Which treatment methods are used in the fight against obesity?

Dr.Adem Dervişoğlu, MD, Professor

Which treatment methods are used in the fight against obesity?

‘First of all, you should know that your excess weight is not your destiny and that you should get rid of this excess weight, and you can get rid of it by receiving medical support’. If your BMI is higher than 30 kg/m2, you should definitely receive appropriate treatment. Obesity should be managed with conservative methods initially; including diet, sports, acupuncture, and the use of some therapeutic medications. Although potential endocrinologic causes of obesity account for less than 1% of all etiologic factors in obesity, they should nevertheless be investigated in the first place. The two leading endocrinologic factors are hypothyroidism due to underactive thyroid hormones and Cushing’s disease, which develops due to excessive cortisol production in the adrenal glands, causing central obesity.

Some psychological problems, especially major depression, may result in obesity, especially in individuals with a weight gain of considerable quantities in the short term. Eating food can transform into a psychological defense mechanism. In other words, eating becomes a way of emotional expression for the patient. These conditions require seeking psychological support. Although the treatment can take longer and be laborious, it can be treated.

The first step in the treatment process in patients without any endocrinological diseases is to change the eating habits under the supervision of a dietician. A controlled dieting program and engagement in regular workouts should definitely be attempted first to lose weight. The use of some therapeutic drugs that act on fat metabolism can support this process. However, treatment with medications should always be approved by an endocrinology specialist physician before the individual starts taking therapeutic drugs.

Obesity surgery candidates are the individuals with morbid obesity, who have been unable to lose weight after adopting at least 2 diet programs or dieting for 6 months, or they are morbidly obese individuals, who return their bodies to their previous weight after weight loss.

Who can undergo obesity surgery?

Obesity surgery is a term that covers a group of surgical methods applied to the digestive system to treat morbid obesity that causes health problems and cannot be resolved by nonsurgical methods including dieting and exercising. According to international guidelines, obesity surgery is the most appropriate method for the treatment of morbidly obese patients. According to the criteria defined in international guidelines; the candidates of obesity surgery are individuals with a body mass index of 40 or more. They are also individuals with a BMI of 35 and more, having one or more comorbid disorders including type 2 diabetes, hypertension, sleep apnea or other respiratory problems, non-alcoholic fatty liver, osteoarthritis, lipid metabolism anomalies, and heart diseases. These patients should not be addicted to alcohol or drugs and should not have serious psychological disorders.

What are the benefits of obesity surgery?

Obesity shortens human life expectancy for about 10-15 years.  It is the second leading cause of death after smoking. This type of surgical procedure is not a type of aesthetic surgery performed for losing weight. Obesity surgery provides significant benefits for our body after weight loss occurs. These benefits include sustained remission of type 2 diabetes, improvements in cardiovascular health, remission in depression, recovery from obstructive sleep apnea, relief from joint pain, and improved fertility.

Is obesity surgery associated with risks?

Obesity surgery is associated with the three most feared risk factors. These are anastomotic leaks (leakage), embolism (clot formation), and bleeding. These risks are seen at a rate of around 1% in surgeries performed by experienced surgeons. It is crucial to identify such problems as early as possible and to perform appropriate interventions. In the long term, 20% of patients can gain weight and a small number of patients return to their previous body weight. Surgery is only a tool for patients. The risk persists in patients, who do not change their lifestyles and dietary habits.

What types of treatment methods are demanded mostly?

Although obesity surgery refers to different types of methods and operations, its effects can be examined in two categories. These are the restrictive effect on food intake and malabsorption that impairs the absorption of food.

The most common method in obesity surgery is sleeve gastrectomy or commonly known as the tube stomach method, which is performed for reducing the size of the stomach all over the world as well as in our country. Gastric bypass is surgery is another method commonly performed by surgeons, especially in metabolic syndrome patients, which refers to patients with type 2 diabetes, hypercholesterolemia (patients having high cholesterol levels), and hypertension * (high blood pressure) accompanying obesity. These operations are performed laparoscopically.

What type of diet should I adopt after the surgery?

It takes 6-8 weeks for the patients to switch to a normal diet. Patients begin with a liquid diet first. After 1-2 weeks of adaptation, patients start eating strained food. Then, they can start soft foods and finally start eating normal foods gradually.  The priority should be given to protein intake. You should eat at least 60 grams of proteins every day. You should drink water 30 minutes before or after the meal. ‘Dead’ or processed food, fast food, and easy and ready-made meals should be avoided. Your diet plan for the rest of your life should “prioritize protein intake and then it should aim the proper intake of calcium followed by the intake of vegetables/fruits rich in vitamins, fiber, and pulp” .

At least 6-8 glasses of water per day should be consumed. No hot or cold drinks except water will replace your fluid need. Your daily water consumption is not only vital for your healthy diet, but also for your kidney functions, skin, and nerves.

What should we pay attention to after surgery?

You should not skip regular meals and you should not starve for long periods. You need to have at least 3 main meals a day and eat at least 1-2 snacks rich in protein. Patients should not starve for more than 4 hours. You need to swallow well-chewed food.  Solid foods should not be consumed simultaneously with liquids. One should have the liquids half an hour before or after meals.  The diet should not include carbonated drinks. After the surgery, people are more likely to drink carbonated beverages at meals; however, this combination of carbonated beverages and meals will eventually result in weight gain. You need to give up eating burgers and fries etc.

Especially during the first six months after the surgery, you should avoid drinking alcohol due to its acidic properties and high calorie content. Because a large part of your stomach has been removed and/or half of your intestines are bypassed, you need vitamin supplements.

It is necessary to avoid junk food as snacks. The carbohydrate portion of the diet should include good-quality food rich in complex carbohydrates including fruits, dried fruits, legumes, fiber foods, and oats.

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