In recent years, the incidence of obesity and the number of people who had obesity surgeries have been increasing rapidly in developed and developing countries. Obesity, which significantly affects public health and health expenditures, is one of the most important health and nutrition problems. In the occurrence of obesity; Many factors such as dietary habits, insufficient physical activity, genetic factors, socio-economic level, physiological and psychological factors are effective (1,2).
The most effective methods in the treatment of obesity: calorie restriction with diet, increasing physical activity and lifestyle changes. When weight loss cannot be achieved with these methods, weight loss can be achieved quickly with obesity surgery for people with a BMI value of 40 and above, which we define as super obesity.
In addition to weight loss, metabolic problems associated with obesity such as type 2 diabetes, hypertension, dyslipidemia and sleep apnea are also greatly improved (3). However, nutritional deficiency and some complications in the digestive system can occur after obesity surgeries. The risk of nutritional deficiency is affected by pre- and postoperative factors, including surgical technique, postoperative weight loss, and patient compliance with nutritional follow-up (4). Current nutritional deficiencies, such as vitamin and mineral deficiencies, can have serious consequences if not diagnosed early.
“IT IS DIFFICULT TO ACHIEVE A LASTING RESULT WITHOUT CORRECTING THE WRONG EATING HABITS.”
One of the most important problems that can be encountered after obesity treatment is regaining some of the weight lost. Although obesity surgery provides rapid weight loss in the short term, when the targeted weight loss is reached, patients can gradually begin to gain weight again. In scientific studies, it was determined that 30-35% of the patients who had surgery regained weight in the 18-24 months postoperatively, which is a very high rate. Unfortunately, especially in the period between 2-5 years after surgery, patients gain weight again widely (4).
The most important reason why patients regain weight after surgery is that the wrong eating habits of the individuals have not been changed. Before and after the surgery, the patient should be followed up by a dietician with proper nutrition education with the needs of the individual.
“AS A CONCLUSION, OBESITY SURGERY IS NOT A MIRACLE.”
These surgeries are the first step of lifestyle change. It helps the patient to lose weight but in this new life, the patient has very important duties. The most important thing is the reorganization of the eating habits. Without lifestyle changes, surgery is not the solution. So, nutrition education and behavioral training should be given to the patient with the help of a dietician and psychologist. In the postoperative period, patients should be followed up regularly by a dietician who is expert in the field to ensure weight control and prevent nutritional deficiencies. It is very important for patients to include sports and regular physical activity in their lives as well as diet.
NOTE: I would like to thank my dear friend, Tuba Rana Çağlar, who specializes in Nutrition in Bariatric Surgery, for sharing her knowledge with us in this article.
1. Kopelman PG. Obesity as a medical problem. Nature. 2000;404(6778):635-43.
2. Berghofer A, Pischon T, Reinhold T, Apovian CM, Sharma AM, Willich SN. Obesity prevalence from a European perspective: a systematic review. BMC Public Health. 2008;8:200.
3. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England). 2014;384(9945):766-81.
4. Ziegler O, Sirveaux MA, Brunaud L, Reibel N, Quilliot D. Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab. 2009;35(6 Pt 2):544-57.
5. Bastos ECL, Barbosa EMWG, Soriano GMS ve ark. (2013) Determinants of weight regain after bariatric surgery. Arquivos Brasileiros de Cirurgia Digestiva: ABCD = Brazilian Archives of Digestive Surgery26 Suppl 1(Suplemento 1): 26–32.