You Are at The Right Place for Bariatric and Metabolic Surgery!
NB Kadikoy Hospital is the first and only health institution in Turkey that provides comprehensive diagnosis, treatment and preventive medicine services by considering Diabetes and Obesity diseases together with the complications they cause in the individual.
Our hospital, which has firstly started its operations under the name of “Diabetes Center” 62 years ago, decided to improve its physical conditions due to the increasing demand over the years and has started to provide services as a “Diabetes Hospital” in its center located in Harbiye in 1990.
Our hospital, which continued its operations in Harbiye until 2015, has become the leading hospital of all of Turkey and started to provide the best medical services in its new building in the center of Kadikoy after deciding to expand its operations.
Providing services of high quality within 22 branches in Kadikoy, the business and residential center on the Anatolian Side of Istanbul, our hospital has specialized in the diagnosis and treatment of "Diabetes" and "Obesity” together with all its multidisciplinary branches, which are among the chronic diseases that have very important consequences in human life.
What Is Obesity?
Obesity is a life-threatening disease that occurs as a result of excessive fat accumulation in the body, usually due to wrong and unhealthy diet in addition to inactivity and lack of physical activity. Besides these factors, many genetic, environmental, neurological, hormonal and psychological factors are the cause of obesity.
The obesity sets the ground for serious problems such as metabolic syndrome first and then diabetes, hypertension and heart diseases, and require absolute treatment.
Obesity and diseases triggered by it threaten modern society like an epidemic that we cannot prevent.
Due to treatment need of concomitant diseases such as type 2 diabetes, hypertension, hepatosteatosis (fatty liver) and dyslipidemia, the purpose of surgical treatments has expanded in patients with obesity, and the positive metabolic results of the treatment have become as important as losing weight.
Despite the benefits of trying treatment plans supported with lifestyle changes, planned nutrition programs and exercises prior to bariatric/metabolic surgery, the most effective and permanent treatment option in individuals with morbid obesity is the bariatric surgery.
Obesity is not an unpreventable disease. Just rely on our professional medical solutions.
How Is Body Mass Index Calculated?
Body Mass Index (BMI) calculation is used as a base in treatment of obesity. Body mass index is calculated dividing body weight by the square of height.
Example: BMI of a person with a weight of 130 kg and height of 170 cm corresponds to 130/(1.7*1.7)= 44.9 kg/m2.
If body mass index is above 40, the person is classified as an obese.
Patients with a body mass index of over 35 and additional diseases such as insulin resistance, hypertension and hyperlipidemia are also suitable for bariatric surgery.
What Causes Obesity?
There may be many underlying reasons of obesity caused by wrong feeding habits and a sedentary lifestyle. These diseases, on the other hand, are triggered by multiple factors such as genetic predisposition, environmental and psychological conditions, neurological and hormonal specificity.
How Is Obesity Treated?
Treatment of Obesity with Diet
Obesity and Medical Nutrition Therapy
Obesity is a chronic disease that results from the fact that the energy taken into the body with food is more than the energy spent, which is also associated with an increase in body fat mass compared to lean body mass.
Obesity is an important health issue that affects all organs and systems in the body, especially the cardiovascular and endocrine systems, causing various disorders and even death.
It has been stated in recent publications that the obesity, which is considered as one of the 10 most risky diseases by the World Health Organization (WHO), is also closely related to cancer.
It is also known that obesity poses a risk for various diseases such as cardiovascular diseases, hypertension, type 2 diabetes, metabolic syndrome, dyslipidemia, some hormone-dependent cancers and obstructive sleep apnea syndrome.
The aim in treatment of obesity is to reduce the morbidity and mortality risks associated with the obesity, provide the individual with adequate and balanced nutrition habits as well as increase the quality of life.
Even small amounts of weight loss (5-10% of initial weight) in individuals with obesity contribute to improvement in health condition in the short term or may reduce the severity of comorbid diseases secondary to obesity.
The aim of the nutritional treatment in obesity should be to reduce fat deposits without mass loss in muscles and vital organs by creating an energy gap and prevent loss of vitamins, minerals and electrolytes. Although there are many methods to lose weight, the main principle in treatment is that the energy spent is less than the energy taken. Favorable weight loss should be aimed while planning a diet.
Losing 5-10% of the excess weight should be favorably aimed in the first 6 months of the weight loss program. This naturally requires energy restriction to provide a weight loss of 0.5-1 kg per week.
Medical Nutrition Therapy for Obesity:
Energy: The basic principle in determining the daily energy amount for weight loss is that the energy taken should be less than the energy spent. The daily energy intake of an individual can be achieved with a reduction of 500-1000 kcal from the daily necessary energy to provide a weight loss of 0.5-1 kg per week.
Protein: 12-15% of the daily energy should be obtained from proteins and more quality protein sources should be consumed. 30-40% of the total protein amount should be get from foods of animal origin to meet the vitamin B12 requirement. Sufficient intake of proteins is important since they provide a feeling of satiety and have positive effects on protection of lean body mass and tissue building.
Fat: In line with the healthy nutrition recommendations, it is suggested that 25-30% of the daily energy amount should be obtained from fats. Ensuring this ratio in the diet is important in terms of taste, providing a feeling of satiety and long-term practice of the diet. In addition, fatty content of the diet should not be reduced too much in order to increase the absorption of fat-soluble vitamins (A, D, E, K), and it should be ensured that the portion of energy obtained from fat does not fall below 20%.
The types of oil to be preferred while cooking foods also play an important role in diet. The ratio of energy obtained from saturated fatty acids should be below 10%. Moreover, ratio of polyunsaturated fatty acid should be equal to 7-8% whereas monounsaturated fatty acid to 10-15%. The amount of cholesterol in the diet should be below 300 mg/day.
Carbohydrate: 55-60% of the energy should be obtained from carbohydrates. Consumption of simple carbohydrates such as sugar should be reduced (≤10 of daily energy). On the other hand, complex carbohydrates including legumes (chickpeas, lentils, beans, etc.), whole grain products, cracked wheat, etc. should be consumed more. It has been reported that carbohydrates, especially oligosaccharides and polysaccharides with high fiber content, create a feeling of satiety, control energy intake and reduce the risk of developing obesity.
Vitamins and minerals: Vitamin and mineral (B vitamins, iron, calcium, etc.) deficiencies can be seen in diets planned for weight loss in parallel with the low energy content. Vitamin or mineral deficiency is not seen while practicing diets balanced with nutritious contents.
Fiber: It is widely believed that increasing dietary fiber is effective in preventing obesity and weight gain, as in many chronic diseases. It is important to include fiber in nutrition programs for many reasons, such as extended time of eating due to the long chewing time, providing a feeling of satiety by slowing the gastric emptying velocity, preventing constipation by increasing bowel movements and stool volume and stabilizing insulin levels. The amount of fiber to be taken daily is 25-35 grams for adults. Vegetables, fruits, legumes, whole grain products, whole wheat flour and whole wheat products are the recommended natural fiber sources.
Alcohol: It is not recommended in diets for weight loss. If the individuals on diet want to consume alcohol, they should calculate the calorific value of the alcohol to be consumed and deduct this calorie amount from their daily energy needs. 60 ml of raki, 270 ml of wine, 750 ml of beer, 75 ml of whiskey, 80 ml of vodka or 90 m of gin can be given as examples of beverages containing approximately 30 grams (200 kcal) of alcohol.
Fluid: Approximately 2-3 liters of fluid should be consumed daily. When consumed before and after meals, it increases stomach fullness and helps digestion of metabolic wastes. Especially 1-1.5 liters of this fluid amount (corresponding to 8-10 glasses of water) should be obtained from water. Drinking water is also very important in preventing constipation, which negatively affects the process of weight loss.
Salt: Salt restriction is necessary in the diet of individuals with obesity suffering from heart failure, edema due to some reasons or hypertension. However, if individuals do not have such problems, salt intake should not exceed 5 grams (a little less than 1 dessert spoon) per day.
Meal Arrangement: The nutrition program varies according to different needs and conditions, and should be arranged as 4-6 meals a day. Eating frequently in small portions prevents overeating, delays feel of hunger and reduces food consumption at the next meal.
General Suggestions on Medical Nutrition for Obesity:
- Eat frequently in small portions. Eating at least 5-6 meals a day will speed up your metabolism and help you lose weight.
- Be sure to start your day with breakfast.
- Have your meals as calmly and slowly as possible, chew well.
- Do not be busy with anything while eating.
- Be sure to drink enough water all day long to make your urine light-colored, which is a good sign.
- Prefer low-calorie but healthy foods instead of high-fat, sugary foods.
- Consume at least 5-8 portions of vegetables and fruits a day. Thus, you will get both vitamins and minerals and you will stay full for a longer time by eating foods rich in fiber.
- Prefer eating brown bread as much as possible instead of white bread.
- Use less oil when cooking. Fats provide twice as many calories as carbohydrates and protein.
- If possible, use vegetable oils.
- Prefer boiling, grilling, baking, which are healthier, instead of frying.
- Buy low-fat dairy products.
- Do not think of diet products as foods that can be consumed without limit, most of them are quite high in calories.
- Be sure to increase your physical activity. Taking a walk at least 3-4 times a week, walking to nearby places, using the stairs, and dancing are beneficial for you.
- Make sure to go shopping when you are full and do not buy foods that will interrupt your diet.
Treatment of Obesity with Endocrinology and Internal Medicine
Obesity is the condition of having more fat than the normal amount in the body, which is one of the most common diseases of our age.
How Is Body Fat Measured?
Body fat percentage is measured with waist circumference measurement, weighing machines, anthropometric methods and DXA analysis.
The obesity rate is increasing day by day in our country as well as in the world. Approximately 50% of women and one-third of men suffer from obesity. Obesity is an insidious disease, which causes the development of chronic diseases that increase the risk of death in the long term. Leading to diabetes, high blood pressure, arteriosclerosis, the obesity has negative effects on all organs. In addition to such diseases, it deteriorates aeration in the lungs and adversely influences the intestinal system.
We, physicians, are fighting a battle against obesity.
The more we save individuals from fatty tissue, the more we will reduce future diseases.
How Is Obesity Treated?
First of all, individuals with obesity are evaluated whether they have hormonal disorders that are seen with a ratio of 15%.
If the tests reveal a hormonal disorder, the first thing to do should be treatment of that disease.
If the individual has another disease, appropriate methods ensuring weight loss are started to be practiced after the treatment. However, if the individual does not have a disease, personalized diet therapy and exercise are firstly planned. For patients who cannot lose weight despite diet and exercise, appropriate weight loss medications are started to be used.
What Are Treatment Methods for Obesity?
Diet programs, exercise and medication treatments are provided with patients for obesity.
Today, there are many more medications and treatment methods available. There are different groups of medications:
- Insulin Resistance (Effective on Liver and Fatty Tissue),
- Medications Effective on Fat Absorption
- Psychiatric medications that act on the gastrointestinal tract and give a feeling of satiety, stop or slow down duration of gastric emptying.
As a result, these methods are combined, and the appropriate treatment method is determined according to the additional diseases of the patient.
The fatty tissue, like other organ systems, produces more than a thousand hormones. It causes diseases such as the development of insulin resistance, deterioration of the liver and disorders affecting the brain and muscle tissue. When the fatty tissue increases, these peripheral effects occur as a result of the imbalance in the hormones produced.
As part of endocrinologic approach, all medical treatments and medication treatment methods are primarily practiced in order to fight against this disease.
However, if these treatments fail, surgical methods are then preferred as a last resort.
Bariatric surgery procedures generally take place in two parts:
- Restriction (Reducing Gastric Volume)
Bariatric surgeries allow reduction in gastric volume. Thanks to these surgeries, patients are satiated early without eating too much. Patients who have undergone bariatric surgeries should drink plenty of fluids and stay away from solid foods and fluid intake containing plenty of carbohydrate.
- Intestinal Bypass Surgeries (Disruption of Absorption as Treatment Methods)
By decreasing the absorption from the intestines of the patient, the patients are ensured to lose weight with the changes in some hormones secreted from the intestines and bypassing.
Also, there are surgeries that these two surgeries can be performed together. Sleeve gastrectomy operations have relatively fewer postoperative complications compared to other operations. On the other hand, more successful results are obtained in surgeries, in which the intestinal segment is shortened. The long-term success rate is higher. Intestinal segment shortening operations, especially on patients with diabetes, can alleviate diabetes or even heal diabetes. Due to the different characteristics and discomforts of individuals, the results may vary from person to person following the operation. Depending on the severity of diabetes and the amount of fatty tissue, different results can be obtained in individuals.
Who Can Undergo Bariatric Surgeries?
- Individuals with a body mass index (BMI) over 40 and excessive fatty tissue are considered as patients suitable for bariatric surgery.
- Patients with a body mass index above 35 and serious diseases, that is, cardiovascular disease, need of intensive diabetes treatment, need of insulin therapy over 100 units a day and lung problems, are considered in the risky group when they cannot get rid of excessive fatty tissue. In this case, bariatric surgeries can be performed.
What Are Surgical Treatments for Obesity?
Obesity and the diseases triggered by it threaten modern society like an epidemic that we cannot prevent. Due to treatment need of co-morbid diseases such as type 2 diabetes, hypertension, hepatosteatosis (fatty liver) and dyslipidemia, the purpose of surgical treatments has expanded in patients with obesity, and the positive metabolic results of the treatment have become as important as losing weight.
The Bariatric surgery, which is the most effective and permanent treatment option in patients with morbid obesity, must be supported with lifestyle changes, planned nutrition programs, exercises and treatment plans to be followed by special teams working on this case.
Bariatric Surgery refers to the surgical interventions performed as a treatment on people who cannot lose weight despite treatment and diet programs or on people with a body mass index (BMI) of over 40 or over 35 in addition to some chronic diseases causing significant health problems.
Thanks to bariatric surgeries, which have an important place in the treatment of obesity, patients can have normal weight and the prevalence of obesity-related diseases in these patients also decreases.
With the bariatric surgeries performed with closed surgical method (laparoscopic), the recovery period of the patients also shortens.
The bariatric surgeries provide 80% weight loss in the first year when supported with necessary lifestyle changes.
Who Are Suitable for A Bariatric Surgery?
Patients with a body mass index over 40 kg/m2 as well as individuals with a BMI over 35 kg/m2 and at least one co-morbid disease are considered as candidates for surgery.
Individuals with metabolic diseases such as type 2 diabetes, hypertension, hepatosteatosis (fatty liver) or significant irregularity in blood lipids can be suitable candidates for the surgery by being analyzed in detail according to BMI groups.
Muscular, skeletal, joint problems, functional and psychiatric disorders and sleep apnea are also important diseases that can accompany obesity and cause people to be defined as morbidly obese.
Patients with type 2 diabetes, whose body mass index is in the range of 30-35 kg/m2 and whose disease cannot be taken under control with standard antidiabetic treatments, are also considered as people with metabolic surgery indications, provided that the decision of the endocrinologist is obtained.
As a result of the evaluation of our endocrinologists, dietitians and general surgery team, bariatric surgeries can be performed within the scope of SSI (social security institution) insurance for people with a body mass index (BMI) over 40.
What Is Bariatric Surgery?
Bariatric Surgery allows individuals, who cannot lose weight despite lifestyle changes, diet, programmed sports and medications, to have their ideal weight again with appropriate surgical intervention. Thanks to this surgical approach, the risks of developing chronic diseases such as diabetes and cardiovascular disorders are taken under control and the patients begin to enjoy life as individuals who are at peace with their bodies.
Is Bariatric Surgery Performed at All Ages?
How Is a Bariatric Surgery Method Decided?
The most commonly practiced methods for bariatric and metabolic surgeries today are sleeve gastrectomy and gastric bypass operations.
Gastric bypass surgery is preferred for patients with type 2 diabetes using high-dose insulin, severe reflux or sugar addiction, while sleeve gastrectomy surgery is preferred as the most commonly practiced method for other patients.
What Is the Role of Endoscopic Methods in Bariatric Surgery?
Intragastric balloon procedure, which should be supported by well-planned nutrition program, exercise and lifestyle changes, is very beneficial for patients with obesity who need to lose weight but are not suitable for a bariatric surgery. In addition, the risks in this procedure are significantly less than other surgeries. However, some necessary precautions should be taken in order not to regain weight in the period after the balloon is removed.
Reducing gastric capacity endoscopically with the sutures to be placed inside the stomach has become a current issue. In the light of medical developments, combinations of medical and endoscopic treatments will be used in combination more frequently in the future.
Is Bariatric Surgery Risky?
Rate of significant complication development is 2% and rate of a life-threatening complication is around 0.1%. It is as safe as other major surgeries as long as it is performed in well-equipped hospitals by experienced surgeons.
What Are Surgical Operations Performed in Treatment of Obesity?
- Gastric Balloon Procedure
- Sleeve Gastrectomy
- Bypass Surgeries
Postoperative Period
Treatment of obesity and metabolic diseases is a lifelong struggle. Both the patient and the medical team arranging the treatment must be ready for this. Under the control of medical supervision, it is very important to limit the amount of food intake due to anatomical changes and ensure that the important benefits to be provided thanks to hormonal changes in the intestines are not damaged because of the possible protein, vitamin, mineral, calcium deficiency.
For effective and permanent weight loss and long-term management of diabetes, some programs are needed in order to gain regular exercise habits and maintain and support the current muscle mass in postoperative period.
A surgeon, endocrinologist, internal medicine physician, dietitian, psychiatrist/psychologist and a team arranging exercise programs will be the greatest assurance for patients in this lifelong struggle at pre/postoperative periods.
How many days are patients hospitalized?
Postoperative Nutrition
Postoperative Recovery Period
Postoperative Weight-Loss Period
What Changes in The Body After the Surgery?
Postoperative Exercises