Multidisciplinary Approach for Patients at Medistate Obesity Center

At the Medistate Obesity Center, after the causes leading to the patient's obesity are identified, different medical units work together to determine the treatment method. At the same time, in this system, which is also called a multidisciplinary approach, specialty areas such as endocrinology and metabolic diseases, nutrition and diet, obesity surgery, physical therapy and rehabilitation, psychology evaluate the patient and the treatment process is shaped.

Obesity is defined as excessive fat storage in the body. As this problem increases, it brings about numerous diseases ranging from respiratory failure to heart problems. To determine whether a person is obese, the Body Mass Index is checked. The value obtained by dividing the square of the neck length in meters by the weight represents the Body Mass Index. Body fat percentage exceeding 25% in men and 30% in women is associated with obesity.

Individuals require daily energy intake that varies depending on age, gender, occupation, genetic and physiological characteristics, and health status. Maintaining a balance between the energy taken in and the energy expended is of great importance for having a healthy body.

When the daily energy intake exceeds the energy expended, it leads to fat storage in the body and causes obesity. Ultimately, this negatively affects quality and duration of life, putting public health at serious risk. Additionally, the burden on insurance systems is increasing day by day.

Personalized Treatment Methods Are Preferred at Medistate Obesity Center

In the treatment of obesity, identifying and eliminating the factors that cause the disease is essential to achieve successful results. Otherwise, the lost weight is quickly regained and the problems recur. In the treatment of obesity, a 10% reduction in body weight over a 6-month period makes a significant contribution to preventing other problems caused by the disease. However, as long as the underlying causes of the disease are not addressed, patients regain the weight they lost and sustainable improvement cannot be achieved. At the Medistate Obesity Center, after identifying the reasons that led to the patient's obesity, different medical units work together to determine the treatment method. In this system, also referred to as the multidisciplinary approach, specialist fields such as Endocrinology and Metabolic Diseases, Nutrition and Diet, Bariatric Surgery, Physical Therapy and Rehabilitation, and Psychology evaluate the patient and the treatment plan is formulated.

The Role of Endocrinology and Metabolism Diseases in the Treatment of Obesity

Apart from eating disorders and sedentary lifestyle, there are many endocrine disorders that cause obesity. Therefore, endocrine evaluation of obese individuals constitutes the first step in the treatment process. Basically, the earlier the fight against obesity begins, the more permanent the results are. Cushing's Syndrome, hypothyroidism, insulin resistance, Polycystic Ovary Syndrome, other genetic syndromes, and certain hormones secreted can cause obesity. Additionally, certain metabolic disorders can make it difficult for patients to adhere to a healthy diet program. For all these reasons, endocrinological evaluation constitutes the first step in the treatment of obesity. After the patient is endocrinologically evaluated, pharmacological treatments are prescribed. Following this process, a dietary program is planned by a nutrition and diet specialist based on the patient's test results, body measurements, hormonal profile, and existing medical conditions. For patients who apply to the Medistate Obesity Center, a surgical risk and benefit assessment is also conducted, and the convened committee determines the most appropriate treatment plan.

The Essential Element of the Obesity Fight: Proper Nutrition and Diet

Another important pillar of obesity treatment is proper nutrition and diet. Before determining a diet program by a Nutrition and Diet Specialist, patients' eating habits are reviewed in detail; a body analysis is performed to determine the amount of fat, muscle, and water in the body, and the body's metabolic rate is assessed. Based on these obtained data, along with age, gender, physical activity level, and blood test results, a personalized nutrition program is prepared.Additionally, when bariatric surgery is planned for patients, a special diet program is implemented both before and after the surgery to contribute to more successful outcomes.s.

It Is Necessary For The Patient To Trust Himself And The Treatment

In addition to the physiological issues of obese patients, their social and psychological support also plays an important role in the success of the treatment program. Past unsuccessful diet and exercise attempts; social pressures at work, school, and in personal life; and the resulting lack of self-confidence are all cited as factors that complicate obesity treatment. In obesity treatment, the patient first needs to believe in themselves and the program. Therefore, social and psychological support is as important as other treatments in permanent weight management. At the Medistate Obesity Center, along with other disciplines, the patient's psychological and social motivation is ensured to achieve sustainable weight control.

Drug Therapy Is Not Sufficient on Its Own

Medications used for obesity prevention are never a standalone treatment method. They are only administered to patients as a complement to therapy.

Physical Therapy Makes Weight Control Permanent

In obesity, which requires an interdisciplinary treatment program, physical therapy provides significant benefits in addition to diet. During obesity rehabilitation, the patient is evaluated by a physical therapy and rehabilitation specialist, and then treatment is planned. Physical Therapy and Rehabilitation offers advantages such as weight loss for the patient, preservation of the musculoskeletal system, and prevention of joint diseases that obesity can cause. After the medical treatment of obesity is evaluated and planned by metabolic specialists and a treatment program is designed in conjunction with a dietitian, obesity rehabilitation is planned according to the patient's individual characteristics. While the patient is on the dietary program, a treatment program for the musculoskeletal system is organized in two phases: Phase I and Phase II. The Phase I program includes the period when the patient is passive and the treatment system is active. The Phase II period consists of exercises performed actively by the patient. Exercise programs are continued regularly in parallel with the patient's medical treatment.

When Is Bariatric Surgery Preferred?

For patients with a body mass index above 40 who cannot lose weight despite regular diet and exercise, surgery may be considered as a treatment method. Additionally, bariatric surgery is performed on patients with a body mass index between 35 and 40 who also have additional diseases such as obesity-related hypertension, diabetes, or sleep apnea. Bariatric surgeries enable patients not only to lose weight and achieve a more fit appearance, but also to get rid of life-threatening and organ-damaging blood values ​​such as hypertension, diabetes, high blood lipids, and high uric acid levels. In sleeve gastrectomy surgeries, some patients may regain the weight they lost over time due to their eating habits; however, after obesity surgery, it becomes more difficult for the patient to return to their previous weight. To prevent the regained weight from being regained, the patient must make the prescribed physical activities a part of their lifestyle. In order to prevent diabetes, it is extremely important not to regain the weight lost.

Conditions That Prevent Obesity Surgery Patients with serious psychiatric problems

Patients who cannot comply with post-operative treatment Patients with substance and alcohol addiction Patients with a condition that prevents them from receiving anesthesia.

Advantages of Obesity Surgery

Obese patients with hypertension problems experience significant improvements in blood pressure measurements after surgery. Between 60% and 70% of patients discontinue their blood pressure medications. In type 2 diabetes patients, there are significant improvements in blood sugar levels. More than half of the patients are able to discontinue their antidiabetic medications. Following the surgery, there is a marked reduction in the risk of heart disease. Sleep apnea problems that develop due to excess weight are improving. There is a decrease in respiratory system problems. Patients' quality of life improves.

Which Methods Are Used in Obesity Surgery?

Gastric Banding, Sleeve Gastrectomy, and Gastric Bypass methods are used in obesity surgery. Prior to the surgery, a dietary program is designed to reduce the patient's body fat ratio, preserve muscle tissue, and prepare the patient for the post-operative treatment.

Gastric Banding

Stomach band surgeries are performed using the laparoscopic method. A small stomach pouch is created through a band placed 3-4 centimeters below the entrance of the stomach. The band is adjustable, allowing its tightness to be increased or decreased based on the patient's follow-up visits. To perform this adjustment procedure, a port is placed under the skin. Potential post-operative complications include band displacement, band erosion, swallowing difficulties, band damage, and port site problems.

Tube Stomach

Gastric sleeve surgery is the most preferred type of bariatric surgery. The surgery can be performed successfully using the laparoscopic method. A large portion of the stomach is removed, leaving approximately 25-30% of the stomach's total volume. During the surgery, the upper part of the stomach called the fundus is also removed. Therefore, the levels of ghrelin, the appetite hormone secreted from the gastric fundus, decrease, and patients find it easier to control their appetite after the surgery. Although there is a reduction in stomach capacity in this surgery, there is no impairment in stomach functions. In addition, the risk of stomach ulcers is reduced.

Gastric Bypass 

In gastric bypass surgery, a stomach pouch of approximately 25-30 cc is created at the stomach entrance, and a section of the small intestine located 100-150 cm away is connected to this pouch. This surgery restricts eating while reducing absorption. Gastric Bypass, which is a technically more challenging surgery, carries relatively higher risks and is an irreversible procedure. The long-term results are similar to those of sleeve gastrectomy; therefore, sleeve gastrectomy is slightly more preferred today.

Kaynakça:

• Endocrine Society. Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism. 2015;100(2):342–362.

• American Society for Metabolic and Bariatric Surgery. Metabolic and Bariatric Surgery Guidelines and Recommendations. 2022.

• International Federation for the Surgery of Obesity and Metabolic Disorders. Global Registry Report & Bariatric Surgery Guidelines. 2022.

• National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. NIH Publication.

• Turkish Obesity Surgery Association. Obesity Surgery Information Guide. 2021.