The Pandemic Changed the View on Obesity Surgeries

The pandemic has changed the perspective on bariatric surgeries
The pandemic has changed the perspective on bariatric surgeries

Medical Park Tokat Hospital General Surgery Specialist Op. Dr. Zeki Özsoy said, “Obesity surgery is an elective surgery, so it is not an emergency. However, when it is revealed that obesity exacerbates the Kovid-19 disease, the opinion that the surgeries of obese patients should not be postponed and that these can be considered urgent has been accepted in the world.

Pointing out that obesity has become an important public health problem on a global scale, Medical Park Tokat Hospital General Surgery Specialist Op. Dr. Zeki Özsoy emphasized that obesity is increasing day by day in both developed and developing countries.

Noting that in the MONICA study, which was conducted by the World Health Organization (WHO) in 6 different regions of Asia, Africa and Europe and lasted for 12 years, it was reported that an increase of 10-10% was detected in the frequency of obesity in 30 years, General Surgery Specialist Op. Dr. Zeki Özsoy said that 1,5 billion people in the world are overweight and 500 million people are obese.

Noting that overweight and obesity, which was once seen as a problem only in high-income countries, is now increasing more dramatically in low- and middle-income countries, especially in urban environments. Dr. Zeki Özsoy said, “The majority of overweight or obese children live in developing countries, where the rate of increase is more than 30 percent compared to developed countries. From 1975 to 2016, the prevalence of overweight or obese children and adolescents aged 5-19 more than quadrupled from 4 percent to 18 percent globally. “Obesity has been recognized as a global epidemic since 4, with more than 2017 million people dying each year as a result of being overweight or obese.”

Sharing the data of the Turkish Statistical Institute (TUIK), Op. Dr. Zeki Özsoy stated that while the rate of obese individuals aged 15 and over was 2016 percent in 19,6, it increased to 2019% in 21,1. Pointing out that in 2019, 24,8% of women were obese and 30,4 percent were pre-obese, 17,3% of men were obese and 39,7 percent were pre-obese, Op. Dr. Zeki Özsoy stated that, in general, the rate of obese individuals in Turkey is 21,1%, and according to the World Health Organization 2018-2019 obesity data, it has been announced that 3 out of every 1 people in Turkey is obese.

Underlining that obesity is not only a visual problem, but also a disease that directly affects the comfort of life of the individual, Op. Dr. Zeki Ozsoy; “Obesity patients experience symptoms such as sweating, palpitations, shortness of breath, snoring, back and joint pain. In addition, it can cause psychological problems such as a decrease in self-confidence, not being tolerated or excluded in the society.

Emphasizing that obesity is the basis of many chronic diseases, Op. Dr. Zeki Ozsoy said:

“The circulatory system, digestive and excretory systems and all other elements are adversely affected by the obesity problem. Obesity also increases the risk of developing cancer. In addition, some studies have shown that morbidly obese pregnant women experience more maternal and fetal problems than those who weaken and become pregnant after bariatric surgery. Prevention and treatment of obesity is the first step in dealing with all these diseases.

Kiss. Dr. Zeki Özsoy listed some of the diseases and health problems that obesity directly or indirectly caused or may cause as follows;

  • Diabetes
  • high blood pressure
  • Cardiovascular diseases
  • Insulin resistance problem
  • High cholesterol
  • Gallstones
  • Paralysis and stroke conditions
  • Cancer
  • Liver Fatty
  • Sleep apnea
  • shortness of breath, asthma
  • Muscle and joint diseases
  • psychological diseases
  • polycystic ovary disease
  • Skin and skin disorders and diseases

Kiss. Dr. Zeki Özsoy stated that due to the above diseases, individuals use a wide variety of drugs and their quality of life decreases considerably.

Adding that according to the report published by OECD in 2019, those with obesity problems tend to benefit from health services more frequently, and that obese people spend about 2,5 times more on health care than normal individuals. Dr. Zeki Özsoy said, “It has been noted that the treatment of obesity-related diseases constitutes 8,4 percent of the total health expenditures. For example, in a patient who develops diabetes mellitus due to obesity, it will be necessary to additionally use many drugs, have tests, deal with diabetes-related problems, and perform many more polyclinic examinations.

Underlining that the studies carried out during the coronavirus pandemic period revealed that Kovid-19 was more severe in obesity patients and that about half of those hospitalized due to the virus had obesity, Op. Dr. Zeki Özsoy shared the following information: “Obesity, defined as an epidemic by WHO, has been recorded as the second most important cause of death after smoking. The change in eating and drinking patterns and the increase in the frequency of snacking due to pandemic conditions have invited obesity. Especially in this period, healthy nutrition has become even more important. In addition, another problem was the postponement of elective surgeries for a while during the pandemic period. Obesity surgery is an elective surgery, that is, it is not an emergency, but when some findings such as obesity increase and exacerbate the Kovid-19 disease are obtained, the opinion that the operations of obese patients should not be postponed and that these can be considered urgent has been accepted in the world. Except for the period when elective surgeries are postponed in the first months of the pandemic, we prepare our patients under safe conditions and perform their surgeries.”

Emphasizing that the methods used in the treatment of obesity are diet, exercise, behavioral therapy, pharmacological (drug therapy) treatment and surgical treatment, Op. Dr. Zeki Özsoy stated that diet and exercise therapy is usually applied at first.

Stating that it is important to detect and prevent the factors that cause obesity in treatment, Op. Dr. Zeki Özsoy said, “There are drugs that have been used in the pharmacological treatment phase in recent years, especially with suppressive effects on appetite. It must be applied under the control of a physician and side effects should be followed up. When all these methods fail to yield results, surgery, which is the last and most effective step of treatment, comes into play. All studies indicate that surgical treatment is superior to all these methods. Surgical treatment is the most effective and best-resulting treatment option in today's conditions.

Underlining that some criteria are needed for obesity surgery, Op. Dr. Zeki Özsoy explained these as follows: “The first criterion we look at is body mass index (BMI). The values ​​used for BMI calculation are the height and weight of the individual. It is obtained by dividing our body weight (kg) by the square of our height in meters. Those with a BMI of 30-35 kg/m2 are defined as stage 1 obese, those with a BMI of 35-40 kg/m2 as stage 2 obese, and over 40 kg/m2 as morbidly obese. For surgery, if the person's BMI is over 40 kg/m2 or if the BMI is between 35-40, it is necessary to have a concomitant disease. These co-morbidities are type 2 diabetes, coronary artery disease, hypertension, high cholesterol, high triglyceride, sleep apnea syndrome, fatty liver disease, obesity-related asthma, gastroesophageal reflux disease, venousstasis disease, urinary incontinence, progressive joint deformities secondary to weight. .

Stating that surgery can be performed on patients between the ages of 15-65, Op. Dr. Zeki Özsoy said, “These operations, also called bariatric surgery, can be safely performed in childhood patients and adolescents with an appropriate profile. It is known that 75 percent of children who enter adolescence as morbidly obese are also morbidly obese in adulthood. In the patient group between the ages of 65-70, general condition and performance evaluation is made. At the end of the examination and tests, suitable patients can be operated. Obesity surgeries; if obesity is due to thyroid gland laziness, cortisone use or endocrine organ disease, drugs, alcohol, etc. It is not applied if there is addiction to stimulant substances, if there is a serious psychiatric problem and if pregnancy is planned within 1 year.

Stating that there is not yet a gold standard procedure in obesity surgery, Op. Dr. Zeki Özsoy said that as in every field of medicine, the method is decided on a patient basis, considering the metabolic, anatomical and hormonal status of the patients and their obesity levels.

Emphasizing that the surgical treatment of obesity is basically performed by three mechanisms, Op. Dr. Zeki Özsoy listed them as follows: “The first of these is the reduction of stomach volume by restriction in terms of restriction, and the second is the reduction of absorption from the small intestines by malabsorption. The third mechanism is the realization of these two mechanisms together. All the aforementioned methods can be easily performed by experienced surgeons using the laparoscopic, that is, closed method, through very small holes. In this way, the patient feels much less pain, is discharged from the hospital in a shorter time and can return to his normal life faster. Wound problems such as infection and bleeding are much less and cosmetically better results are obtained.

Stating that sleeve gastrectomy, that is, sleeve gastrectomy, or in other words, gastric reduction surgery, is the most common volume-restricting surgery in recent years, Op. Dr. Zeki Özsoy said, “Stomach sleeve surgery is the most common weight loss surgery and the easiest to implement. Patients can be discharged in a short time and do not need lifelong vitamin and mineral support.

Stating that the most common operation called gastric bypass (stomach bypass) is applied as an absorbing surgery, Op. Dr. Zeki Özsoy said, “With gastric bypass, an effective weight loss is achieved as a result, while vitamin and trace element supplementation is required in the long term. Gastric bypass surgery is preferred in our patients, especially if they have diabetes (type 2 diabetes) in addition to obesity. It is more effective on weight loss and sugar than sleeve gastrectomy surgery. Adjustable gastric band (clamp), which is one of the volume-restricting methods, is rarely used today due to the complications it creates.

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