake is restricted. Patients who have a gastric balloon procedure cannot lose weight with the effect of the gastric balloon alone. As with other procedures, patients must follow an appropriate diet and exercise program for gastric balloon surgery.

Gastric balloon procedure; It is performed under sedation in the endoscopy unit under the supervision of an anesthesiologist. Patients do not feel anything during the procedure. After the procedure; The patient is discharged after being monitored for 3-4 hours under the supervision of a doctor.

Methods that disrupt absorption

They reduce calories by reducing nutrient flow and bypassing the absorptive area. These; biliopancreatic diversion (BPD) and Jejunoileal bypass.

Combined methods

These are methods that both restrict food intake and reduce absorption. These; Roux en-Y gastric bypass (RYGB) and duodenal switch (DS). **It is possible to achieve successful results in the fight against obesity with endoscopic methods as well as surgery. Patients who are concerned about the risks of surgical methods may prefer gastric balloon and endoscopic gastric sleeve procedures.

Gastric Bypass

There are many methods applied in obesity surgery. Among these methods, the most commonly applied is Gastric Bypass surgery. Gastric Bypass surgery; It is applied in the treatment of obesity-related diseases. One of the most preferred and applied diseases is; Type 2 diabetes is coming.

Gastric Bypass surgery; It is a method that both restricts eating and prevents absorption. Since the patient’s stomach volume will shrink after the surgery, the desire to eat will also decrease. This allows the patient to lose weight more easily.

Common Misconceptions in Obesity Surgery

‘Surgery will not work from now on’

The patient’s age or excess weight, in other words, whether he/she meets the necessary criteria to undergo this surgery, is a situation that can only be determined by the specialist physician. As a result of technological developments in the field of medicine, the experience and opinions of our physicians will be the only determinants that can enlighten you on this subject.

‘Obesity surgeries are very risky’.

Obesity surgeries do not carry more risks than any other surgery. However, performing these surgeries by surgeons who do not have sufficient experience in this field and in hospitals that do not have adequate equipment can unfortunately result in death. Obesity surgeries must be performed in a center fully equipped with expert, experienced staff and technology.

‘There is no need to do anything else after the surgery’.

Another issue that is at least as important as surgical treatment in getting rid of obesity is that the patient should switch to a nutritional regime under the supervision of a specialist after the surgery. The patient must also adapt himself emotionally and psychologically to this new nutritional regime. While the surgery causes a decrease in appetite in patients, the shrinkage of the stomach also increases the feeling of fullness. Thus, the patient does not have difficulty in correcting his old eating habits.

‘I will not gain weight again after surgery’.

We stated that surgery alone is not sufficient. 20 percent of patients may gain weight again after obesity surgery, and some may even return to their previous weight and have to undergo surgery again. Therefore, the thought that there will be no weight gain after surgery is wrong. To avoid such a situation, the patient must be extremely careful about his nutrition after surgery.

‘Eating will not be as pleasurable as before’

It is a wrong thought that the person will experience difficult days after obesity surgery and will completely lose the pleasure of eating. Adequate and balanced nutrition will be possible without any difficulty, as if dieting, due to reasons such as less attachment and appetite to food in patients, the stomach shrinking as less food is consumed, and a faster and more pronounced feeling of fullness. Surgeries have no effect on the taste and pleasure people get from food.

Why Medipol Mega University Hospital?

At Medipol Mega University Hospital, patients with many problems are evaluated and the most appropriate medical assistance is provided. It is aimed to provide the most appropriate support for weight loss with support from endocrinology, dietitianship, general surgery and, when necessary, psychiatry, pulmonology and cardiology. Our intensive care service is provided in single rooms with the most advanced technology. With the robotic system, these surgeries can be performed with minimal surgical trauma.

Your obesity profile is created with a multidisciplinary approach by a team specialized in the field and a surgical procedure is performed according to your suitability. For this purpose, we recommend surgery to our patients who have been obese for the last 5 years and have been struggling with obesity for the last 2 years. In addition, we recommend obesity-related surgery to patients with a body mass index (BMI) of 35 and above, who have additional diseases such as blood pressure, sugar, high cholesterol, sleep apnea, or to obese patients with a BMI of 40 and above who do not have any diseases.

The Role of the Dietitian in Obesity Surgery

Long-term and successful results of bariatric surgery depend on the patient’s lifelong nutrition and lifestyle changes. It is important for the dietitian to monitor the nutritional status of patients after surgery to increase success after bariatric surgery. The duty of the dietitian is to evaluate the nutritional status of patients according to the ASMBS guide in the pre- and post-operative period and to provide dietary consultancy for nutritional support in the post-operative period. Research on this subject provides data that patients who continue to follow a dietician after surgery are more successful after surgery, have a greater decrease in body mass index, eat fewer calories, and are more successful in changing their nutritional behavior. It is also stated that patients who participate in support groups and similar motivational meetings lose more weight than those who do not participate. Points that patients can benefit from in support groups: These can be listed as social support, exchange of experiences, responsibility and getting tips on diet.

Post-Surgery Nutrition

The new stomach pouch created by surgery has the capacity to hold approximately 150 ml of food. To ensure the healing of the stomach pouch, juicy, soft and pureed foods should be consumed for four weeks. Eating habits and lifestyle changes are essential for weight loss. However, it is important not to cause stomach discomfort or vitamin and mineral deficiencies while doing this. The postoperative eating pattern is followed in a 4-stage process, and transitions in the stages must be made with the doctor’s approval.

Stage 1: Clear watery foods: Approximately 3 days after the surgery, clear watery foods (tea, water, compote, apple juice, broth, etc.) are started. When the patient tolerates these foods, soup, yoghurt, biscuits and white cheese are added on the 5th and 6th days. The patient should take these foods little by little and at frequent intervals.

Stage 2: Juicy, soft and blended foods. Watery, soft and blended foods should be continued for 4 weeks after surgery. Soft fruits (apricots, peaches, strawberries, watermelon, etc.) can be easily taken. Hard fruits should be blended. To avoid protein deficiency, the patient should take 70 grams of protein per day.

Stage 3: Semi-solid foods. You can start eating semi-solid foods 4 weeks after the surgery. The stomach pouch is now healed. Soft and semi-solid foods can be tolerated easily. At meals, it is necessary to focus primarily on foods containing protein and avoid foods that are high in fat and sugar and are difficult to digest.

Stage 4: Low-fat, solid foods. The restrictions were lifted approximately 3 months after the surgery. All solid foods, red meat, raw vegetables and raw fruits can be eaten, provided that they are chewed well. It is necessary to avoid sugar and sweets, high-fat foods such as cream soups, sauces, butter, fried foods and fast food.

Things to Do in the Preoperative Period

• General health and nutritional status should be evaluated.
• The diet program to be followed after the surgery should be explained.
• In order to minimize the risks in surgical procedures, comorbidity treatment should be done in the best possible way.
• The patient’s commitment and motivation to follow-up programs should be evaluated.
• He/she must be guaranteed to receive all necessary information about the need for lifelong follow-up and the risks and consequences of surgical options. The patient should be made to understand the potential consequences of surgery.
• The patient should be given accurate information that surgery may involve risky situations, and the patient should accept lifelong behavioral changes and follow-up programs.
• The patient’s clinical condition and bariatric operation plan should be evaluated.
• Sleep apnea syndrome and lung respiratory function
• Metabolic and endocrine disorders
• Gastro-esophageal reflux disease
• Helicobacter pylori gastritis
• Body composition (densitometric assessment)
• Bone density
• Indirect calorimetry

Success and Failure After Obesity Surgery

When defining a successfully completed Bariatric Surgery, we can express it as the patient losing 50-70% of his excess weight and gaining a new and regular eating habit after the surgery and maintaining this habit.

At the same time, the patient’s support of this new eating habit with physical activity is a factor that will ensure the continued success of the surgery by preventing the patient from regaining the weight he lost. Postoperative failure can be defined as not being able to achieve the set goals and regaining the lost weight over time. After a successful operation, it is of critical importance for the patient to enter into a new lifestyle and purify himself from old eating disorders and maintain continuity in this regard, in order to maintain the lost weight.

Who is a candidate for bariatric surgery?

Those who are between the ages of 18-60 and have a body mass index (BMI) of 40 kg/m2 and above, and those with a BMI of 35-40 kg/m2 and metabolic disorders such as type 2 diabetes, cardiorespiratory disease (hypertension), sleep apnea syndrome, serious joint disease (arthrosis). Patients with at least two of the accompanying diseases such as , polycystic ovary syndrome (PCOS) and serious psychological problems due to obesity can undergo surgery.

Before deciding on surgical treatment, the patient must have been obese for at least 5 years, have tried to lose weight for 5 years but failed, and the patient must not have hormonal diseases. Also, one should not be addicted to alcohol or drugs. The patient must understand the surgery method very well and be able to adapt after the surgery.

Body Mass Index Calculation

Body mass index; It is a calculation method that shows whether a person is at ideal weight or not.

How Long is the Recovery Time?

Thanks to the method used in obesity surgery, there is very little pain after the surgery since no large abdominal incision is made. After the operation, patients stand up and walk. As a result of observing the patient’s health, the patient is discharged on the date deemed appropriate by the doctor. Shortly after the operation, the patient continues his active life. If the necessary doctor’s checks are continued without interruption, the weight loss process will continue in a healthy way.

How Much Weight Loss Will There Be?

After obesity surgery, the amount of food consumed decreases significantly because there is no capacity to feel hungry and eat as much as before. However, it is recommended not to consume sugary foods, drinks and alcohol. While general checks constitute an important element to prevent possible mishaps, it is estimated that people who comply with all these conditions can lose at least 50-60 percent of their excess weight in approximately 12 months.

Exercise After Obesity Surgery

After obesity surgery, the patient should consult the doctor about what exercises he can do and the exercises should be started in the most appropriate time period recommended by the doctor. Patients who have bariatric surgery cannot lose the desired weight just because of the effect of the surgery. As with other methods, patients must follow an appropriate diet program and exercise.