20 Temmuz 2017 Perşembe

Cancer of The Era: Obesity

Being the second most common cause of death following the smoking, obesity not only devastates social life, but it also paving the way for many diseases. Obesity is one of the leading diseases that definitely require countermeasures and there are medical and surgical treatment options for this condition. Obese patients, who require losing weight under supervision of a doctor, should change their social circle, if needed.

Obesity, defined as “cancer of the era”, is a multi-factorial disease. Considering preventable deaths, it is regarded as the second most common cause of death following the smoking. For May 21st European Obesity Day, Prof. Zafer Ferahköşe, M.D., Head of General Surgery Clinic at Söğütözü Bayındır Hospital, a subsidiary of Türkiye İş Bankası, informs about the obesity that is rapidly snowballing and posing threat to the health.

Although obesity is benign condition that is so hazardous to be referred as “cancer of the era”, it is a medical problem that may even lead to death. Prevention of obesity requires avoiding high-calorie foods, especially fast food and fizzy and sweetened beverages, and doing workout regularly.
Obesity is assessed with Body Mass Index (BMI), which is calculated by dividing weight in kilograms by the square of height in meters (kg/m2). Reference range issued by World Health Organization is taken into account for the diagnosis of obesity. With reference to body mass index, readings in the range of 18.5 to 24.9 refer normal weight, while 25-29.9 is overweight, 30-34.9 obese I, 35-39.9 obese II and 40 and above obese III.


OBESE PARENT OBESE CHILD
Severe obesity, characterized with a BMI score greater than 40, follows a global endemic increase. For instance, most recent data shows that 35.7% of adults in the U.S.A. are in the obese group.
Genetic and environmental factors play very significant role in the development of the obesity. It is found that prevalence of obesity is 10% in children of parents with normal weight, while the risk of obesity in adolescence is around 80-90% in children of obese parents.

PAY ATTENTION TO INTESTINAL FLORA!
Diet and culture play active role in the development of the obesity. Occasional or excessive calorie intake and loss of feeling of fullness are the other factors. Psychological underlying cause of the loss of feeling of fullness has not been clearly understood yet.
Insufficient physical activity, decreased thermogenic activity (fat burning) for meals and growth in population of bacteria that ensure absorption of foods in the bowel pave the way for the obesity. Studies show that intestinal flora of obese individuals and normal individuals vary.
Obese individuals have excessive fat cells (in terms of number and size). Number of those cells is determined at young age. Those cells enlarge in adult obesity.

AN IMPACT TO SOCIAL LIFE
As the stage of obesity increases, the obese individual becomes gradually reluctant to participate in the social life. For instance, obese individuals face difficulty in selection of clothes, inability to fit into seat in a movie theater, bus or on plane and suffer from lack of energy. This may lead to falling into depression.

A PREDISPOSING FACTOR FOR ALL DISEASES
Obesity causes very serious medical problems and paves the way for many diseases. Degenerative joint disease in knees, low-back pain, degenerative discs, hypertension, sleep apnea, gastroesophageal reflux, cholelithiasis, Type II diabetes mellitus, hyperlipidemia, pancreatitis, hypercholesterolemia, asthma, hypoventilation and secondary respiratory distress, fatal cardiac arrhythmias, right heart failure, migraine, pseudo tumor cerebri, venous stasis ulcers, leg wounds secondary to varicose veins, deep venous thrombosis, redness on skin folds secondary to fungal infection, skin disorders, abscesses, urinary incontinence, infertility, menstrual irregularities, increase in various cancers (uterus, breast, colon, prostate gland etc.), abdominal wall hernia and depression.

OBESITY STEALS YEARS FROM LIFE.
According to researches; 21-year old male with morbid obesity lives 12 years less than non-obese of the same age, while 21-year old female with morbid obesity lives 9 years less than non-obese of the same age. Male population with BMI greater than 40 pass away due to early cardiac arrhythmia and coronary artery disease below 50 years of age.

SOCIAL CIRCLE SHOULD BE CHANGED, IF NEEDED
Medical treatment of obesity intends reducing the body mass by limiting the energy intake and increasing the energy output and exercise. This should be based on a particular balance and rate under supervision of dieticians and doctors.
It is necessary to lose 34 kilograms (75 pounds) to restore body weight into normal ranges, but it is, undoubtedly, very difficult. Final body weight can be maintained only by 3 percent. Therefore, obese patients should modify life style, friends and the social circle as well to maintain permanent weight loss. However, this is very difficult too.

CHANGING SOCIAL ENVIRONMENT
Low calorie intake (800-1500 kcal/day), in other words a decrement of 500 kcal per day, results in loss of 400 g of the fat mass per week. This provides 8 kg of weight loss in 6 months. Moderate physical activities bring extra 2 to 3 kg of weight loss. For those with BMI = 30-35 kg/m2, diet, exercise and modified social environment may decline BMI below 30 and rule out the diseases secondary to obesity.
SURGERY, IF MEDICAL TREATMENT FAILS
Surgical treatment of obesity (bariatric surgery) is an effective method for weight loss. Although it has certain morbidity and very low mortality rates, it should not be the first-line treatment. These methods should be considered when medical treatment fails or weight gain relapses. Surgical treatment intends limiting the food intake. This surgical approach leads to reduced volume, suppression of feeling of fullness or reduced absorption of food. Surgical treatment options for obesity are as follows:
Primary Restrictive Surgery:
Laparoscopic Sleeve Gastrectomy (banana shaped stomach-Gastric reduction): Success rate is 60% for weight loss.
Primary reduction of absorption:
Biliary Pancreatic Diversion
Duodenal Switch: Success rate is 90% for weight loss.
Combined restrictive – reduced absorption
Roux-en-Y gastric bypass: Success rate is 90% for weight loss.



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