Obesity Treatment

Obesity Treatment

Obesity is characterized by an excessive and abnormal accumulation of fat in the body, leading to detrimental effects on health. Body Mass Index (BMI), calculated using height and weight, serves as a common metric for determining obesity. BMI is calculated by dividing weight in kilograms by the square of height in meters. Individuals with a BMI above 30 are classified as obese, while those exceeding 40 are considered morbidly obese.

Adipose tissue, responsible for fat storage, secretes hormones and chemicals that impact various bodily functions. Some of these secretions contribute to increased appetite, elevated satiety thresholds, and the progression of obesity.

Beyond posing significant health risks, excessive weight gain can impede mobility and predispose individuals to serious medical conditions. Obesity, stemming from diverse causes, exerts its effects on numerous organs within the human body. Therefore, the management of obesity necessitates a comprehensive and collaborative approach involving various medical disciplines.

Patients seeking treatment for obesity undergo initial evaluations by an interdisciplinary team comprising endocrinologists, nutritionists, psychiatrists, physical therapists, and exercise specialists. Cardiologists and pulmonologists may also assess patients if warranted. Moreover, eligible individuals receive consultations from experienced General Surgeons specializing in obesity surgery.

Obesity, an increasingly prevalent condition worldwide, profoundly impacts both the quality and duration of life. Nevertheless, it is a treatable ailment.

In addressing obesity, treatment options encompass dietary modifications combined with exercise regimens or surgical interventions. Experts tailor treatment plans to each individual, striving to achieve and sustain a healthy weight.

Combatting obesity offers the potential to mitigate various diseases, including high blood pressure, heart disease, sleep apnea, breast cancer, colon cancer, and prostate cancer, thereby facilitating a transition to a healthier lifestyle.

Morbid obesity, or obesity necessitating surgical intervention, signifies an extreme accumulation of fat in the body, resulting from an imbalance between calorie intake and expenditure. This condition, characterized by a Body Mass Index (BMI) exceeding 40, is deemed "morbid" due to its association with life-threatening illnesses that significantly reduce life expectancy.

Obesity is a Treatable Disease

Individuals with a BMI falling within the range of 35-40 who experience complications such as type 2 diabetes, hypertension, or sleep apnea attributable to obesity are also classified as morbidly obese, warranting consideration for obesity surgery. Moreover, surgical intervention is now a viable option for patients with "new-onset" type 2 diabetes and metabolic disorders resulting from obesity, even if their BMI falls between 30 and 35.

Who is a Candidate for Obesity Surgery?

For morbidly obese patients, the primary treatment approach typically involves dietary interventions. However, if dietary regimens lasting less than six months and attempted at least twice prove ineffective, continuing diet therapy is no longer advisable. In such instances, surgery emerges as the most efficacious treatment option and should be promptly considered and pursued.

How Should Morbid Obesity Be Treated?

The administration of botulinum toxin (Botox) to the stomach represents a relatively recent approach to weight loss. This method involves the endoscopic injection of botulinum toxin into specific regions of the stomach.

What is stomach botox?

Stomach botox can be considered for individuals seeking weight loss who have been unable to achieve desired results through traditional methods such as diet and exercise. However, it's important to note specific criteria for eligible candidates:

Gastric botox is not intended for individuals with a body mass index (BMI) exceeding 40, as these patients may benefit more from bariatric surgery.
The procedure is typically recommended for individuals with a BMI below 40. Specifically, it is suitable for those with a BMI between 27-35 and 10-20 kg of excess weight, who have struggled to lose weight through conventional means.
Ideal candidates are individuals with excess weight but do not meet the criteria for obesity surgery, yet still wish to pursue weight loss.

Furthermore, patients with stomach ulcers or gastritis should first undergo appropriate treatment for these conditions before considering gastric botox. Once these gastrointestinal issues have been addressed, gastric botox may be an option for weight loss in eligible patients.

Who is stomach botox suitable for?

Botox has been a staple in the medical field for several years, and when administered by a specialist physician at the appropriate dosage, there are typically no known adverse effects. However, it's important to recognize that while gastric botox application is considered a standard endoscopic procedure, there have been minimal reports of significant harm associated with it in the medical literature.

It's crucial to consider contraindications for gastric botox, including individuals with muscle diseases and those who have allergies to botox. These contraindications are essential to ensure patient safety and avoid potential complications. Therefore, thorough evaluation by a qualified healthcare professional is necessary before undergoing gastric botox treatment.

Are there any side effects of gastric botox?

Gastric Botox is not classified as an obesity surgery.
It is an entirely endoscopic procedure conducted through the mouth, eliminating the need for incisions.
The procedure typically lasts around 20 minutes.
Patients undergo sedation administered by an anesthetist during the procedure.
Hospitalization is generally unnecessary.
Following the procedure, patients typically require only 1-2 hours of observation.
Appetite suppression and improved appetite control are typically experienced within approximately 3 days after gastric botox application.

How long does the gastric botox procedure take, is hospitalisation necessary?

The effects of the drug utilized in gastric botox are entirely eliminated from the body within 4-6 months. Consequently, there is no potential for permanent damage stemming from the procedure.

Does gastric botox cause permanent damage to the stomach?

Following gastric botox application, a reduction in hunger sensation typically occurs within 2-3 days. Subsequently, weight loss becomes noticeable after approximately 2 weeks. The intended weight loss target of 10-20 kg is typically achieved through this procedure.

When does the effect of gastric botox begin?

It's crucial to maintain realistic expectations regarding any treatment, including gastric botox. Following the procedure, attention to nutrition is paramount. Specifically, individuals should avoid consuming excessive amounts of fast food, which typically contain high levels of fat and carbohydrates. Opting for a balanced and nutritious diet is essential for maximizing the benefits of gastric botox. Adhering to a healthy eating program as much as possible can significantly enhance the outcomes of the treatment.

How should nutrition be after gastric botox?

Indeed, it's important to recognize the potential harm associated with consuming fast foods and acidic drinks. Following gastric botox application, patients typically experience delayed hunger, increased satisfaction with smaller meal portions, and earlier feelings of fullness. This change in appetite regulation can significantly aid in weight management efforts and promote healthier eating habits. Therefore, it's advisable for individuals to prioritize nutritious, whole foods and avoid processed, high-fat, and sugary items to maximize the benefits of gastric botox treatment and support overall well-being.

What should be considered after gastric botox?

The gastric balloon is a temporary weight loss solution that involves placing a silicone balloon into the stomach and inflating it to a volume of 400-700 cc with either air or liquid. This procedure is performed endoscopically and is typically recommended for patients who have struggled to lose weight through conventional means such as diet and exercise, those who prefer non-surgical options, or individuals deemed high-risk for surgery. Removal of the gastric balloon is necessary after 6 months to 1 year following placement. However, it is contraindicated in cases of gastric ulcer, large gastric hernia, and pregnancy. While complications such as nausea, pain, ulceration, stomach bleeding, perforation, and intestinal obstruction are rare, they can occur.

The gastric balloon works by reducing the size of meal portions and the frequency of eating, leading to a sensation of fullness for a longer duration. This helps individuals consume less food and eliminates the habit of snacking between meals, ultimately promoting weight loss.

Research studies have shown that gastric balloon treatment can significantly reduce the prevalence of metabolic syndrome, diabetes, gout, and high levels of cholesterol and triglycerides over a follow-up period of 6 months to 1 year.

What is a Gastric Balloon?

STOMACH BALLOON BRANDS

Medsil®

Medsil® is a Russian-manufactured gastric balloon designed to remain in the stomach for a period of 6 months. This balloon is inserted orally under anesthesia using an endoscopic procedure and is later removed in a similar manner. Medsil® is recognized as one of the most commonly utilized balloon brands in Turkey for weight loss treatment.

Spatz3®

The Spatz3® adjustable balloon system, developed by Spatz Medical located in Great Neck, NY, stands out as the only system offering adjustable balloon volume. This unique feature allows healthcare professionals to deflate the balloon to alleviate any discomfort associated with it or to reinflate it to enhance weight loss efficacy. The Spatz3® system is approved for use over a period of 12 months, offering an extended duration compared to other gastric balloon systems.

Orbera®

The Orbera gastric balloon, developed by Apollo Endosurgery headquartered in Austin, TX, received FDA approval for clinical use in the USA in 2015. However, it has been in use in Europe since 1991. The Orbera balloon is designed to remain in the stomach for a duration of 12 months.

Sleeve Gastrectomy

Sleeve gastrectomy is a surgical procedure where a significant portion of the stomach is removed, leaving behind a tubular stomach resembling a banana, with a capacity of 100-150 ml. During this operation, the section of the stomach responsible for producing hunger hormones is removed, resulting in a decrease in the patient's appetite. Consequently, the sensation of fullness helps prevent overeating. Sleeve gastrectomy is considered a restrictive procedure, meaning it does not impair nutrient absorption. Since food absorption remains unaffected, patients typically do not require additional vitamin or mineral supplements.

The sleeve gastrectomy method is relatively straightforward compared to other types of bariatric surgery. Its success is generally permanent; however, it is crucial to ensure that this procedure is appropriate for the individual patient. Before and after the surgery, patients should receive dietary counseling from a registered dietitian who will provide personalized nutritional guidance.

Radiological monitoring should be conducted on patients within 24-48 hours post-operation to identify any potential complications. Close medical supervision and follow-up care are essential throughout the sleeve gastrectomy process. Patients must adhere to a strict follow-up schedule, which typically includes appointments at the first, second, and fourth week, 3, 6, 9, 12, 18, and 24 months after surgery. These follow-up visits are critical for monitoring progress, addressing any concerns, and ensuring optimal outcomes for patients undergoing sleeve gastrectomy.

What are the advantages of sleeve gastrectomy surgery?

Regression of obesity-induced diseases such as type II diabetes, hypertension, and sleep apnea.
Reduced stomach volume leads to a sensation of satiety, aiding in weight loss and portion control.
Most foods can be consumed without significant issues, allowing for greater dietary flexibility.
Absence of dumping syndrome, a common complication in other bariatric procedures, such as gastric bypass surgery.
Decreased production of hunger-stimulating hormones due to removal of a portion of the stomach.
Relatively easier application compared to gastric bypass surgery, making it a preferred choice for some patients.
No foreign body effect, unlike gastric banding, as no implantable device is used.
Long-term success: Sleeve gastrectomy has demonstrated lasting results in weight loss and obesity management.
Weight loss following the procedure tends to be more manageable and sustainable compared to other methods.

What are the disadvantages and risks of sleeve gastrectomy?

Risk of staple line leakage: This is a serious complication where the surgical staples used to seal the stomach may leak, leading to infection and other complications.
Less weight loss compared to gastric bypass: Sleeve gastrectomy may result in less weight loss compared to gastric bypass surgery in some cases.
Risk of weight regain: Although rare, some patients may experience weight regain after initial weight loss following sleeve gastrectomy.
Nausea and vomiting: Overeating or consuming certain foods may lead to nausea and vomiting due to the reduced stomach size.
Reflux risk: Some patients may experience acid reflux or gastroesophageal reflux disease (GERD) following sleeve gastrectomy.
Food intolerance: Certain foods may not be well-tolerated by some individuals after the surgery, leading to discomfort or digestive issues.

It's important for patients considering sleeve gastrectomy to discuss these potential risks with their healthcare provider and to undergo thorough evaluation to determine if the procedure is suitable for them. Close post-operative monitoring and adherence to dietary and lifestyle guidelines can help mitigate these risks and optimize outcomes.

What is Gastric Bypass?

Gastric bypass surgery is a common type of bariatric procedure, similar to sleeve gastrectomy but with some key differences. The term "bypass" refers to creating a shortcut, typically by rerouting food from the stomach directly to the intestines. Gastric bypass aims to reduce the size of the stomach and accelerate the passage of food to the intestines.

During the procedure, a small stomach pouch is created by stapling the upper part of the stomach. The duodenum, the first part of the small intestine, is then separated from the jejunum, the second part. The jejunum is rerouted and connected to the newly formed stomach pouch, while the duodenum is reconnected further down the small intestine. This rerouting aims to achieve two main objectives: restricting calorie intake by reducing stomach size and decreasing food absorption by bypassing a portion of the small intestine.

Gastric bypass surgery typically results in slightly higher weight loss success rates compared to sleeve gastrectomy. However, it also entails a longer hospital stay, usually ranging from 4 to 6 days, compared to 2 to 4 days for sleeve gastrectomy.

It's important for individuals considering gastric bypass surgery to understand the potential risks and benefits and to undergo thorough evaluation to determine if the procedure is appropriate for them. Close post-operative monitoring and adherence to dietary and lifestyle guidelines are crucial for optimizing outcomes and ensuring long-term success.

What is mini gastric bypass?

Mini gastric bypass (MGB) is recognized for its effectiveness in achieving significant weight loss and improving comorbid diseases when compared to volume-restrictive techniques. Unlike Roux-en-Y Gastric Bypass (RYGB), which involves more complex anatomical changes and multiple anastomoses, MGB is preferred by many centers due to its simplicity and lower perioperative complications.

In MGB, the stomach is fashioned into a tube shape using specialized stapler instruments, creating a long gastric pouch. This configuration allows for the rerouting of food directly from the newly formed pouch to the small intestine, bypassing a portion of the stomach and duodenum. By reducing the size of the stomach and altering the digestive pathway, MGB restricts calorie intake and decreases nutrient absorption, resulting in significant weight loss and improvement of associated health conditions.

Overall, MGB offers several advantages, including easier implementation, fewer anastomoses, and reduced perioperative risks compared to traditional RYGB. However, as with any surgical procedure, it's essential for patients to discuss the potential benefits and risks with their healthcare provider to determine the most suitable treatment option for their individual needs.

What are the advantages of Gastric Bypass?

Rapid Achievement of Targeted Weight Loss: Gastric bypass surgery typically leads to significant weight loss within 18-24 months post-operation, providing patients with tangible and rapid results.
Substantial Improvement in Obesity-Related Diseases: Gastric bypass surgery often results in a notable regression or resolution of comorbid conditions such as Type 2 diabetes, hypertension, sleep apnea, and gastroesophageal reflux disease (GERD), contributing to overall health enhancement.
Enhanced Quality of Life: Patients frequently report a noticeable increase in their quality of life following gastric bypass surgery, as they experience improvements in physical health, mobility, self-esteem, and emotional well-being.

What are the disadvantages and risks of gastric bypass surgery?

Staple Leakage: There is a risk of staple line leakage at the site where the stomach is stapled or divided during the surgery. This can lead to complications such as infection, abscess formation, or peritonitis.
Increased Risk of Gallstones: Rapid weight loss following gastric bypass surgery may increase the risk of developing gallstones. The rapid reduction in body fat and changes in bile composition contribute to the formation of gallstones, which can cause abdominal pain, nausea, and vomiting.
Internal Hernia: After gastric bypass surgery, there is a risk of developing an internal hernia, where a loop of intestine becomes trapped within the abdominal cavity. This can lead to bowel obstruction and require surgical intervention to correct.

Duodenal Switch Surgery

The Duodenal Switch surgery, akin to gastric bypass, is a surgical procedure with dual restrictive and absorption-reducing properties. Primarily indicated for individuals with a body mass index exceeding 50 Kg/m2 or those with Type 2 diabetes, it stands out as an effective intervention for managing obesity-related conditions like diabetes and hypertension. Nonetheless, it may lead to unpleasant side effects such as malodorous diarrhea. Patients undergoing Duodenal Switch surgery typically experience prolonged hospital stays compared to other bariatric procedures. Moreover, deficiencies in essential nutrients like vitamins, iron, and protein are commonly observed post-surgery due to its absorption-reducing effects.

Robotic Obesity Surgery

The utilization of da Vinci Robotic Surgery technology in laparoscopic obesity surgeries worldwide offers significant advantages for both surgeons and patients alike. The precision required in such procedures, particularly due to the anatomical structure of obese patients, can be enhanced by the robot's steady arms and delicate movements within the abdominal region.

Robotic technology provides surgeons with a three-dimensional, high-resolution view, enabling better protection of adjacent organs, tissues, and nerves during the procedure. In some cases, surgeries can be performed through a few small incisions or even a single incision, minimizing aesthetic concerns for patients.

The privileges provided by robot technology for patients and surgeons include:

Reduced Risk of Infection: Closed surgical techniques and minimal incisions significantly reduce the risk of infection compared to open surgeries, where organs are exposed to air.
Enhanced Protection of Tissues and Organs: The 3D digital view provided by robot technology allows surgeons to navigate more precisely, minimizing the risk of injury to nerves, vessels, muscles, and tissues.
Minimal Surgical Incisions: Instead of a large incision, procedures are completed through small holes, resulting in reduced post-operative pain, almost eliminating the risk of infection, and enabling a more comfortable recovery period for patients.
Faster Recovery and Return to Daily Life: Shortened hospital stays, quicker return to oral feeding, and improved pain control contribute to a faster recovery process for patients, allowing them to resume daily activities and work sooner, ultimately enhancing their quality of life.

What can I expect after bariatric surgery?

After undergoing bariatric surgery, you can expect several changes in your lifestyle and dietary habits to support weight loss and prevent weight regain. Here are some key expectations:

Dietary Changes: Following bariatric surgery, you'll need to adhere to a healthy and balanced diet. Initially, you will consume primarily liquids, then progress to pureed foods, and eventually transition to solid foods in small, frequent meals. It's important to focus on nutrient-dense foods and avoid high-calorie, high-fat options.
Vitamin and Supplement Intake: Due to the reduced food intake and changes in digestion, you'll likely need to take vitamins or other supplements for an extended period to prevent nutritional deficiencies. Your healthcare provider will recommend specific supplements based on your individual needs.
Physical Activity: Engaging in regular physical activity is essential for supporting weight loss, improving overall health, and maintaining long-term success after bariatric surgery. Aim to incorporate both aerobic exercise and strength training into your routine, as advised by your healthcare provider.
Lifestyle Changes: Bariatric surgery is a tool to assist weight loss, but long-term success also requires adopting healthy lifestyle habits. This may include practicing mindful eating, managing stress, getting adequate sleep, and avoiding unhealthy behaviors such as smoking and excessive alcohol consumption.
Regular Follow-up Care: Following bariatric surgery, you'll have regular follow-up appointments with your healthcare provider to monitor your progress, adjust your diet and medications as needed, and address any concerns or challenges you may encounter during your weight loss journey.

Overall, bariatric surgery can be a life-changing procedure for individuals struggling with obesity, but it requires commitment to making lasting lifestyle changes to achieve and maintain weight loss goals. Working closely with your healthcare team and embracing a healthy lifestyle will maximize the benefits of bariatric surgery and improve your overall health and well-being.

Assoc. Prof. Dr. Mutlu Ünver graduated from Ege University Faculty of Medicine. Mutlu Ünver, who completed his specialty training in Ege University Faculty of Medicine, Department of General Surgery, serves his patients in his own clinic.