What are the definition and symptoms of obesity?
The classical definition of obesity is increased fat percentage in the body. However, the danger we deal with is far more than this definition that causes a societal problem. As a surgeon who has been dealing with obesity surgery for a long time; I can say the main symptoms of obesity is unhappiness and losing the love an individual has for themselves. This is demonstrated after the surgeries as I notice changes in these aforementioned symptoms besides the physical ones. If one of the reasons of our lives is to be happy, and we cannot be happy without loving ourselves, we should prioritize obesity besides all the health problems it causes as a psychological deformation.
What’s The Connection Between Obesity And Type II Diabetes?
Type II diabetes is a chronic disease that is characterized as the lack of efficient utilization of body-made insulin, which causes elevated blood sugar. Hormones, nervous system and environmental factors are vital in its progress. Obesity is especially important in Type II Diabetes progression. People who have family history of diabetes enter the risk group upon weight-gain. The surgeries that we perform are considered to be the most efficient solution of obesity and closely related comorbidities such as Type II diabetes. Furthermore, these surgeries are revolutionary in treating these diseases that we used feel hopeless about.
What Is The Relationship Between Eating Habits And Obesity?
Our generation has experienced the biggest reform in food technology and presentation. Unfortunately, we also experienced the most devastating harms of refined foods. We all remember that we did not encounter this many diabetic patients when we were kids. Also, the number of overweight people weren’t this many either. Healthy and balanced eating, with or without surgery must be all of our focus.
What Does Obesity Do To Me?
Obesity restricts patients’ lives, which leads to numerous comorbidities. You can take a look at some of the obesity-based comorbidities below.
Advanced obesity increase the chance of having comorbidities and their mortality rates. Overall mortality rate in one year in the advanced obese female patients are 1.4 times higher than the obese female patients and 2 times more than health-body weight female patients. Moreover, cardiovascular diseases or the impact of diseases/factors that may cause cardiovascular problems such as diabetes, hypertension and hyperlipidemia also increase with obesity.
Type II Diabetes:
There is especially a strong correlation between Obesity and Type II Diabetes. While Type II Diabetes prevalence is 3% in the patients who are healthy weight, it’s 6% for overweight, 11% for obese and 19% for morbidly obese.
Morbidly obese individuals experience a significant decrease in their heart and lung reserves, which creates an effect very similar to heart failure. Patients who are morbidly obese have much higher chance of developing health problems and mortality that is associated with them.
Sleep apnea, obesity hypoventilation syndrome, asthma, gastroesophageal reflux, hypertension, coronary artery diseases, congestive heart failure, liver disease [not related to alcohol], fatty liver [not related to alcohol], sirosis, back pain, degenerative joint diseases (knee, hip), pseudotumor cerebri, urinary incontinence, polycystic ovary syndrome and umbilical hernia are commonly seen medical comorbidities that are closely associated with obesity.
[Food tube (esophagus), uterus, stomach, large intestine (colon), breast, prostate, liver and liver cancers have higher risk of prevalence with obesity.
Morbidly obese individuals experience higher rates of depression, anxiety and eating disorders. The quality of life scores of morbidly obese individuals decrease regardless of their ages.
The health expenses of morbidly obese individuals are twice of the individuals with healthy weight.
Am I A Good Candidate For The Obesity Surgery?
Patients That Are Suitable For Surgery:
- Patients who are between ages of 20-65 (Anyone older than that will be considered in a person-centric manner)
- Patients who do not have comorbidities with BMI (body mass index) 40 kg/m2 and above
- Patients who have comorbidities (diabetes, hypertension, high cholesterol, sleep apnea, asthma, polycystic ovary syndrome, serious joint problems) and BMI (body mass index) is between 30-35 kg/m2
- Patients with diabetes that is difficult to control and BMI of 30-35 kg/m2
- Patients who tried to diet in the past and showed effort
- Patients who will come back for routine checkups after the surgery and comply with the recommended support medications
- Patients who do not have active psychiatric condition
- People who do not have drug and/or alcohol addiction(s)
- People who received positive results from the pre-surgery assessment
Patients that are NOT suitable for the obesity surgery:
- Patients with alcohol and/or drug dependency
- Patients with no family support
- Patients who will not comply with the post-surgery lifestyle changes are not good candidates for the surgery (It is very important to maintain the weight-loss after the operation)
- Patients who have stomach cancer or stomach cancer precursor lesions (stomach ulcer) are not appropriate candidates
- Patients who smoke are not appropriate candidates. The first life-style change will be quitting smoking. Quitting smoking before the surgery will be a great indicative of the patient’s desire and seriousness.
MİDE KÜÇÜLTME OPERASYONU
What are your goals with the obesity surgeries?
- Ensuring that our patients thoroughly understand obesity surgery and its pros,cons and consequences.
- Helping them self-reflect by assessing pros and cons in order to better understand whether they are ready for the change
- Not every obese patient is the right candidate for surgery. The post-surgical success of the operation is as much related to the surgery’s success as to the patient’s appropriateness to the operation. The obesity surgery is not a shortcut. Furthermore, the reason it is vital to ensure patient compatibility is that in the case of patient’s lack of compatibility with the operation, it is not possible for the patient to reach the ideal results. Lifestyle changes should begin starting from the decision to get the surgery.
We aim to minimize the preventable problems by thoroughly and carefully executing the preparation process and ensuring the appropriate patient selection.
Where should I begin?
The assessment process begins with our first encounter with the patient. For our patients who reached out to us through social media or phones and met our basic requirements get invited to our hospital for more detailed assessment. In order to better understand their compatibility for the surgery, they go through an extensive medical check up. During this assessments, our patients get many detailed tests, which gets assessed by several physicians in order to finalize their appropriateness for the operation.
- After the required tests and assessments are done; the patients who are appropriate for the surgery have a through discussion with Prof. Dr. Recep Aktimur about the different types of operations, their pros/cons, complication profiles, possible outcomes and expected results. The most appropriate operation for the patient and the date get decided.
- During the encounter, the patient and his/her family gets informed about the accelerated-recovery protocol that is applied in our clinic. Furthermore, it is ensured that the patient has a refined and clear understanding about bariatric surgery. Suggestions such as reaching out to our patients who had gone through is recommended and encouraged. The process until the surgery is explained in detail.
Why are there so many procedures being performed?
The aim is not just to operate on our patients; it is to assess our patients thoroughly in a multi-faceted fashion as obesity’s treatment requires a multidisciplinary approach. A higher tendency for health problems is well-known in this patient group. It is very important to carefully assess this patient group as the surgical process is more prone to be problematic in this group compared to patients with healthy weight.
These procedures are performed not only to apply a surgical treatment on our patients but also to ensure that they stay at the healthy weight they achieve after the surgery and minimize the preventable health problems in their lives. We recommend alternative treatments to our patients who demonstrate incompatibility to the recommended pre-surgical practices.
When all the tests are done, what is the procedure that will be done?
After all the required tests are done, the patient’s admission to the hospital on the planned day is required.
It is important for our patients and their families’ to understand our clinic’s special accelerated recovery program, early movement, early feeding and early discharge protocols. Any questions that the patients and their families have should be asked to Prof. Dr. Recep Aktimur.
Before the procedure:
- Ameliyattan en az 2 hafta önce sigara kullanılıyor ise kesilmelidir, bu durum ameliyat sırasında solunum problemleri yaşanma ihtimalini düşürmektedir.
- Ameliyattan 2 hafta önce karaciğer küçültücü diyete başlanmalıdır (Bol proteinli, bol sıvı tüketilen, az yağ ve karbonhidratlı)
- Ameliyat randevusu verildiği sırada reçete edilen mide koruyucu ve eğer varsa eksik olan vitaminler ile ilgili ilaçlar ameliyat gününe kadar kullanılmalıdır.
- Doç. Dr. Recep Aktimur’un önerilerine uyarak kan sulandırıcı ilaç kullanımı var ise kesilmeli, görüşme sonrasında başka bir ilaç kullanımı var ise yatış öncesinde mutlaka bildirilmelidir.
- Sürekli kullanılmakta olan (diyabet, hipertansiyon ilaçları vb) ilaçlar kesilmemelidir, ilaçlar ile ilgili düzenleme görüşme sırasında yapılacaktır.
Ameliyattan Önceki Gece ve Ameliyat Günü:
- 2 weeks prior the surgery, the patient should quit smoking to decrease any breathing problems during the surgery
- 2 weeks prior the surgery, liver-shrinking diet should be started (Rich in vitamins, liquid, low fats and carbohydrates)
- The stomach protector and any deficient vitamins that are prescribed before must be used until the day of the surgery
- Dr. Recep Aktimur’s recommendations on stop using blood thinners should be listened. Dr. Aktimur must be informed if there is a new medication being used after the last encounter.
- The medications that are always used such as (diabetes, hypertension etc.) should be continued. The discussion about medications will be done during one of our encounters.
The night before and the day of the surgery:
- The patient shouldn’t come to the hospital alone! The family support is one of the keys for the success in bariatric surgery.
- The water consumption is allowed until 3 hours prior the surgery.
- The stomach protector must be taken the night before and 3 hours before the surgery with minimal water.
- 12 hours before the surgery, the blood thinner injection that is prescribed by Prof. Dr. Recep Aktimur must be done.
- There should be no makeup
- Any ring(s) needs to be removed during the surgery.
- You will be taken to the operating room at the scheduled time. Your operation will last 40-60 minutes but your overall time in the operating room will be around 2.5 hours.
- During the operation the use of: drainage, nasogastric tube and urinary catheter will strongly be avoided
The day after surgery and discharge:
If you reach your goals on the surgery day ;
- A lot of walking
- At least 1000 cc oral fluid intake
- No nausea/vomiting
- No significant pain
The day after the surgery, you will be assessed for your discharge. If you meet the special discharge criteria, you will be informed by Prof. Dr. Recep Aktimur about important points and principles that you need to apply in your new life and then get discharged.
Patients who meet the criteria will be discharged the following day after the surgery at 15:00/3 PM
For our patients who came out of city or country will be admitted to our hospital for 3 days and will be discharged on the third day.
Prof. Dr. Recep Aktimur will inform you about the targeted fluid intake for the day after surgery.
Every verbal information provided to you can be found in the forms that are given to you previously.
What is there to watch for after the surgery?
By a standard perspective, it would take a while to answer this question; however, according to my perspective and experience, turning the lifestyle changes into permanent ones is the key to success. The “accelerated recovery protocols” is a project that I have been working on for a long time and only applied to this patient group in my clinic in Turkey. Accelerated Recovery Protocols add a lot of positive factors to patient comfort such as “liberal nutrition recommendations”. We only expect compliance with one suggestion from our patients who had gone through obesity and metabolic surgery: eating healthy and in reasonable proportions. Therefore, we do not suggest any restrictive diets to any of our patients.
What is the difference between this surgery and other obesity surgeries?
While in the obesity surgeries the aim is permanent and safe weight loss, for the metabolic surgeries; we aim to keep our patients in a normal blood sugar levels without using any medications or insulin treatment or without letting them to lose further weight from their appropriate weight. I think it is important to talk about a topic that I think does not get enough recognition. Obesity and metabolic surgeries should be selected and modified based on each and every patient’s needs. No two patients have the same weight or intensity of diabetes equally. Therefore, their surgeries should not be standard. Unfortunately, I had been treating many patients who had surgeries in other medical centres who had experienced complications due to this thinking pattern.
Should I be afraid of the surgery?
The death risk in obesity surgeries is the same as gall bladder operations. Considering you have numerous individuals around you who had gall bladder operations, it makes sense to get the surgery for obesity, a disease that is scientifically proven to shorten human life by 12 years. Obesity surgery is the only method that allows permanent weight loss.
Furthermore, a medical treatment that can extend and improve human life this much is very rare.
The success of morbid obesity surgery and surgical weight loss’ impact on the prolonged life:
According to the scientific studies, there is an observed effect of 30% less mortality (death) rate after the obesity surgery. A study from the U.S. noted a 40% decrease in mortality rate after sleeve gastrectomy in morbidly obese patients. According to another study done in Sweden, the comparison between 2010 obese patients who got the obesity surgery versus 2037 obese patients who did not want to get the surgery (received an alternative treatment). After 11 years of follow up (99% of the patients remained in the study), there were 101 deaths in the group who received the surgery versus 129 deaths observed in the group that chose alternative treatments and there is a reported 29% decrease in the observed death rate in the surgery group.
Another study from the U.S. that involved 7925 gastric bypass patients were followed up with on average 7 years after the procedure are compared with 7925 randomly selected adult patients. Overally, the surgical group had a 40% decreased death rate. Additionally, compared to the group without surgery, there was a decrease of 92% on the deaths related to diabetes, 59% decrease on deaths related coronary artery disease and 60% decrease in cancer related deaths in the group that received the surgery.
Ideal Morbid Obesity Surgery:
While there is not one surgical procedure that is considered ‘golden standard’ for the treatment of obesity; it is clear that the best approach is a patient-centric, need-based selection of the surgery.
Every patient reach out to us having their unique solutions to their unique problems. Therefore, patient-centric selection of the surgery will increase the success of the operation. The important point is that our patients need to be cognisant of that, which requires them to consult to a surgeon who is knowledgeable in numerous different surgeries and have objective criteria to select the best one for the patient.
Therefore; we assess our patients in detail in our clinic including criteria such as lifestyle (i.e. eating habits) and comorbidities to optimally determine the best surgery for the patient.
Our philosophy with Obesity Surgery:
The real success after the obesity surgery is not only to reach the ideal body weight but also permanently stay in that weight. In order to reach that goal, it is clear to NOT have restrictions, which are against the human nature.
Why do we not recommend a diet?
No one gives the decision for the obesity surgery easily.
All of our patients had gone through long and tiring diet processes, used various medications and products, and acupuncture. These attempts might have been sometimes successful for them but they eventually got tired of trying and most importantly, lost confidence in themselves.
Our conclusion based on our patients’ stories: classical approaches can never lead to success due to it being against the human nature.
Therefore, at this point I think differently than most of my colleagues and do not recommend any diet programs to my patients.
What’s the perspective that I want to contribute to my patients?
To all my patients; I recommend and encourage you to develop healthy and balanced eating habits that allow a free life where you can explore new adventures instead of giving them restrictive recommendations. At this point, I recommend type of suggestions that allow my patients to internalize and digest instead of complex recommendations that they are not comfortable with and in turn, will make them passive in choosing the life that they want to live. I am always there for my patients during this entire process.
We should never forget; the best recommendations are the ones that are simple to utilize and digestible based on your preferences, needs and how enjoyable you find them to be. It is possible to remain at a healthy weight rest of your life by finding the right lifestyle for you and making it personalized.
I understand that behaviours that does not become a lifestyle for you will not be effective in your life in long term. In our opinion, this understanding will be the key for permanent success after the surgery.
What are our expectations from our patients?
- Eating quarter of the portion you used to eat in each meal
- Eating 3 meals a day (we do not recommend snacks)
- Taking whole foods in smaller pieces in your mouth and chewing slowly and abundantly
- Making sure to consume fresh veggies, fruit and protein-rich foods
- Doing the additional treatments based on the surgery you had
- AS LONG AS THE MAIN MEALS ARE HEALTHY, WE STRONGLY ENCOURAGE OUR PATIENTS TO EAT ANYTHING THEY LIKE IN SMALL AMOUNTS
- WE HAVE A LARGE AND CONSCIOUS FAMILY OF INDIVIDUALS WHO EATS WHAT THEY WANT IN SMALL AND CONTROLLED AMOUNTS
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