OBESITY TREATMENTS
As we cannot evaluate obesity as being overweight or having a high fat ratio in the body, the point of view that only one method can be successful in its treatment will not be correct
Treatment should be multidimensional with a multidisciplinary approach. It is a long and difficult process for the patient. One of the most important factors in the treatment of obesity is the patient’s determination, as it will take time to reach the treatment results
During this process, the patient must adhere to the treatment methods applied resolutely, follow the targets set closely and display a devoted and disciplined approach in order to achieve the purpose of the treatment together with the doctor, dietitian or psychologist
In order to determine the treatment process, first of all, many other factors involving obesity such as the root causes of obesity, the patient’s character, lifestyle, body mass index and obesity class, waist circumference, fat rate should be addressed
By evaluating these factors, the most appropriate treatment method to be applied for the treatment of the patient is determined by the doctor. This method is not just the application of one of the methods we will talk about below. It is also important that these methods are applied together with the ones that are suitable for the person
In other words, only surgical intervention does not mean that obesity is cured. For example, the patient should change his/her lifestyle after surgical treatment, follow a nutritional diet and include exercise or sports activities in his life
It is important that the root cause of obesity is known by the patient and awareness is raised, and obesity is accepted as a treatable disease
HEALTY EATING & PHISICAL ACTIVITY
The goal in the treatment of obesity is to reach the ideal weight and therefore the body mass index of the patient. Thus, complications caused by obesity or excess weight will be eliminated. For this reason, weight gain should be stopped immediately and the loss of excess weight should be started in the first place
As might be expected the first step of the treatment will be the right diet. Exercise or an active lifestyle also supports treatment but this is sometimes not possible for obese patients
Significant weight loss after surgery in the first 6 months is important both for maintaining the stability of the patient in the continuity of treatment and more importantly, for eliminating the health problems caused by obesity
As mentioned in the causes of obesity, in case obesity is triggered by another health problem, the patient may also need to use regular medication for the treatment of this health problem
NON SURGICAL TREATMENT
We mentioned about the importance of significant weight loss in the first 6 months of obesity treatment. Since calorie intake must be limited in order for the patient to lose weight, the most common application that does not require surgical procedure is the application of gastric balloon
GASTRIC BALLOON
It is endoscopically placed in the stomach in a deflated state and then inflated. It creates a feeling of satiety in the stomach and thus restricting food intake
It is a widely used, easy to apply, effective and reliable method in the treatment of obesity. Operation can be applied to overweight people (non-obese) who cannot lose weight with diet and exercise and do not require surgery
In morbidly obese patients, in order to reduce the risk of anesthesia and surgery before the bariatric surgery for providing some weight loss, and also it can be applied in obese patients when there is fear of surgery and any medical restrictions that prevent surgery as the advantages of gastric balloon application
It can be placed in a very short time under clinic conditions Afterwards, the person can return to his/her normal life without the need for hospitalization
This procedure is very easy and painless
It can be considered that the patient can be removed at any time, so it is reversible any time
The disadvantages of the gastric balloon are as follows
Nausea, which is frequently seen, can sometimes decrease the quality of life for a short time (3-7 days) due to abdominal tension
It can stay in the stomach for 6 months – 1 year
The amount of weight lost is less than surgical methods
The patient’s determination facilitates the weight loss process After the stomach balloon is removed from the stomach, as long as it is not supported by diet and exercise programs, the lost weight can be regained
Swallowable Gastric Balloon (Allurion Elipse Gastric Balloon)
It has the same effect as the endoscopic gastric balloon. It restricts food intake by occupying space in the stomach and allows the person to lose weight by eating less with a constant feeling of fullness
The difference between gastric balloon and elipse balloon is that no endoscopy and anesthesia required
The deflated balloon is in the capsule and swallowed with water without the need for endoscopy or sedation. It is then inflated and placed in the stomach
The elipse balloon does not need to be removed. After about 4 months, it goes out by itself and is thrown out of the intestines by natural way. Thus, the required endoscopy and sedation for removal process are not applied again
SURGICAL TREATMENTS (BARIATRIC SURGERIES)
The amount of morbid obesity disease is increasing day by day According to the researches of the World Health Organization approximately 2 billion people in the world are overweight and 650 million of them are obese
Obesity is a disease and can be treated. It is wrong to see obesity as excessive adipose tissue formation and gaining weight. Obesity must be treated because of the vital diseases it causes. Obesity is involved many diseases such as Type-2 diabetes, cardiovascular diseases, joint disorders, asthma, sleep apnea, respiratory failure, cancer, stroke, psychological problems, skin diseases
Rapid weight loss is vitally important for patients with morbid obesity who has a body mass index of 40 and above. Because day by day, obesity releated diseases becoming chronical. It is important to eliminate vital risks. If there are vital health problems in patients with a body mass index of 35, surgical treatment should be considered also
Surgical treatments like Bariatric Surgery, the general purpose of stomach reduction surgeries or weight loss surgeries is to reduce food intake and absorption. Bariatric surgeries are performed laparoscopically
Bariatric surgery treatment methods are the most successful and most effective treatment method for obesity treatment today. After the surgery, the metabolism of the patient changes. Since the stomach becomes very small, appetite and food intake cravings decrease. Some bariatric surgeries limits the amount of nutrients the body absorbs by bypassing a portion of the small intestine begin to lose weight rapidly
Bariatric surgeries can´t be reversed. Considering that the treatment is a serious operation and the patient’s psychology, the first approach in the treatment of obesity is to evaluate the treatments that do not require surgery, of course depend on the health status of the patient
As mentioned before, surgery doesn´t mean that obesity is cured. The patient’s determination and lifestyle changes (nutrition and physical activity) after surgical treatment are important Classifying surgical treatments according to their purpose is important in terms of information. We can classify surgical techniques as restrictive surgeries, absorption-reducing-malabsorptive surgeries, or both restrictive and malabsorptive surgeries
RESTRICTIVE SURGERIES
Gastric Sleeve (Sleeve Gastrectomy)
It is the most commonly used surgery in the treatment of obesity in the world. It has become the most widely used method in laparoscopic bariatric surgery applications in the treatment of obesity, as it provides significant weight loss in a short time
It is done by cutting a large part (80%) of the stomach by laparoscopic methods and leaving the stomach in the form of a tube. Depend on the size of the removed part the secretion of the appetite hormone ghrelin decreases. As the appetite decreases, creates a feeling of fullness
Since gastrointestinal anastomosis or intestinal bypass is not applied in this technique, it is technically much easier than other bariatric surgeries. Post-operative complications are much less
It does not impair absorption, vitamin deficiency is not observed Loss of excess weight depends on the patient’s adherence to diet, determination and lifestyle. In this technique, it has been observed that patients lose up to 60% of their excess weight on average. This rate may increase depending on the person
Gastric Band
As can be understood from the name of the gastric band, the silicon-coated band made of titanium alloy is placed on the stomach
The band creates a small stomach pouch at the top by placing it approximately 5 cm below the esophagus and compressing it Before the food goes into the stomach, it enters this stomach pouch and provides the patient with a feeling of fullness without overeating
Restrictive & Malabsorptive Surgeries
It is one of the most common surgical methods used in the treatment of obesity
This surgery, called Roux-en-y Gastric Bypass, is performed by cutting the stomach leaving a small part just after the esophagus and creating a small stomach, and then bypassing and connecting a part of the small intestine to the formed stomach. Thus, both the volume of the stomach is restricted and the absorption is restricted by shortening the intestine
This surgery is widely used in general. The surgery is more complicated than sleeve gastrectomy surgery. Complications that may occur after surgery are 2 times more. It has been observed that there is no significant difference in excessive weight loss rates when compared to Sleeve Gastroctemy (Gastric Sleeve) surgery. RYGB surgery is effective in the treatment of diseases associated with obesity
WHICH TREATMENT ?
Factors causing obesity and the patient’s determination to change their lifestyle have a great impact on determining the most appropriate treatment for the individual. In addition, of course, factors such as body mass index, comorbidity with obesity, other health problems, whether the patient wants a surgical operation or not, are evaluated
Revision Surgery may be required for patients who have previously had bariatric surgery but have not been able to achieve results in the treatment
In general, among individuals who have not been successful in losing weight through pre-surgical or non-surgical dietary habits and exercise, morbidly obese patients with a body mass index of 40 and above or 35 or above and also obesity-related type 2 diabetes, hypertension, sleep apnea, respiratory, bariatric surgical treatment is considered. It is appropriate for individuals with comorbidities such as respiratory disease, non-alcoholic fatty liver disease, joint diseases, and heart diseases
Although the expected result in surgical methods varies according to the individual, up to 80% of the excess weight is lost within 2 years in surgical treatment In the gastric balloon application, 10-15% weight loss is expected in 6 months