Description

Obesity Surgery Department

What is Obesity?

Changes in life style and nutritional habits bring along
obesity. Defined by the World Health Organization (WHO) as “abnormal or
excessive fat accumulation that presents a risk to health” obesity is a
public health problem that becomes increasingly frequent and widespread. It is
very important to prevent the increase of obesity and treat obesity which ranks
second in the world’s “preventable health problems” list after
smoking. Surgery is a successful treatment approach to obesity which is considered
a life-threatening condition. Surgery leads to a successful result when it is
properly applied to the patient and its stages are clearly described to the
patient.

Modern life – obesity correlation

Researches show that 32 percent of the Turkish population
has a Body Mass Index (BMI) in excess of 30%, in other words, are obese. It is
known that the negative change in feeding habits and inactive lifestyle has a
great impact in this picture. Particularly, increased inclusion of women in
work life increased consumption of convenience foods instead of home made
foods. Due to time limitations, the use of fast cooking methods that increase
calorie gain climbed. In addition, the use of additives in convenience food
played a role in the present condition of obesity. Food technology is also
successful in making us feel hungry. Also in modern culture, consumption is
considered to relieve the stress of daily life, to change the routine, and to
have a rehabilitating effect.

Importance of Body Mass Index in the diagnosis of Obesity

Body Mass Index (BMI) gives information about the rate of
obesity. Dieticians note that BMI is not always sufficient in its own right,
and state that, of two persons who have the same weight and height, one may
have more belly fat, and the other may have higher muscle mass.

Specialists note that insulin resistance is another major
factor for the development of obesity. Insulin secreted by the pancreas
transport blood glucose into the cell. In doing so, it opens a lock of the
cell. When insulin resistance occurs, the lock-key relationship between the
cell and insulin is broken, and insulin starts accumulating in blood. Insulin
accumulated in blood causes high blood pressure, and leads to damage to
internal surfaces of the wall and gives rise lipoidosis in the liver. Unless
insulin resistance is broken by medications, these patients hardly lose weight.

Exercise in obesity treatment

According to specialists who note that exercise is very
effective in obesity treatment, exercising uninterruptedly for minimum 35
minutes four days a week has great importance in boosting metabolism and eliminating
problems like gas and constipation. Exercise becomes indispensable for obesity
treatment in order to relieve restrictions brought by diet.

Obesity – diabetes relationship

The relationship of obesity with several diseases
including diabetes is a scientifically proven problem. Diabetes which has now
transformed into a global epidemic is the most common. People with a Body Mass
Index (BMI) higher than 30 kg/m2 are 20 times more likely to develop Type 2
diabetes. 90 percent of people with Type 2 diabetes are diagnosed with obesity.
Obesity and diabetes and their causes are so intertwined with each other that
the term ‘diabesity’ is used in the literature to describe both clinical
conditions. Some medications may cause obesity. Antidepressants, notably
cortisol, insulin and insulin-releasing diabetes drugs may induce weight gain.

Does obesity lead to renal insufficiency?

According to the Obesity Prevalence Study in Turkey
(TURDEP) carried out jointly by Istanbul University, Faculty of Medicine,
Metabolism and Diabetes Unit, Obesity Research Unit, Prime-Ministry State
Statistics Institute (DIE) and Ministry of Health of the Republic of Turkey, obesity
rate in Turkey is 22 percent. In the study performed on 324 thousand 788
adults, a BMI of 30 kg/ m2 was used as a basis. In the same study, it was
demonstrated that obesity and metabolic syndrome which often accompanies
obesity were risk factors in the development and progress of chronic kidney
disease. Chronic Kidney Disease (CKD) is characterized by a three month or a
longer filtration rate less than 60 ml / minute and/or presence of
kidney-related urinary abnormalities (blood in urine and/or protein). The
course of CKD changes rapidly subject to the underlying cause and use or
omission of effective therapies. The stage when CKD requires dialysis or kidney
transplant is called the “End Stage Renal Disease” (ESRD).

As obesity is closely related to Type 2 diabetes and
hypertension which are the two most common causes of ESRD, it increases the
risk for end-stage renal disease. 15-20 year-long scientific researches show
that excessively fat and obese individuals are 40-80 percent more likely to
develop a renal disease than individuals with a normal body weight. Obesity
also affects the course of the disease negatively in people with known renal
diseases.

Protein leakage in obesity

How obesity increases the risk of development of a renal
disease is not clearly known. Based on the findings, it is thought that in
obese persons, there is increased perfusion of blood through the network of
capillaries called “glomerulus” in the kidneys (hyperfusion) and increased
infiltration rate through glomeruli (hyperfiltration). These increases
initially give rise to a hidden protein leakage known as “microalbuminuiria”,
and later to a protein leakage (proteinuria) detected in routine urinalysis. After
development of protenuria, the vessel structure of glomeruli deteriorates, and
become a structure made of connective tissues.

Microalbuminuria is an early sign of kidney damage as
well as an important risk factor for the development of cardiovascular diseases
just like high cholesterol and smoking. Also, a molecule called “leptin”
released by the fatty tissue is known to lead to sclerosis directly in
glomeruli. Obesity also causes diabetes and/or hypertension, giving rise to
negative effects on kidneys such as rise in fasting blood sugar called the
“metabolic syndrome” and rise in blood lipids (hyperlipidemia), and
hypertension.

In order to determine the negative effects on kidneys at
an early stage, amicroalbuminuria test is used. In addition to the microalbuminuria
test, other tests related to renal functions, creatinine, electrolytes,
urinalysis and if necessary ultrasound are necessary for a healthy evaluation.

Obesity and Hypertension

According to the Hypertension Prevalence Study in Turkey
carried out by the Turkish Hypertension and Renal Diseases Society, 60 percent
of individuals with a BMI equal to and over 30 kg/m2 have hypertension. In
addition to data showing the role of genetic predisposition, the primary factor
was determined to be the increased fatty tissue in the body. The fatty tissue
produces some hormonal effects which may increase blood pressure in the body,
giving rise to increased water and salt retention in kidneys, spasm and
stenosis in arteries. Thus, hypertension develops.

Overwheight people are under higher risk for renal disease

15-20 year-long scientific researches show that
overweight and obese individuals are 40-80 percent more likely to develop a
renal disease than individuals with a normal body weight.

Subsequent steps after deciding surgery in obesity treatment

After a person applies to a doctor for excessive weight,
blood analyses are performed after initial examination, and causes and
underlying diseases are investigated. Endocrinological and psychological
evaluations of the patient are performed. Support is sought from a dietician to
arrange his/her diet. The patient’s risk factors are evaluated. The patient has
a lot to do in this multidisciplinary process. Once surgery is decided, the
patient should know that surgery is not a magic wand, and surgery is no easier
than diet.