Obesity (obesity) treatment:

OBESITY

Definition: Genetic background, irregular and excessive nutrition, sedentary life, hormone disorders, the effect of drugs used in the treatment of other diseases, as a result of excessive fat accumulation in the body. The condition is called obesity.

Classification: There are many parameters used in the classification of obesity. The most commonly used parameter today is BMI (Body Mass Index). We can find our body mass index by dividing our weight by the square of our height in meters.

Obesity Classification by Body Mass Index

Causes of Obesity:

1- Ba sit Obesity: It occurs as a result of unhealthy diet and sedentary life in people with suitable genetic background. It is the most common form of obesity in the population.

2- Endocrine Obesity: It is obesity that occurs as a result of disorders in hormones that affect fat metabolism, appetite and energy metabolism. The hormones and diseases that are effective here can be listed as follows.

Insulin Resistance

Hypothyroidism (Low Thyroid Hormone)

Cushing’s Syndrome (Cortisol hormone excess)

Insulinoma (Insulin-producing Tumor)

Polycystic Ovary Syndrome

Hypogonadism (testosterone in men, estrogen deficiency in women)

Growth hormone deficiency

3- Genetic Diseases: In the course of some rare genetic diseases, there are serious may accompany obesity. Some of these syndromes are .

Prader-Willi Syndrome

Bardet Biedl Syndrome

Cohen syndrome

Börjesen-Forrsman-Lehmann Syndrome

Obesity-Related Health Problems : The excess adipose tissue accumulating in our body leads to the production of many hormones and cytokines. Many different metabolic diseases occur in the long term in obese people through these hormones and cytokines produced. We can classify diseases that are directly related to obesity as follows.

Insulin Resistance

Type 2 Diabetes (Diabetes)

Gestational Diabetes

Hypertension

Hyperlipidemia (High cholesterol)

Coronary Artery Disease of the Heart

Osteoarthritis (Joint problems)

Gallstones

Sleep apnea syndrome

Various cancers (Breast, Colon, etc.)

In these diseases associated with obesity, serious improvements are seen with weight loss alone.

Treatment of Obesity: The Department of Endocrinology and Metabolic Diseases helps patients especially in the treatment of simple obesity and obesity due to endocrine causes. Obesity treatment is a stepwise and long-term treatment. One of the most important points in this treatment is the good communication between the physician and the patient and the patient’s ability to continue the treatment without losing motivation throughout the treatment. In this, at the beginning of the road, patients should be explained in detail what kind of treatment scheme will be followed and which measures will be taken in which situations. The steps of obesity treatment are

1- Lifestyle Changes: Here, obese people are provided to modify their nutrition and physical activities to lose weight. The diet and exercise programs recommended at this step should be aimed at returning people to their lifestyles. Because diet and exercise that is done only during the weight loss period and then left does not have much benefit in the long term.

Diet: There are many different types of diets such as low-calorie, low-calorie and low-fat, low-carbohydrate, high-protein and Mediterranean diets. In studies examining the relationship between different diets and weight loss, it has been observed that weight loss occurs regardless of the type of diet, as long as the total calorie intake is less than the person’s total calorie expenditure. On average, if a daily restriction of 500 kcal is made in the diet, a weight loss of half a kilo per week can be achieved. Diets in which the total daily calorie intake is 800 kcal less, which is generally in the fasting diet category, are not healthy diets that can be sustained for a long time. When deciding on which type of diet to start, additional health problems (insulin resistance, diabetes, hypertension, hyperlipidemia, gout) must be taken into account.

Exercise: It is extremely important for those who want to lose weight to do exercise together with diet. Because if people who have calorie restriction with diet do not activate their metabolism with exercise, a slowdown develops in the metabolism of people depending on the diet in the long term. In this case, the benefit seen from the diet decreases day by day. Therefore, Diet and Exercise should be inseparable. In addition, exercise has many extra benefits, as it is known. regular exercise has positive effects on sugar metabolism, cholesterol metabolism and cardiovascular system. Exercise also increases the synthesis of happiness hormone (endorphin). The ideal duration of exercise is 30 minutes on average, 5 days a week. The type of exercise to be performed (isometric, isotonic, etc.) should be decided by considering the other health problems of the patients (joint, heart, blood pressure, diabetes). Fatburn type exercises should definitely be applied in those who do not have additional health problems.

2- Medical (Drug) Treatment of Obesity: In patients with obesity-related co-morbidities, BMI>27, and in those without additional disease, BMI>30 values, besides lifestyle changes, drug therapy can be added.

3- Endoscopic Intragastric Balloon Application: This method is not a surgical procedure. With endoscopy, a balloon made of silicone is inserted into the stomach with a procedure that takes about 20-30 minutes, and this balloon is inflated in the stomach as needed. The aim here is to reduce the stomach volume by means of a balloon, to give patients a feeling of fullness and to eat less. Gastric balloons can be kept in the stomach for 6-12 months. It can then be removed endoscopically again.

4- Surgical Treatment Methods of Obesity: People with a body mass index (BMI) >40 kg/m2 or 40>BMI>35 and having any obesity-related disease (Diabetes, Apnea, Hypertension, Hyperlipidemia, etc.) There is an indication for bariatric surgery when there is no adequate response from diet, exercise and drug therapy. However, bariatric surgery is contraindicated and not recommended for individuals under the age of 18 and over 65, those with major depression, those who are addicted to alcohol or drugs, those with severe eating disorders (bulimia nervosa), and those with advanced heart disease. Surgical methods used in the treatment of obesity are generally divided into 3 main groups.

Restrictive (stomach resection) Surgery: The main purpose here is to reduce the stomach volume with the applied surgical method and to enable obese people to eat less. However, restrictive surgical methods do not only reduce the stomach volume. Ghrelin, which is synthesized from the stomach and has an effect on appetite, also causes a decrease in appetite by changing the level of hormones such as GLP-1. Sleeve Gastrectomy (tube stomach) method is preferred most frequently.

1-Sleeve (Tube Stomach) Gastrectomy

2-Horizontal Gastroplasty

3-Laparoscopic Gastric Banding

Malabsorbsive (Inhibiting Food Absorption) Surgery: This In the method, basically, an anastomosis line is created between the stomach and the small intestine, and a large part of the intestinal lumen, which is necessary for the absorption of nutrients, is bypassed. In this way, weight loss occurs as a significant part of the food eaten cannot be absorbed from the intestines. They lose more weight and faster than restrictive surgical methods, but they are irreversible surgical methods with a higher probability of complications. The most preferred method is Roux-en Y gastric bypass surgery.

1-Roux-en Y gastric bypass

2-Jejenoileal bypass

3-Biliopancreatic diversion

Combination Surgery (Restrictive+Malabsorbtive)

Follow-up After Obesity Surgery: When deciding on obesity surgery, an Endocrinology specialist should be consulted, the surgical indication should be set correctly, and the patients should be informed about the possible effects and side effects of the surgery to be performed. It is very important for patients to follow up with an Endocrinology specialist and dietician, especially after surgery, in terms of regulating the early and late period diets, arranging and monitoring supportive treatments against possible vitamin and mineral deficiencies. Many different clinical symptoms may occur due to weight regain due to malnutrition or vitamin and mineral deficiency in patients who are not followed up properly after surgery.