What is Obesity?
Obesity, with its simplest definition, can be defined as excess fat storage in the body. It is a chronic, multifactorial disease with genetic and environmental causes. Excess fat accumulation in the body causes many diseases, impairs quality of life and shortens life expectancy. Obesity and obesity-related diseases are the second most common cause of death worldwide. Although there are many reasons; decrease in physical activity, bad eating habits, hormonal diseases, genetic factors can be counted among the main causes of obesity. An increase in the prevalence of obesity is observed all over the world. Between 1975 and 2019, a three-fold increase was observed in the number of obese individuals. According to the World Health Organization (WHO) 2016 data, 2 billion people worldwide are overweight and 650 million of them are obese. Proportionally, 39% of the adult population is overweight and 13% is obese. Although the disease was seen only as a disease of the adult population, its frequency is increasing in children and adolescents. It has been determined that there are 340 million obese individuals in the population between the ages of 5-19.
The fact that obesity is observed in children and young people as well as adults is an indication that the number of obese individuals will increase further in the coming years. The obesity pandemic threatens the whole world. The desired success rates have not been achieved in the fight against this pandemic.
Various definitions have been made for the existence and classification of obesity. It is most commonly calculated using body mass index (BMI). Obesity is defined as a proportionally excessive accumulation of fat in the body.
However; body mass index may not always accurately reflect obesity, that is, body fat ratio. Similarly, BMI in childhood may not give accurate results. For this reason, different definitions are also used; such as percentile values in childhood, body fat ratios and waist-hip measurements in adults.
BMI is obtained by dividing weight (kg) by height (m) squared.
BMI: (kg) / (m2)
OBESITY CLASSIFICATION ACCORDING TO THE WORLD HEALTH ORGANIZATION (WHO) BODY MASS INDEX
BMI CLASSIFICATION (kg/m2)
Normal Range 18.5 – 24.9
Preobese – Overweight 25 – 29.9
Obese Class I 30 – 34.9
Obese Class II 35 – 39.9
Obese Class III >40
Super obese >50
Obesity Classifications Excluding BMI
• Waist measurement greater than 88 cm in women; 102cm in men is considered the obesity limit and requires treatment.
• More than 25% in men; A fat ratio of more than 35% in women is considered the obesity limit and requires treatment.
• Being overweight more than 120% of the 95th percentile in children is class 2; More than 140% of the 95th percentile is considered class 3 obesity.
• Type 2 Diabetes
• Obstructive sleep apnea
• Hyperlipidemia and hypercholesterolemia
• Non-alcoholic fatty liver
• Degenerative joint disorders
• Low back and back pain
• Gastroesophageal reflux disease
• Cholelithiasis (gallstones)
• Heart failure
• Pseudo tumor cerebri
• Deep vein thrombosis and other vascular diseases
• Venous stasis ulcers
• Stress urinary incontinence (incontinence)
• Polycystic ovary syndrome
• Sexual dysfunction
• Increase in the frequency of many cancers,
Who Should Have the Surgery?
Dietary and lifestyle changes should be recommended primarily to all patients. Surgical treatment should be considered in patients who have not been successful with dietary and lifestyle changes.
1-) BMI ≥ 40 kg/m2,
2-) BMI 35 – 40 kg/m2 and comorbid obesity-related disease,
3-) Metabolic surgery is recommended for people who cannot achieve glycemic control despite optimal treatment, even if their BMI is as low as 30.
In addition, it is required to have failed with diet under medical supervision and to be psychologically stable.
Who Cannot Have the Operation?
• Those who have psychological instability,
• Known and documented alcohol-substance abuse,
• Those who have eating disorders,
• Serious medical conditions that make anesthesia or surgery prohibitively risky. ASA (American Society of Anesthesiologist)
• Those who are mentally deficient,
• Those who lack a supported home environment.