The Obesity Center

Gaining too much weight is not only a serious threat to your health, it can also limit your physical abilities and make you susceptible to serious illnesses. If you still have not made the transition to a healthy diet, it is time to consider changing your eating habits.

What is obesity?

Obesity can be defined as the excessive and abnormal accumulation of body fat. If a man or woman’s bodyweight is respectively 20% and 30% higher than it should be, he or she is considered obese. Adipose (fat) tissue excretes hormones and chemicals that affect the entire system. Some of these excretions increase appetite, elevate limits of feeling full and cause obesity to progress. For the effective diagnosis and treatment of obesity, firstly it is quite important to know where fat accumulates in the body. Obesity can generally be separated into two categories – apple and pear shaped. In apple type obesity, fat accumulates in the belly. Whereas in per shaped obesity, fat accumulates around the hips. Studies have shown that, compared to the hips, fat in the belly area is more likely to increase risk of developing dangerous health problems, especially cardiac disease. Men with a waistline of more than 94 cm are considered to have increased risk, while waistlines in excess of 102 cm are seen as high risk. In women, waistlines greater than 80 cm is increased risk and 88 cm is high risk.

Obesity figures double…

Obesity has become one of the main health problems in developed countries around the world. According to World Health Organisation figures, 2 billion people on the planet are overweight, with 700 thousand of these being clinically obese. Unless serious measures are taken, future generations will have to fight against problems caused by obesity.

The outlook is not much different in Turkey. According to studies, 25% of men and 44% women in Turkey are obese. Comparing figures from a study carried out a decade ago, the prevalence of obesity has doubled in men, while prevalence in women over the age of 50 has increased from less than 40% to 50%.

How to implement obesity treatment?

The treatment method chosen for obese patients depends on the presence of other medical conditions and body mass index values. If a person’s BMI is less than 35% it is possible to lose weight with exercise and a healthy diet. Surgical methods are usually preferred for patients with BMI greater than 35%.

There are two main treatment methods for the increasingly prevalent medical condition known as obesity:

Diet and exercise
Surgical operation

People usually feel anxious about obesity surgeries however, the risks involved in surgical operations performed at obesity clinics are rather low on condition that the procedures are executed by a team experienced in obesity surgery. People concerned about the risks of operation generally try to lose weight with diet and exercise however these methods alone might not always be adequate. Surgery might be necessary depending on the severity of conditions.

How is obesity measured?

The World Health Organisation’s obesity scale is universally used to determine obesity. The figure is usually measured in Body Mass Index (BMI) value. To calculate BMI, divide your weight in kilograms (kg) by your height in metres (m) then divide the answer by your height again. Morbid obesity obesity is the condition when BMI is greater than 40 kg/m2

Classification according to the Body Mass Index

Value Interval	Result
BMI lower than 18.5 kg/m²	Underweight
BMI between 18.5 – 24.9 kg/m²	Normal (healthy weight)
BMI between 25 – 29.9 kg/m²	Overweight
BMI between 30 – 39.9 kg/m²	Obese (fat)
BMI over 40 kg/m²	Morbid (severely) obese

Besides BMI, waist length is also used to determine the risk level of obesity. We now also know that adipose tissue is not merely a simple storage place. It also secretes hormones and chemicals that affect the entire body system. These excretions intensify obesity by increasing appetite and elevating limits of feeling full. Another important factor is where fat is building up in the body. Fat in the belly area is known to pose more risk than fat in the hip area. That is why apple type overweight patients have increased risk, especially in cardiac disease, compared to pear type patients. In other words, men with a waistline circumference of more than 94 cm are considered to have an increased risk, while waist in excess of 102 cm are seen as high risk. In women, waist length greater than 80 cm is increased risk and 88 cm is high risk.
Besides the initial measurements mentioned above, metabolic rate and detailed body analyses provide more comprehensive information about the individual’s obesity problem.

ACIBADEM Obesity Clinic

Obesity has many causes and the illness itself affects multiple organs in the body. This is why a comprehensive obesity treatment requires a multidisciplinary approach during planning and implementation.
All patients coming to ACIBADEM Obesity Clinic will first undergo an assessment by several specialists including an endocrinologist, a dietician, a psychiatrist, a physiotherapist and exercise consultant. If medical conditions demand, the patient will also be assessed by a cardiologist and pulmonary diseases specialist. If necessary, suitable patients will also be consulted by the obesity surgical team.
Every patient applying to our clinic will first be examined to determine underlying factors that cause obesity, dietary habits, psychological issues and general state of wellbeing. The assessments carried out on the patient determine the treatment method that suits the individual’s specific needs.
ACIBADEM Obesity Clinic employs the following methods in treating obesity:
– Special diet treatment
– Exercise treatment
– Behavioural change treatment
– Drug treatment
– Surgical treatment

What is Obesity Surgery?

Obesity surgery fundamentally depends on two principles: the decreasing of stomach volume, and/or ‘malabsorption,’ i.e. the prevention of food absorption in certain stages. These operations are lifesaving when performed on the right patient at the right time.

For whom is obesity surgery suitable?

Obesity surgery is suggested to patients with body mass indexes of 35 and above who cannot lose weight with programs such as specialist-controlled medical nutrition, exercise, or medical therapy. It is also recommended for patients with body mass indexes above 30 who also suffer from conditions like high blood pressure, diabetes, and sleep apnea that negatively affect life quality. The decision on the type of operation to perform is made following various examinations and observations done by specialists.

It is advised that fertile women planning to have a baby in the near future to consult their doctors before doing so as pregnancy is not recommended within the first twenty-four months following obesity surgery.

The following methods are performed in general for obesity surgery and all present patients with a more comfortable recovery period than open surgery through the use of laparoscopic or robotic surgery methods that use only small incisions. Patients return to their daily lives in a very short time and adjust to their new diets monitored by metabolism specialists and dieticians of the ACIBADEM Obesity Center.

The Gastric Band

Commonly known as “stomach clamp”, the adjustable silicone gastric band method involves inserting a band around the stomach immediately underneath where the oesophagus and stomach merge. In effect, the volume of the stomach is reduced. The inner membrane of the band could be likened to a balloon or bicycle tire. This balloon is connected to a subdermal port with a fine tube. Approximately one month after the operation, the band is gradually inflated through the port with serum injections. So after the operation it becomes possible to adjust the size of the passage with a simple intervention. In this method, the aim is for the patient to feel full although he or she eats small amounts.

How is it performed?

Gastric bands are most often implanted with the laparoscopic method. Most patients are able to resume their normal daily life very quickly because the surgery only requires minor incisions.

Post-surgery period

In this type of surgery, patients lose up to 60-80% of their excess body weight within 18 to 24 months. Unless there is a problem with the band, these patients do not face the risk of regaining their weight.

The Gastric Sleeve

Also known as “sleeve gastrectomy”, stomach reduction involves the reduction of the stomach volume (by about 60-100 cc) which in result makes the patient feel full with smaller amounts of food. To achieve this, a part of the stomach is removed with a surgical procedure leaving behind a small, tube shaped stomach (about the size of a banana). The operation also removes the part of the stomach that secretes the hunger hormone so the patient no longer feels hungry. This operation only involves limiting the amount of food intake. The patient will not require vitamin or mineral supplements because nutrients continue to be absorbed by the stomach.

How is it performed?

The laparoscopic method is employed for sleeve gastrectomy operations. The surgery is performed through minor incisions in the abdomen.

Post-surgery period

The Gastric Bypass

Gastric bypass surgery is a surgical procedure that involves bypassing a large section of the stomach and creating a small stomach pouch (of approximately 30-50 cc) for digestion before the small intestine is rearranged to connect to the both. As with other types of obesity surgery, this type of surgery also reduces the volume of the stomach but it also aims to by-pass a part of the intestines so that a portion of the nutrients is discarded without being absorbed. In effect, patients feel full with smaller amounts of food and can only absorb a portion of their nutrient intake.

How is it performed?

Similar to other forms of obesity surgery, gastric bypass surgery is also generally performed with the laparoscopic method. The surgery is carried out through small incisions opened in the abdomen. This method significantly reduces risks of post-surgical wound infections and hernias. The robotic surgery method is also used for gastric bypass surgeries.

Post-surgery period

After surgery, patients will feel full by only eating small amounts and in time this sense of feeling full will change into loss of appetite. Total food intake drops significantly. Due to the smaller stomach size and reduced food absorption, patients undergoing this type of surgery will have to follow the instructions of surgeons and dieticians regarding the use of vital vitamin and mineral supplements. In this approach patients can lose weight without experiencing vitamin and mineral depletion. Patients are discharged 3-4 days after the operation.

Surgical Methods

In this method, a deflated balloon is implanted in the stomach orally with the help of an endoscope. In the next stage, the balloon is inflated to give the patient a sense of being full. Unlike the three other methods mentioned above, the stomach balloon method can be considered as a non-surgical method. Facts that make it different from other methods is that it is removed after 6 months and that the achieved results are permanent.

How is it performed?

In this method, a balloon is implanted in the stomach through the oesophagus with the help of an endoscope. The incision-free procedure can be completed under minor anaesthesia. Once the deflated balloon is inserted, it is inflated with air up to 900 cc with the help of a tube connected to the balloon. Once inflated, the tube removed and leave the balloon in the stomach.

Post-procedure

The balloon is used for the temporary treatment of obesity and helps weight loss and maintaining a healthy weight. The balloon is also effective in helping obese patients lose some of their weight and reduce surgical risks prior to obesity surgery. However, the balloon cannot remain in the stomach for more than 6 months. Failing to follow his or her specific diet or exercise programme, patients can easily gain weight after this treatment.

If a general surgeon recommends surgery for weight control, it means that the patient could be a candidate for obesity surgeries using the robotic surgery method.

The procedure that is performed with the Robot “da Vinci” is defined as the “robot assisted laparoscopy surgery”. Considering the patient’s physical condition, certain problems can occur during surgical interventions on obese patients due to excessive weight. These problems may prevent effective intervention to the problem area.

Thanks to the da Vinci robot, the specialist surgeon can preform the surgery on the patient as necessary with just small incisions. This method reduces blood loss and the size of the incision.

From urology to cardiology, gynaecology to general surgery, the robotic surgical method is used in many areas and makes it possible to perform surgery on morbid obese patients. Amongst obesity surgeries, gastric by-pass surgery is the most popular surgery type that employs the da Vinci robot.

Surgical interventions with robotic surgery on obese patients reduce blood loss, risk of infection, scars and recovery times.

Post-operation weight loss

Patients undergoing obesity surgery are recommended to stick to a regular exercise programme and diet. The success of the surgery is considered to be associated with changes in these daily habits.

Under these conditions, all patients rapidly lose weight. Most patients achieve their ideal weight within 1-1.5 years after the operation.

Patient undergoing obesity surgery will experience the following improvements in their overall wellbeing:

Regulated blood pressure. 70% of patients stop using blood pressure medication.

Improved blood cholesterol levels. 80% of patients experience a drop in cholesterol levels. Values can reach normal levels within 2-3 months after surgery.

Reduced risk of heart disease.

Most Type II diabetes patients stop using medication.

Borderline diabetes patients usually have complete recovery.

Asthma attacks are reduced significantly. Some patients experience complete recovery.

Respiratory problems improved within a few months after surgery. Many patients get involved in activities and daily routines which had become impossible due to breathing problems.

Obesity-related sleep disorders like sleep apnoea disappear.

An end to acid reflux problems.

Weight loss achieved with these methods are permanent on the condition that the rules are adhered to.

Advantages of Surgical Obesity Treatment

Patients are recommended to follow their diet and exercise program regularly and it is understood that the success of the operation is directly related to the adherence of the patient to this principle.

All patients who follow this program lose weight very quickly, and within approximately a timeframe of 1-1.5 years, they have reach the target weight and begin a new life.

The following health conditions are alleviated in the follow-up of obesity surgery:

– High blood pressure is regulated. 70% of patients are able to terminate their blood pressure drug therapies.

– Blood cholesterol improves. Reports indicate lower cholesterol levels in 80% of patients. Values can return to normal levels following two to three months after the operation.

– Risk of cardiac disease is decreased.

– A fewer number of patients with type II diabetes diagnosis continue to need to use drugs.

– Patients in the diabetes threshold usually recover in full.

– Asthma exacerbations decrease significantly, with some patients recovering completely.

– Respiration problems are healed within a few months following operation. Many patients are to their routine and to activities that they have had to leave because of respiration problems.

– Obesity-related sleep disorders such as sleep apnea are cured.

– Acid reflux illness is cured.

– The weight lost is permanent as long as the patient continues to follow the rules.

Diet Therapy

At ACIBADEM Obesity Clinic, we aim for our patients to achieve a healthy weight loss under the supervision of dieticians and nutritionists experienced in obesity. A custom diet is planned for each patient with consideration to dietary habits, overall wellbeing and specific calorie intake. The main objective of diet programmes is to encourage patients to eat small portions frequently without feeling starved. Patients are supervised by nutritionists throughout the programme.

What is obesity surgery?

Obesity surgery is based on two basic principles: reducing stomach volume and/or facilitating malabsorption, in other words preventing the absorption of nutrients in certain stages. Performing the right surgery on suitable patients can be life saving.

Who can undergo obesity surgery?

Obesity surgery is recommended for patients with a BMI greater than 35 who have failed to lose weight with methods like exercise and medical treatment, under specialist supervision. Surgery is also recommended for patients with a BMI above 30 who also suffer from diseases that affect quality of life and life expectancy like hypertension, diabetes and sleep apnoea. Certain examinations and tests help us determine the most suitable surgical method for the patient.

Fertile female patients who intend to have children in the short term must consult this issue with their doctor. Getting pregnant within 24 months of obesity surgery operations is not recommended.

Employing laparoscopic or robotic surgical methods for obesity surgery offer a quicker and more comfortable recovery period compared to open surgery. After the surgery, patients can quickly resume their normal daily routine and are able to adapt to their new dietary programme under the supervision of metabolism experts and dieticians.