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Post Bariatric Surgery

Plato says there is only one ideal human, who is only in the realm of ideas. According to Plato; people living in this world somehow bear resemblance to that ideal human. These little differences constitute today’s world’s humans, whom we can enumerate; and enable us to name each human and define them as our fathers and uncles because of these differences. Although the faces, heights and weights of people bear resemblance to each other, they are not the same. We have not seen that ideal human, and we do not know to whom his face looks like, and what are his height and weight.

Goddess sculptures made between B.C. 25,000 and 6,000 persistently indicate gynoid type (pear-shaped) obese people. Moreover, they strongly accentuate them. Waist-hip ratio of all them is less than 0.8. It is obvious that people in that period saw women in this obese form ever since their birth, and carve the stones accordingly.

Human beings encountered many glacial periods (some of them lasted 1-to 1.5 years) up until now. Many of people could not survive long periods of scarcity and died during these glacial periods, while some others survived. And we, the people who live today, are the descendants of those survivors. Those who could survive long periods of scarcity were not humans with today’s ideal body sizes, and they were probably obese. Maybe each of us bears a so-called goddess and one or more of their genes related to obesity.

If we return again to this world and medical science; we do not correctly know what an ideal body weight should be. We have a fiction related to human shape that has been toughed to us in recent periods; and we have also a body mass index (BMI) that we invented by measuring the heights and weights of people who are close to this fiction. (Body mass index is calculated by dividing the individual’s weight by the square of his/her height.)

Body mass index (BMI) is used throughout the world for obesity; however, today this index has been ascertained not to adequately reflect the risk of early death behind obesity. You may ask why the system has not been replaced, and why this much simple shortage could not be solved up until now. Science does not abolish anything as long as you do not replace it with something better. But science is what is known lastly, and today a new health indicator has been formed to substitute body mass index, which reflects both obesity and the risk of death behind obesity, arising from fat accumulation in the internal organs. The name of this index is ABSI (A Body Shape Index). It is a health indicator that reflects both body mass index and premature deaths estimated based on the waist circumference; and is formulated as ABSI= Waist circumference (m) / weight of 2/3 (kg) x height 1/2 (m).

When the fact that people who began to live a sedentary life and eat excessively for any reason gained weight rapidly has been investigated; and as a result, it has attracted attention that those individuals had genetic characteristics different from that of individuals who did not gain weight. Genes that differ from others have been defined as candidate genes for obesity, and then it has been ascertained that the number of these genes are insuperably high. 228 candidate genes thought to control obesity have been mapped.

Obesity is a multifactorial disease, with genetic and environmental components. Even if there is a genetic predisposition, everyone knows that diet, physical activity and psychosocial phenomena are the environmental factors that determine whether obesity will appear.

You can say that ideal-weight, overweight and obese people are classified based on only their external appearance; and that the ideal measures are considered to be ideal not because they are really ideal measures, but because we have been told that. If you eat too much and move too little, the excess calories you have taken are now in the form of fat stored in your abdomen and buttocks, which are waiting for the days of famine. However, you cannot say the same for a morbid obese person, who cannot meet the requirements of his/her life, who cannot walk, work, go to the toilet, and carry out personal cleaning and maintenance processes without getting help.

In case the energy received on a daily basis is greater than the consumed energy, the amount of energy that cannot be consumed is stored as fat in the body, and leads to the formation of obesity. Concordantly, the advancements in today’s technology has facilitated the life, but on the other hand, they considerably limited the daily motions of people. The adipose tissue constitutes 15-18 % of the body weight of adult men and 20-25 % of t the body weight of adult women. In cases where this ratio exceeds 25% in men, and 30% in women, the condition is defined as obesity.

Obesity is a genetic based chronic disease that emerges with excessive fat increment (weight gain) and is triggered by environmental factors.

What are the types of obesity ?

It is classified in 2 types as Android-Apple type (male type) obesity and Gynoid-Pear type (female type) obesity.

Android-Apple Type (male type) obesity:

The type of obesity that involves fat accumulation inside the abdomen, in the waist, and around the abdomen, is called apple-type obesity. It is also called central obesity.

Among the disorders that can be seen in apple-type obesity, the ones that pose high risk include cardiovascular disorders, (heart attack caused by clog formation in the blood vessel, and other disorders that appear in association with the cloth formation in the blood vessels), Type II diabetes, hypertension, hyperlipidemia, steatohepatitis, high blood fat values, and stroke.

Gynoid-Pear Type Obesity (female type):

In pear-type obesity, fat accumulation gets denser in the hipline and buttock areas. In this type obesity, there is not an important risk of getting cardiovascular diseases or diabetes, as in apple type obesity. We can say that this type of obesity is more innocent; but nevertheless, they should be treated.
Obesity is currently responsible for 5% of the deaths in the world!

Although today we have not data showing individual differences clearly, there are detailed statistical data on overweight and obese people, which vary depending on countries. For example, the United States is an economically developed country, where people are accustomed to eat in large portions and eat too much. Whole population of the society is not obese or overweight. However, 63% of people are obese or overweight. This ratio is 25% in Japan, a country as rich as the US. More than 2.1 billion people in the world, i.e. 30% of the global population, are overweight or obese. In the declaration of the National Obesity Forum, this figure is foreseen to be half of the world’s population by 2030.

So, What Should be Done ?

In order to prevent obesity, we can provide simple solutions such as reducing the size of portions in fast foods and packaged foods, giving paternal training, teaching healthy
diet to schools and workplaces, adding more physical activity to activities in schools, and orienting people towards exercise.

How to treat obesity?

Obesity is treated with medications or surgery. In cases where medication is no longer sufficient, the patient should think about the surgery. Specialist general surgeons trained in the field of Bariatric Surgery should do surgery. Procedures carried out include intragastric balloons, gastric bands, and by-pass surgeries.

What is Post-Bariatric Surgery?

People who have lost a lot of weight will have a considerable amount of volume increase in the skin and subcutaneous tissue, muscle slackness, and a decrease in the skin elasticity. Despite the considerable decreas in these tissues after weight loss, the regional muscles cannot adequately shape the skin and subcutaneous adipose tissue. The elastic fibers of the expanded skin get separated from each other, and mostly create rebarbative deep cracks. Thus, a deformation of skin occurs due to fat accumulation, sagging skin, and slack muscles, which cannot be corrected with exercise or diet.

Besides loosening of the abdominal skin and muscles, also sagging/flattening of the buttocks, and loosening of the leg skin are common conditions observed after excessive weight gain and loss. In full body reshaping (Body-Lift) surgeries, the mons-pubis, buttock and side areas of the upper leg are lifted and the leg skin is stretched in addition to tummy tuck operation, through a circular incision that extends from the front to back, in such a way as to remain the scar in the bikini. With this surgical procedure that we call “Bodylifting”, the entire lower body is lifted in a single session.