Obesity

Obesity

Holistic treatment of Obesity

At the Obesity and Metabolic Disorders Clinic of St Luke’s Hospital, the problem of obesity is treated comprehensively, with the assistance of all relevant specialties:

• Pathologist
• Endocrinologist
• Nutritionist
• Gastroenterologist
• Psychiatrist
• Specialized bariatric surgeon
• Plastic surgeon.

Starting from ascertaining the causes that lead to excessive weight gain and understanding the complexity of the problem, we can proceed to the definitive treatment of obesity, achieving gradual and permanent weight loss.
The Obesity clinic has specialized surgeons, who are ready to intervene when this is deemed necessary.
What is Obesity?

Obesity is a complex and multifactorial disease characterized by an excessive amount of body fat. In general, it increases the risk of other diseases, such as:

• Heart diseases
• Diabetes
• High blood pressure
• Certain cancers.

Typically, obesity is the result of hereditary factors, combined with the patient’s environment, eating habits and physical activity levels.
However, even modest weight loss can improve one’s health or prevent obesity-related health problems. Dietary changes, increased physical activity, and behavioral changes can help you lose weight. Additional options for treating obesity include certain medications, as well as specific weight loss procedures.

Relationship of Obesity and body mass index

Obesity is diagnosed when the body mass index (BMI) is 30 or higher. To determine your Body Mass Index, divide your weight in kilograms by your height in meters squared (e.g. for a weight of 80 kg and a height of 1.80 meters, one’s BMI equals 80 / 1.80^2 = 24.7).

Obesity and quality of life

Obesity can negatively affect one’s quality of life. They may not be able to do things they used to do, avoid public places or even face discrimination. Other weight-related issues that can affect quality of life may include some of the following:
• Depression
• Sexual problems
• Shame and guilt
• Social isolation
• Lower work performance

Complications of Obesity


People with obesity are at greater risk of developing some serious health problems, including:
 Heart disease and strokes. Obesity contributes to high blood pressure and high cholesterol levels, which are risk factors for heart disease and stroke.
 Type 2 diabetes. Obesity can affect the way your body uses insulin to control blood sugar levels, contributing to non-insulin-dependent diabetes.
 Certain cancers. Obesity can increase the risk of cancer in many organs.
 Shortness of breath. Obese people are more likely to experience sleep apnea.
 Osteoarthritis. Obesity puts stress on the joints, increasing the risk of osteoarthritis.

Prevention of weight regain after obesity treatment

  • Weight regain after obesity treatment is a common occurrence. This is especially true for those who lost weight through invasive methods or medication, but without changing their lifestyle and habits.
  • Regular physical exercise
  • One of the best ways to prevent regaining the weight you’ve lost is to exercise regularly. 45 to 60 minutes a day is a good and healthy habit that should be maintained even after treatment is completed.
  • Healthy and balanced diet
  • Combining a healthier diet with a regular exercise program is the best way to maintain the weight you’ve lost long-term.
  • Good mental health
  • Surround yourself with supportive people and be sure to seek help if you experience feelings of stress or sadness.


Visit to the doctor’s


The visit to the hospital includes:


• Detailed analysis of the person’s obesity characteristics (profile) and metabolic complications by the entire scientific team
• Complete metabolic and hormonal control
• Gradual and safe weight loss on a weekly basis with the ultimate goal of long-term maintenance
• In selected cases, referral for specialized surgical treatment of the problem

What is Bariatric Surgery?


Bariatric Surgery i
s a specialty of surgery that includes a variety of weight loss surgeries. Bariatric Surgery is for morbidly obese people who have exhausted their attempts and choices to lose weight through other methods, such as lifestyle and diet changes, exercise or medication, or who simply wish to lose weight through surgery in the first place. The basic principle of Bariatric Surgery is to reduce the size of the stomach, which is achieved in various ways.
 

What is morbid obesity?


Obesity is a disease that affects approximately 30% of the general population. In other words, about one in three people are either overweight or obese. That is why, after all, it has been declared by the World Health Organization as the epidemic of the 21st century. Obesity can be hereditary, as it has a strong genetic basis, or it can be related to environmental conditions and lifestyle and diet. This will be investigated by the doctor in charge.

Why is it classified as a disease?


Being overweight condemns people to physical pain, serious health problems and social isolation. Some of the problems associated with obesity are the following:

  • Diabetes
  • Hypertension
  • Hyperlipidemia
  • Coronary artery disease
  • Hormonal disorders
  • Infertility
  • Apnea during sleep
  • Musculoskeletal algae
  • Depression

In addition, obesity has been found to significantly increase the risk of neoplasms, such as colon or prostate cancer. For all these reasons, the WHO classifies it as a disease and recommends its early treatment.

Modern treatment of obesity


Obesity can be treated with diet, in combination with physical exercise, with the help of pharmaceutical preparations or with the help of surgery. Surgery today offers a solution to obese patients who have failed to lose their excess body weight despite repeated attempts at dieting.

Who is obesity surgery for?
The terms overweight and obese describe gradations of body weight greater than ideal for a given height. What determines the “size” of obesity is the body mass index (BMI), a number that relates body weight to height.
BMI= Body Weight (Kg) / Height (m)²
Therefore, based on the BMI, patients who need surgical treatment of their obesity are those who have a BMI > 40 (or > 35 and some accompanying diseases, such as diabetes mellitus or hypertension).

Types of bariatric surgery
Bariatric surgeries are divided into two major categories.


Surgeries that simply limit stomach capacity:

  • Gastric ring
  • Long gastrectomy
  • Gastric fold
  • Short helix gastric bypass

Surgical operations that combine a reduction in gastric capacity and malabsorption of food:

  • Long helix gastric bypass
  • Biliopancreatic diversion.

The adjustable gastric band is an operation to limit gastric capacity. The ring can be adjusted over time by adjusting the diameter of the inner orifice accordingly. The operation is performed laparoscopically and the hospitalization lasts up to one day. In most cases, the patient can be discharged a few hours after the operation.
Post-operatively, follow-up by a dietitian is needed, as well as adjustment of the ring according to weight loss.

Birmingham stitch technique
At St Luke’s Hospital, the Birmingham stitch technique is used for the application of the ring. This is a special technique of fixing the gastric ring, by creating a form of folding of the stomach around it. In this way, the risk of slippage, which is the most frequent complication of the method, is almost eliminated.


Long gastrectomy
It is a relatively new technique, with approximately 85% of the stomach removed, as a result of which it takes the shape of an elongated tube or sleeve. The additional advantage of the method is that it removes the dome of the stomach, which is the body’s main source of ghrelin. Ghrelin is the messenger that the stomach sends to the brain’s hypothalamus to let it know it’s hungry. So, by eliminating the sending of the hunger message, appetite is significantly reduced.
The operation is performed laparoscopically and the patient is admitted as inpatient on the morning of the operation. After the pre-operative check-up, the operation is performed laparoscopically. They are fed the next morning and discharged a few hours later.


Gastric bypass
It is primarily an operation to limit gastric capacity and less of a malabsorption operation, whereby food bypasses most of the stomach, duodenum and part of the small intestine. This results in excellent regulation of diabetes mellitus type II, due to the fact that the food does not stimulate the secretion of hormones associated with insulin resistance.
The operation is also performed laparoscopically. Postoperative hospitalization is one day. Gastric bypass patients need post-operative monitoring by their treating physician to avoid vitamin, iron or calcium deficiency problems.

 

Gastric fold
Laparoscopic gastric bypass is a new technique for the treatment of obesity based on limiting the capacity of the stomach. The operation is performed laparoscopically and the postoperative hospitalization is one day. The advantage of the method over the classic longitudinal gastrectomy is that:

  • It is reversible
  • It avoids all the complications associated with a long suture cross-section
  • It has a limited cost because it requires minimal consumables

Its disadvantage compared to longitudinal gastrectomy is that it does not limit appetite, since it does not affect the concentration of ghrelin.

Which surgery is best for you?


All bariatric procedures, if performed correctly by an experienced surgeon, are safe and effective. The most important thing for choosing the most suitable method is the correct and objective information of the patient:

  • For the advantages and disadvantages of each
  • For the expected result (weight loss, regulation of metabolic disorders)
  • For their lifestyle and diet after surgery

It is important therefore that the specialized bariatric surgeon is able to perform all the operations and not try to direct the patient towards the type of operation he is performing. The specialized obesity team, taking into account the medical history, clinical examination, eating habits and psychological profile of each patient, will recommend the most appropriate operation in each case.

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