Obesity contributes to the development of life-threatening and disabling diseases such as coronary heart disease, hypertension, type 2 diabetes, degenerative joint disease, obstructive sleep apnea and hyperlipedemia.

Morbidly obese women and men have a very high risk of death. Body Mass Index (BMI), which is the most used value in defining morbid obesity, is obtained by dividing the person's weight (in kg) to the body surface (height2) (in meters) (kg/m2). This value is independent of age and gender.

BMI (Body Mass Index) Value

Although the total amount of fat in the body is important, it is more important to know where the fat accumulates. Fat accumulation around the abdomen causes greater health risks than fat accumulation in the hips and other parts of the body.

Diseases Caused by Morbid Obesity

• Accelerated atherosclerosis and coronary artery disease
• Left ventricular hypertrophy and congestive heart failure over time
• Hypertension
• hyperlipidemia
• Impaired glucose tolerance and insulin resistance, Type 2 diabetes
• Alveolar hypoventilation and somnolence (Pickwickian syndrome)
• sleep apnea syndrome
• Hypercoagulability and DVT, pulmonary embolism
• Necrotizing panniculitis
• Hepatic steatosis, cirrhosis
• stone pouch
• Varicose veins and venous stasis leg ulcers
• Reflux esophagitis
• hernia
• Amonerea, infertility problems (in women)
• Urinary incontinence in women
• Endometrial hyperplasia and endometrial cancer
• Breast, cervix and ovarian cancer
• Prostate and colon cancers in men
• Foul-smelling intertrigo, acanthosis nigrigans
• Degenerative arthritis in weight-bearing extremities and lumbar region
• Fatigue, accident proneness
• Psychosocial and economic problems
• Increased risk of mortality.

Although the basic mechanism of morbid obesity is not fully known, hypothalamic metabolism disorders (Setpoint theory), problems in the transmitter controlling the hypothalamic hunger-satiety center (such as serotonin deficiency causing insatiable carbohydrate hunger or dopamine deficiency leading to eating), poor eating habits inherited from the family or abnormal reactions to stress. Theories such as the answer have been put forward.

Recently, the protein called "leptin" released from the "ob" gene has been blamed. Leptin, a 16 kD glycoprotein, is primarily secreted in fat tissue. The increase in its level in the blood is seen with insulin resistance syndrome, in which high blood pressure, decrease in HDL level, and high fasting insulin levels are observed, as well as an increase in body fat rate and BMI.

Ghrelin, which is secreted from the gastric fundus and whose secretion increases in case of hunger, has been found to be associated with obesity. Postprandial secretion is suppressed by food intake. In contrast to insulin, ghrelin levels first double before each meal and fall to the basal level within an hour after the meal. Ghrelin level increases with protein-poor foods and decreases with fat-rich foods. After 48 hours of fasting, gastric expression of ghrelin increases with the administration of insulin and leptin. In short, obesity is a set of polygenetic and environmental factors.

Many methods such as diet, exercise, behavioral regulation, appetite suppressant drugs and surgical interventions have been used in the treatment of this disease until today.

Intragastric Balloon (IGB) Application

Antiobesity surgery, orthopedic operations, etc. are recommended for those with a BMI of 40 and above and those with a BMI of 35 and comorbidities. reducing comorbidity by reducing excess weight beforehand, risky health problems due to significant obesity in those with a BMI between 30 and 39 kg/m2 and not being able to lose weight despite various weight control programs, those who are severely obese (BMI 40 or BMI 35 and additional diseases) and do not want or cannot undergo surgery. patients are included.

It can provide -20% weight loss. However, IGB application has a limited place in treatment. Some studies have shown that; With this method, the weight lost is regained.

IGB application must be supported by an antiobesity procedure and a multidisciplinary team. This team should include an endocrinologist, nurse, dietitian, physiotherapist and psychotherapist.

Surgical Treatments Used in the Treatment of Morbid Obesity

• Malabsorption surgeries that disrupt the absorption of food from the intestine
• Bariatric methods that limit food intake capacity.

Surgical Methods Preferred in Bariatric Surgery Today

• Adjustable Gastric Band Application (AGBT)
• Vertical Banded Gastroplasty (VBG)
• Roux-en-Y Gastric Bypass (RYGP)
• Gastric Sleeve Resection (GSR)
• It can be listed as Bilio-pancreatic Diversion (BPD).

Indications for Surgery

• BMI 40 or above patient group
• Patients with a BMI between 35 and 40 and any comorbidities (Pick-wickian syndrome, Diabetes Mellitus, Hypertension, additional system disorders, skin diseases, and patients who know that there will be a significant change in food and eating habits after surgery and are prepared for this).
• Patients who have seriously tried to lose weight many times with diet and other non-surgical medical methods but have failed in all of them.
• Those who have been overweight for more than 5 years.
• Those between the ages of 17 and 65.

Surgery Contraindications

• Previous upper abdominal surgery (relative).
• Obesity originating from the endocrine gland.
• Advanced age.
• Psychological imbalance.
• Drug-Alcohol addiction.
• Patients who are unwilling or unable to comply with a dietary restriction.
• Those with acute inflammatory disease of the gastrointestinal system (esophagitis, duodenal ulcer, Crohn's, stomach ulcer).
• Hiatus hernia.
• Pregnant patients.
• Cases with any infection or risk of contamination during the surgical procedure.
• Organ failure (kidney, liver, etc.).
• Patients at potential risk of upper GI bleeding (such as portal hypertension).
• Patients who must use aspirin or another NSAID.