Patient Education Guideline

What is obesity?

Obesity is defined as abnormal or excessive fat accumulation that may impair health. Obesity is not just a cosmetic concern; it is also a complex medical problem.

What is body mass index?

Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. In clinical settings the way to determine people's body composition is mostly done by the BMI. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m²).

World Health Organization has created a classification according to the BMI. According to this classification, a person with a BMI of 30 or above is called obese.

Table: BMI defined by the WHO expert committee

How common is obesity?

The obesity problem has reached epidemic proportions. More than 4 million people died as a result of being overweight or obese in 2017 according to the global burden of disease. Rates of overweight and obesity in adults and children continue to rise. From 1975 to 2016, the prevalence of overweight or obese children and adolescents aged 5-19 years increased from 4% globally to 18%. In other words, there is a more than fourfold increase.

The USA has one of the highest rates of obesity among all developed countries in the world. In the US, 40% of all adults aged 20 and older have obesity, and an additional 32% are overweight. Obesity and obesity-related health problems are increasing not only in the USA but all over the World except sub-Saharan Africa and Asia.

Why do people become obese?

Many people become obese because they eat or drink too much, are inactive, or a combination of both. In other words, the main cause of obesity and overweight is the energy imbalance between calories consumed and calories taken. Obesity is increasing all over the world due to the increase in the intake of energy-dense foods high in fat and sugar, the increasingly sedentary nature of many forms of work, and a decrease in physical activity due to increasing urbanization. In a small number of cases, hormonal disorders, medications, or genetic predispositions increase the chances of becoming obese.

What are the risks of obesity?

The risk of developing some serious health problems increases in individuals with overweight and obesity. These health problems are;

v  High blood pressure

v  Heart disease

v  Stroke

v  Diabetes

v  Hyperlipidemia

v  Breathing problems

v  Osteoarthritis

v  Fatty liver disease

Obesity is also associated with certain type of cancers. These are;

v  Colorectal cancer

v  Breast cancer

v  Prostate cancer

What is the effect of obesity on quality of life?

Obesity has quite negative effects on the overall quality of life. You may not be able to do physical activities you used to enjoy, and you may avoid public places. People with obesity may even face discrimination. Depression, disability, feelings of shame and guilt, social isolation and lower job success are other important aspects that reduce the quality of life in obese people.

How to get rid of obesity?

The aim of obesity treatment is to reach and maintain a healthy weight. Achieving a healthy weight improves overall health, improves quality of life and reduces the risk of obesity-related complications. Treatment methods for obesity can vary, depending on the severity of the obesity and overall health.

·         Dietary changes: Reducing excess calorie intake and adopting healthier diet protocols are vital to overcoming obesity.

·         Exercise and activity: Increasing physical activity and exercising regularly is an integral part of obesity treatment.

·         Lifestyle changes: It may be beneficial to make lifestyle changes to lose weight and have a fit body.

·         Medications: In addition to diet change, exercise program, and lifestyle changes, some medications can help with weight loss. However, the use of drugs alone is not effective.

How can you change the game?

Many obese people have tried diet and exercise programs before, but have been unsuccessful. Therefore, you may need to reinstall the game in a different way to regain your health and get rid of obesity.

·         Endoscopic procedures for weight loss: Endoscopic procedures do not require any incision in the skin. After sedation, some procedures are performed through flexible tubes inserted from the mouth into the stomach. Almost all endoscopic methods have limited effect on obesity.

ü  Sleeve gastroplasty: In this method, sutures are placed in the stomach to reduce the volume of food that the stomach can take.

ü  Gastric balloon: In this procedure, a balloon is placed in the stomach and inflated by injecting liquid into it.

ü  Botox: The application of botulinum toxin (botox) is based on injecting botox into certain parts of the stomach. By preventing the contraction of the stomach muscles, the gastric emptying time is delayed and the patient loses appetite.

·         Obesity Surgery:  Weight loss Surgery, also known as bariatric surgery, works by reducing stomach volume, limiting the amount of food you can eat, or reducing the absorption of food and calories. Weight loss surgeries are very effective methods. But long-term success depends on the commitment to make lifelong changes in your eating and exercise habits. These surgical methods are;

ü  Laparoscopic adjustable gastric banding: In this surgical method, an inflatable band separates the stomach into two sacs. The band is pulled tightly like a belt to create a small passage channel between the two sacs. The adjustable band is placed on the upper part of the stomach. This creates a very small stomach pouch. Therefore, it means that you will feel full after eating less food.

ü  Gastric bypass: After gastric bypass surgery, food and liquid flow directly from the stomach pouch into the intestine, bypassing most of the stomach.

ü  Sleeve gastrectomy: In this surgical procedure, part of the stomach is removed and a smaller space is created for food. It is a less complicated operation compared to the gastric bypass method.

Who is a suitable candidate for weight loss surgery?

This surgery can be applied to people between the ages of 18 and 65 years. Surgery can be performed in morbid obese (BMI ≥40 kg/m²) patients in this age range, if they do not have any comorbidity. Patients with a BMI ≥ 35 kg/m² and one or more comorbidities (diabetes, hypertension, hyperlipidemia, fatty liver disease etc.) may benefit from surgery. In addition to these, surgery can be applied to patients with a BMI of 30-35 kg/m² and those with diabetes and metabolic syndrome.