1) METABOLIC SYNDROME
Metabolic syndrome (MetS) describes a metabolic dysfunction in which more than one risk factor is present, increasing the risk of developing diabetes and cardiovascular disease in the future. To make a diagnosis, at least three of the following criteria must be present.
a) Abdominal obesity: Waist circumference ≥102 cm in men and ≥88 cm in women
b) TG ≥ 150 mg/dl or receiving pharmacological treatment for elevated TG
c) HDL cholesterol: <50 mg/dl in women, <40 mg/dl in men, or taking pharmacological treatment because of low HDL
d) Having a blood pressure of ≥130/85 mmHg or taking anti-hypertensive therapy.
e) Fasting blood sugar ≥100 mg/dl or receiving treatment for high blood sugar.
2) TYPE 2 DIABETES
a) Type 2 DM has a very close relationship with obesity, and studies have reported that obesity plays a role in the etiology of more than 80% of type 2 diabetes cases. It is known that weight loss in obese patients reduces the risk of diabetes.
b) Treatment of type 2 DM is also specific and important if it is accompanied in obese cases. In obese patients with diabetes, 5-15% weight loss and significant improvement in glycemic parameters are observed.
c) Bariatric surgery may be recommended in cases with BMI ≥35 kg/m2, where lifestyle changes and antidiabetic treatment are not successful in terms of weight control and blood sugar regulation.
d) Bariatric surgery can be considered in patients with a BMI of 30-34.9 kg/m2, whose body weight and blood sugar control cannot be achieved with standard approaches.
3) DYSLIPIDEMIA
a) Dyslipidemia is one of the metabolic disorders frequently seen with obesity and its frequency increases in direct proportion to BMI.
b) The first cardiovascular (CV) risk factor to appear in young patients who gain weight is dyslipidemia.
c) High TG and LDL cholesterol, low HDL cholesterol and a Total cholesterol/HDL cholesterol ratio >5 are associated with an increased risk of cardiovascular disease (CVD).
d) Triglyceride >150 mg/dL indicates that the patient has insulin resistance and an increased CV risk.
e) In overweight or obese patients with dyslipidemia, at least 5-10% weight loss should be achieved with lifestyle changes. An average of 15 mg/dL decrease was observed in TG level with every 3 kg lost.
f) Cholesterol disorder, whose incidence was given as 40% before the operation, has been reported as 85% after at least 2 years after bariatric surgery.
4) HYPERTENSION
a) Weight gain causes blood pressure to rise. In the Framingham heart study, 26% of hypertensive men and 28% of women were found to be overweight or obese.
b) As obesity contributes to the development of hypertension, weight loss also has a serious lowering effect on blood pressure.
c) According to studies, there is a significant decrease in blood pressure as a result of bariatric surgery.
5) RELATIONSHIP OF CARDIOVASCULAR DISEASES AND DEATH
a) Polycystic Obesity has been found to be associated with decreased life expectancy and increased morbidity (problems related to obesity). The relationship between obesity and cardiovascular diseases has been studied for a long time. Studies have shown that obesity is effective on the development of atherosclerosis, symptomatic coronary artery disease, heart failure and atrial fibrillation (rhythm disorder).
b) In these cases, screening and effective treatment for other cardiovascular risk factors besides weight control is extremely important.
6) OBESITY AND POLYCYSTIC OVER SYNDROME RELATIONSHIP
a) Polycystic ovary syndrome (PCOS); It is the most common endocrine disorder in women of reproductive age accompanied by symptoms and signs related to reproductive, hormonal and metabolic systems.
b) The average of obesity in women with polycystic ovary syndrome is higher than the average of obesity in healthy women. About 30-75% of women with PCOS are overweight or obese.
c) If a woman with PCOS is overweight or obese, she is more likely to face reproductive and metabolic problems.
d) In selected cases with obesity and PCOS, improvement in symptoms and ovulation can be achieved with laparoscopic RYGB.
7) OBSTRUCTIVE SLEEP APNEA SYNDROME
a) Obstructive Sleep Apnea Syndrome (OSAS) is a syndrome characterized by repetitive partial or complete upper airway (URI) obstruction resulting in oxygen starvation during sleep.
b) OSAS is associated with an increased risk of developing cardiovascular diseases, metabolic diseases, insulin resistance and diabetes.
c) Obesity is the most important and modifiable risk factor for OSAS. It has been reported that a BMI of >29 kg/m2 increases the risk of OSAS 10 times.
d) A 10-15% reduction in weight reduces OSAS by 50%. Therefore, it is recommended to add weight loss programs to the treatment of all sleep apnea patients who are obese or overweight.
8) ASTHMA/REACTIVE AIRWAY DISEASE
a) Osteoarthritis All overweight or obese patients should be evaluated for asthma and allergic airway disease.
b) Ifsigns and symptoms suggest asthma and allergic airway disease, lung tests should be performed.
c) Allpatients with asthma should be evaluated for overweight or obesity.
9) JOINT DISEASES
a) Osteoarthritis is a common joint disease that causes pain and limitation of movement. Its prevalence is increasing for two reasons.
b) The first is the aging of the population, and the second is the significant increase in obesity, which is a well-defined risk factor for the development of osteoarthritis, in recent years.
c) Excessive body weight causes an increase in the load on weight-bearing joints such as knees, hips and spine, erosion of the cartilage structure, and degeneration of the joints.
d) All patients with osteoarthritis should be evaluated for overweight or obesity.
10) CANCER
The association between obesity and certain cancers has been well established. According to the International Agency for Research on Cancer Handbook Working Group, the 13 types of obesity-associated cancer include esophageal cancer, renal cell cancer, breast cancer (in postmenopausal or oophorectomized younger patients), gastric cardia cancer, colon cancer, rectal cancer, liver cancer, gallbladder cancer, pancreatic cancer, ovarian cancer, uterine cancer, thyroid cancer, and multiple myeloma. Obesity also increases the likelihood of worse oncologic outcomes.