Obesity Treatment

As with all health problems, preventive health services and measures to be taken before the problem develops are very important in obesity. The goal of obesity treatment after it has developed is to reach and stay at a healthy weight. This improves overall health and reduces the risk of obesity-related complications.
In general, obesity treatment can be examined under two headings as medical treatment and surgical treatment:

MEDICAL THERAPY
Medical treatment includes dietary changes, increased exercise and activity, and drug treatments. All weight loss programs require changes in eating habits and increased physical activity. Although these are the treatments that should be applied first, they can often be insufficient in the treatment of obesity. However, although the most appropriate treatment method is planned for you, the outcome depends on the severity of your obesity, your general health, and your willingness to participate in your weight loss plan. It would be more rational to aim for a modest weight loss of 5-10% at the beginning of treatment.

diet changes
Reducing calorie intake and adopting healthier eating habits are vital for obesity treatment. There is no magic diet that works for everyone. A diet plan should be made that includes healthy foods that you think will work for you. Dietary changes to treat obesity include:

⦁ Reducing the amount of calories. The key to losing weight is to reduce your calories. The first step is to review your typical eating and drinking habits to see how many calories you normally consume and where you can reduce them. You and your doctor can decide how many calories you need each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 calories for men.
⦁ Feeling full for less. Some foods, such as sweets, sugars, oils and processed foods, contain a lot of calories even in a small serving. In contrast, fruits and vegetables provide a larger serving size with fewer calories. By eating smaller calorie foods in larger portions, the feeling of hunger can be reduced.
⦁ Making healthier choices. To make your overall diet healthier, choose more plant-based foods such as fruits, vegetables and whole grains.
⦁ Restricting harmful foods It is helpful to limit or completely eliminate the amount of a certain food group, such as high-carb or full-fat foods.
⦁ Meal substitutes. These plans include replacing one or two meals with low-calorie beverages or foods, eating healthy snacks and a healthy, balanced third meal that is low in fat and calories.
In the short term, such dietary adjustments can help you lose weight. However, you also have to make changes in your general lifestyle. Weight lost through dieting can be quickly regained. Popular diets that promise quick and easy weight loss may be tempting, but remember, there are no magic foods or diets. The long-term results of this type of diet are not much different from other diets. In order to lose weight and make it permanent, you need to adopt sustainable healthy eating habits and lifestyle.

Exercise and activity
Increasing physical activity and regular exercise is an important part of obesity treatment:
⦁ Exercising. People with obesity should engage in at least 150 minutes of moderate-intensity physical activity per week to prevent further weight gain or maintain moderate weight loss. You will probably need to gradually increase the amount of exercise you exercise as your stamina and fitness improves.
⦁ Move. While the most effective way to burn calories and lose weight is regular aerobic exercise, any extra movement helps burn calories. It’s helpful to park away from store entrances, use the stairs instead of the elevator, and track how many steps you take in a day with a pedometer. Gradually increase the number of steps you take daily to reach your goal of 10,000 steps per day.

Behavior changes
A behavior modification program can help you make lifestyle changes, lose and maintain weight. Steps to take include examining your current habits to find out what factors, stressors or situations contribute to obesity.
⦁ Consulting. Talking to a mental health professional can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you’re overeating and learn healthy ways to deal with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and deal with your appetite. Counseling can be one-on-one or in a group.
⦁ Support groups. Support groups, where other people share their experiences and feelings, and interact with those experiencing similar difficulties, can also be helpful.

drug treatments
Weight loss medications should be used in conjunction with diet, exercise, and behavioral changes. Health history and possible side effects should be taken into account before choosing the right drug for the person.
The most commonly used drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of obesity are:
⦁ Bupropion-naltrexone (Contrave)
⦁ Liraglutide (Saxenda)
⦁ Orlistat (Alli, Xenical)
⦁ Phentermine-topiramate (Qsymia)

SURGICAL TREATMENTS
Weight loss surgery, also known as bariatric surgery, limits the amount of food you can comfortably eat or reduces the absorption of food and calories. However, these surgeries can also cause nutritional and vitamin deficiencies.
It is possible to collect the surgical treatments used under 3 main headings:
1- Intake Restrictive Surgeries (volume reduction): These are surgeries that provide weight loss by reducing the stomach volume and reducing food intake. There is no change in the absorptive function of the small intestine. Typical examples are the adjustable gastric band (clamp), which was frequently used in the past, and sleeve gastrectomy, which is more frequently applied today. The main goal in these surgeries is to reduce the daily food volume of the patient and thus the calorie intake. Since the path and physiology of the digestive system are not changed in these surgeries, the vitamin and mineral deficiencies that the person will experience are mild and usually temporary.
Adjustable gastric band (clamp) surgery. In this surgery, an inflatable band divides the stomach into two sections. The surgeon pulls the tape tightly like a belt to create a small channel between the two sites. The tape prevents the opening from expanding and is usually designed to stay in place permanently. Band surgeries have been almost completely abandoned due to the problems caused by the band. Gastric sleeve surgery, which is widely performed all over the world, has taken its place.
Sleeve gastrectomy surgery. In sleeve gastrectomy surgery, approximately 2/3 of the stomach is removed and the stomach is shaped into a tube and a smaller reservoir for food is created.

TUBE STOMACH (SLEEVE GASTRECTOMY) SURGERY

2- Absorption Surgeries: These are the surgeries that lead to weight loss by shortening the length of the small intestine where absorption is made or by skipping (bypassing) the absorbing area (a significant part of the small intestine) and/or shortening the time it encounters bile and pancreatic secretions that play a role in absorption. Its typical example is jejunoileal by-pass surgery, which is one of the pioneering operations of bariatric surgery. In these surgeries, the transition place of the food taken from the stomach to the small intestine is changed.
In order for the ingested food to be absorbed, it must meet with the pancreatic and bile secretions after leaving the stomach and move forward together.
With these operations, the passage of food from the stomach to the small intestine is changed farther, so that the time and area in which the food taken meets the bile and pancreatic secretions is shortened. Although they provide significant weight loss, these surgeries have serious complications such as severe diarrhea, fluid and electrolyte imbalances, and nutritional disorders. More importantly, they also carry a mortality risk of up to 10%. Despite all the modifications made to reduce these inconveniences, due to the continuation of complications, they are performed less and less and have been replaced by less problematic surgeries.
3-Combined Surgery: These are the methods developed by combining these two types of surgery.
Gastric by-pass surgery (Roux-en-Y). It is the first combined method, which is a landmark in bariatric surgery. In gastric bypass surgery, a small pocket (20-30 mL) is created in the upper part of the stomach and separated from the rest of the stomach, but the stomach is not removed.
It is separated by cutting 30-50 cm from the beginning of the jejunum (upper small intestine). Anastomosis (connection) is made to the small stomach pouch formed above the free jejunum end on the lower side. On the other hand, the operation is completed by anastomosis with the other cut jejunum tip to the small intestine segment at a distance of about 100-150 cm from this connection.
Following food intake, nutrients come from the esophagus to the small stomach pocket and then pass directly to the small intestine (they do not pass through the first part of the large stomach, duodenum and jejunum). Thus, since all of the foods do not visit the areas where absorption is most common in the intestines, they pass directly to the lower parts of the small intestine without being absorbed. On the other hand, the secretions from the deactivated areas (stomach fluid, bile and pancreatic fluid) mix with the foods from the place where the connection with the small intestine is made and pass to the common path.

It is a method that has been increasingly used in recent years by many centers because it is similar to gastric bypass surgery (Roux-en-Y) but involves less anastomosis (connection) and has fewer complications.
MGB, which is a restrictive and malabsorptive combined technique, is also called loop gastric bypass. As in gastric bypass surgery, a small pocket is created in the upper part of the stomach. However, unlike the jejunum, it is connected to this stomach pocket with a single anastomosis (as a loop).

Biliopancreatic diversion (BPD) and duodenal displacement with BPD (duodenal switch-DS). BPD can be performed with or without duodenal displacement.
In biliopancreatic diversion, the lower part of the stomach is removed and attached to the upper part of the small intestine (jejunum) (Roux leg = alimentary leg) and the remaining stomach pocket. The small intestine (biliopancreatic leg), which carries bile and pancreatic secretion, is connected to the lower Biliopancreatic diversion part of the small intestine to form a short common canal.

Biliopancreatic diversion

In biliopancreatic diversion surgery with duodenal displacement, first of all, tube stomach, then duodenal displacement is performed by preserving the valve in the gastric outlet. Its difference from biliopancreatic diversion is the amount of stomach removed and the preservation of the valve in the gastric outlet.
In addition, gastric sleeve and duodenal displacement The main purpose of these surgeries is to minimize the contact of the nutrients taken with the bile and pancreatic secretions and to reduce the absorption. The amount of food taken with tube stomach is also reduced.

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