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Obesity Surgery

 

Obesity is a global health problem with an ever-increasing prevalence. If left untreated, it can lead to many acute and chronic diseases such as heart disease, diabetes mellitus, and hypertension, making it a serious condition that requires careful management. Among the diseases strongly associated with obesity are type 2 diabetes mellitus, hypertension, cardiovascular diseases, as well as breast, prostate, and colorectal cancers, and various gynecological disorders.

The main causes of obesity include unhealthy eating habits and a sedentary lifestyle. Although the exact underlying mechanisms are not fully understood, genetic predisposition, physiological, cultural, and environmental factors are known to play significant roles. Fundamentally, obesity occurs when daily energy intake exceeds energy expenditure, resulting in fat accumulation in the body.

Due to increased body weight, obese individuals often experience reduced physical activity. This decrease in activity further reduces calorie burning, creating a vicious cycle that accelerates obesity. If not addressed, obesity can severely affect quality of life and damage nearly all body systems.

Considering the aesthetic concerns caused by excess weight, life-threatening diseases, chronic conditions requiring lifelong treatment, and psychological impacts, obesity must be treated with a multidisciplinary approach.

At Private Istanbul Regional Hospital (Sancaktepe), our Obesity and Metabolic Surgery Department works in close collaboration with all other departments. The first step in treatment is diagnosing obesity and determining its severity.

Diagnosis of Obesity

Obesity is determined using the Body Mass Index (BMI) formula:

BMI = Body weight (kg) / Height (m²)

Classification:

  • BMI < 18.5 → Underweight
  • 18.5–24.9 → Normal weight
  • 25.0–29.9 → Overweight
  • 30.0–39.9 → Obese

  • 40 → Morbid obesity

  • 50 → Super obesity

After diagnosis, the presence of obesity-related diseases is evaluated through multidisciplinary consultations.

Diseases Associated with Obesity

  • Insulin Resistance & Diabetes Mellitus: Excess fat reduces insulin sensitivity, leading to prediabetes and type 2 diabetes.
  • Hypertension: Significantly more common in obese individuals; increases cardiovascular risks.
  • Coronary Artery Disease: Disruption in fat and glucose metabolism increases heart disease risk.
  • Stroke: Vascular blockage or hemorrhage may occur due to obesity-related conditions.

In summary, obesity negatively affects nearly all systems of the body.

Treatment of Obesity

The primary prevention starts with healthy nutrition and an active lifestyle from childhood.

Treatment is complex and requires a multidisciplinary team including physicians, dietitians, physiotherapists, psychologists, and metabolic surgeons.

Treatment Steps

  • Lifestyle and behavioral changes
  • Diet therapy
  • Exercise counseling
  • Medical treatment
  • Metabolic (bariatric) surgery

Lifestyle Changes

Healthy eating and regular exercise habits are essential. Even moderate exercise (e.g., 30 minutes, 3 times per week) can significantly help weight loss. Long-term success depends on maintaining these habits.

Diet Therapy

A personalized nutrition plan is created to regulate calorie intake and correct vitamin/mineral deficiencies.

Exercise Counseling

Customized exercise programs are planned to safely increase physical activity without overloading the cardiovascular system.

Medical Treatment

Medication focuses on treating associated conditions such as diabetes and hypertension.

Metabolic (Bariatric) Surgery

Surgical treatment helps patients achieve and maintain a healthy weight and improves obesity-related diseases.

This is not purely aesthetic surgery, but a long-term health investment.

Criteria for Bariatric Surgery

  • BMI ≥ 40
  • BMI 35–39.9 with comorbidities
  • BMI 30–34.9 with unsuccessful non-surgical treatments
  • Previous diet, exercise, and medical treatments failed
  • Suitable overall health condition for surgery

Preoperative Preparation

Includes comprehensive evaluation:
blood tests, imaging, consultations, and anesthesia assessment.
A personalized surgical plan is created after full evaluation.

Mechanism of Surgery

  1. Restrictive: Reduces stomach volume
  2. Malabsorptive: Reduces nutrient absorption
  3. Mixed: Combination of both

Types of Bariatric Surgery

  • Sleeve Gastrectomy
  • Gastric Bypass (Roux-en-Y)
  • Mini Gastric Bypass
  • Transit Bipartition
  • Jejunoileal Anastomosis
  • Revision Surgery

Sleeve Gastrectomy

Performed laparoscopically.
Approximately 80% of the stomach is removed, reducing volume and hunger hormone (ghrelin).
This leads to reduced food intake and prolonged satiety.

It also positively affects diabetes and hypertension.

Postoperative Period

Patients stay in the hospital for 4–5 days.
Recovery is closely monitored, and nutrition guidance is provided.

  • First week: liquid diet
  • After 1 week: pureed foods
  • Around 2 months: small portions of solid foods

Patients must:

  • Eat slowly and chew thoroughly
  • Avoid drinking water with meals
  • Take vitamin and mineral supplements regularly

Long-Term Outcome

Patients are expected to lose at least 50% of excess weight within the first year.

Sustained success depends on:

  • Healthy nutrition
  • Regular exercise
  • Long-term lifestyle changes