Obesity is a chronic disease and is defined as an increase in body fat mass. The prevalence of obesity has become a rapidly growing major public health problem all over the world. Taking more energy than you consume and sedentary life seem to be the two main reasons for this increase. Obesity is characterized by endocrine and metabolic changes and is associated with many chronic diseases. The most important effect of obesity is that it causes insulin resistance. Epidemiological studies show that the prevalence of metabolic syndrome increases in parallel with the increase in obesity. This syndrome is an important health problem associated with abdominal obesity, impaired fasting glucose, high blood pressure and dyslipidemia (high triglyceride and low HDL cholesterol).

Metabolic sydrome was defined according to American guidelines, which stipulated at least 3 out of 5 of the following criteria had to be met:

(1) Fasting blood glucose (FBG) ≥ 110 mg/dL or known diabetes mellitus (DM), taking anti-hyperglycemic medication,

(2) Triglycerides (TG) ≥ 150 mg/dL,

(3) High-density lipoprotein-cholesterol (HDL-C) ≤ 50 mg/dL for female,

(4) Systolic blood pressure (SBP) ≥ 130 mm Hg and/or diastolic blood pressure (DBP) ≥ 85 mm Hg or taking anti-hypertensive medication, and

(5) Waist circumference (WC) ≥ 88 cm for women.

Today, the most valid measurement for diagnosing obesity is body mass index (BMI). BMI; It is calculated by dividing body weight (kg) by the square of the height in meters. A BMI between 25-29 kg/m2 is called mild obesity, and a BMI over 30 kg/m2 is called obesity.

Inadequate metabolic control, vascular problems such as neuropathy and non-healing foot wounds are more common. With the development of foot ulcers, restriction of joint movements, poor foot care and foot deformities also pose a risk. Progressive attack lesions increase the risk of amputation in the lower extremity.

According to the American Diabetes Association, the HbA1C level in a normal individual should be between 4-5.9%.

Table 1: Evaluation by Glucose Level in Oral Glucose Tolerance Test (OGTT)
 

In patients with diabetes, some questions can be asked in order to obtain information about the degree of discomfort caused by diabetes (1. Not at all, 2. Not at all, 3. A little, 4. A lot). These:

Do you have swelling in your legs?

o How much does the swelling in your legs bother you?

Do you urinate frequently?

o How much does frequent urination bother you?

Do you have numbness in your legs-hands?

o How much does the numbness bother you?

Do you suffer from blurred vision?

o How much does blurred vision bother you?

Do you have social problems related to the diabetes problem?

o How much do you think diabetes disrupts your relationship with your family and environment?

o How much do you think diabetes disrupts your work, social life or housework?

Do you find it difficult to follow the diet recommended for diabetes?

o How much difficulty do you have in maintaining the diet?

How satisfied are you with your diabetes treatment? (Please explain...)

o What is the degree of dissatisfaction?

What other problems do you have with your diabetes? (Please explain.........)

o How often do you have diabetes problems?

Do you have difficulties in administering diabetes medications (Please explain........)

o How often do you have problems with diabetes medication administration?

Do you feel anxious about living with diabetes?

o How often do you worry about the risk of further complications of diabetes in the future?
 

Obesıty Surgery

The most effective treatment for obesity is surgery. In surgical treatment, it is aimed to restrict the stomach volume and to limit the absorption of nutrients from the small intestines. Surgical method is a more permanent, safe and innovative treatment method applied by individuals who cannot achieve success with diet and exercises.

Along with surgical treatment, a multidisciplinary evaluation such as psychological and behavioral therapy counseling, dietitian counseling, and endocrine examination should be performed. The surgical procedure should be decided by considering the results of the medical history, physical examination and metabolic values. The success of surgical processes is highly dependent on patients' adopting healthy lifestyle changes. In the management of the process, it is important to evaluate the patient selection criteria before surgery. These:

• BMI≥ 40 kg/m2

• BMI ≥ 35 kg/m2 and those with obesity-related medical conditions such as hypertension, liver disease, sleep apnea, stress incontinence, reflux, asthma, type 2 diabetes, metabolic syndrome or insulin resistance.

• Those with a BMI of 30-34.9 kg / m2 and those with prediabetes, type 2 diabetes, insufficient glycemic index, and those who could not get results from non-surgical treatments.

Obesıty Surgery Methods

There are different methods of obesity surgery. The choice of these methods may vary according to the medical condition, diseases, age, gender, weight and preferences of the patients. Surgical methods;

• Gastric sleeve surgery (Sleeve gastrectomy)

• Gastric band

• Gastric bypass

• Gastric balloon

• Metabolic surgery

The Importance of Weight Control in Treatment After Obesity Surgery

According to bariatric surgery efficiency statistics;

• As long as the recommendations after obesity surgery are followed, 70-80% of the weight is lost.

• 90% of sleep apnea is cured.

• Even 5-10% weight loss can control all components of the metabolic syndrome.

• Even 10% weight loss reduces the risk of developing Type 2 DM by 50%.

• Death rate from type 2 diabetes is reduced by 95%.

• The mortality rate from coronary artery disease is reduced by 80%.

• The rate of catching cancer decreases by 70%.

Importance of Physical Activity in Treatment

Regular physical activity improves insulin resistance, provides glucose, lipid and blood pressure control and improves cardiovascular functions.

In order to prevent weight gain, 45-60 minutes of physical activity should be done regularly every day. For cardiovascular risk reduction, it is recommended to take 10000 steps per day.