Obesity:
Obesity is defined as having a body mass index (BMI) of 30 kg/m² or higher. BMI is a measure calculated based on an individual’s height and weight.

Obesity Surgery:
Obesity surgery, also known as bariatric surgery, refers to surgical procedures performed to assist individuals in losing weight, especially those who struggle to lose weight through methods like diet and exercise.

Types of Obesity Surgery:

1. Gastric Bypass Surgery: In this procedure, the stomach is transformed into a smaller tube, and a small portion of the small intestine is rerouted, reducing food intake and absorption.
2. Malabsorption Surgeries: These procedures involve removing a section of the small intestine to decrease the absorption of consumed foods. Examples include biliopancreatic diversion and jejunoileal bypass.
3. Combination Surgeries: These surgeries combine both gastric reduction and malabsorption techniques. Examples include gastric bypass and duodenal switch.
4. Endoscopic Obesity Surgery: Non-invasive procedures are used for patients not suitable for surgical methods. Procedures include endoscopic balloon, endoscopic sleeve gastroplasty, and endoscopic gastric bypass.

1. Gastric Reduction Surgeries:
a. Sleeve Gastrectomy: In this procedure, a large portion of the stomach is removed, transforming it into a smaller tube. It is less invasive compared to other gastric reduction procedures.
b. Gastric Bypass Surgery: The stomach is reduced to a smaller tube, and a small section of the small intestine is rerouted, reducing food intake and absorption.
c. Adjustable Gastric Band: A band is placed on the upper part of the stomach, creating a smaller pouch. It is less invasive than other procedures.

These surgeries are effective in alleviating health problems associated with obesity, such as hypertension, type 2 diabetes, sleep apnea, heart disease, asthma, and joint pains.

2. Malabsorption Surgeries:
a. Biliopancreatic Diversion: The lower part of the stomach is removed, and sections of the small intestine are cut. These cut sections are connected to the upper part of the intestines, reducing food digestion and absorption.
b. Jejunoileal Bypass: The stomach is transformed into a smaller tube, and sections of the small intestine are cut. These cut sections are connected to the middle part of the intestines, reducing food digestion and absorption.

Malabsorption surgeries are effective in weight loss but may lead to nutritional deficiencies. Patients may require vitamin and mineral supplements.

3. Combination Surgeries:
a. Gastric Bypass: The stomach is transformed into a smaller tube, and the upper part of the small intestine is connected to it, reducing food digestion and absorption.
b. Biliopancreatic Diversion with Duodenal Switch (BPD/DS): The stomach is transformed into a smaller tube, and sections of the small intestine are cut and connected to the middle part of the intestines.

Combination surgeries are more effective than individual procedures but come with higher risks. They are recommended for suitable candidates under careful evaluation by a bariatric surgeon.

4. Endoscopic Obesity Surgery:
a. Endoscopic procedures are non-invasive and use techniques like gastric reduction, gastric balloon, and small intestine transit devices to promote weight loss.

Endoscopic obesity surgery is less invasive and has a shorter recovery period but may be less effective compared to other methods.

B. Candidates for Obesity Surgery:

1. Criteria for Obesity Surgery:
To be eligible for obesity surgery, individuals must meet specific criteria:
a. Body Mass Index (BMI): Individuals with a BMI of 30 or higher are considered eligible.
b. Obesity-Related Health Issues: Presence of health problems related to obesity, such as hypertension, diabetes, sleep apnea, heart disease, and joint pain.
c. Ineffectiveness of Diet and Exercise: Failure to lose weight through diet and exercise.
d. Psychological Stability: Candidates should be psychologically stable, ready to adapt to post-surgery changes, and undergo a new lifestyle.
e. Age: Surgery is typically performed on individuals aged 18 and above.
f. Surgical Risks: Candidates should not pose a high risk for surgery due to medical conditions or other factors.

2. Preoperative Evaluation for Obesity Surgery:
The preoperative assessment includes:
a. BMI Calculation: Measurement of BMI to assess the degree of obesity.
b. Health Status: Evaluation of the individual’s health, medical history, family history, and current health conditions.
c. Age: Considering the age factor, although not the sole criterion.
d. Psychological Assessment: Evaluation of the candidate’s mental health and readiness for lifestyle changes.
e. Nutritional Assessment: Determination of nutritional status and the risk of deficiencies post-surgery.
f. Risk Assessment: Evaluation of surgical risks and potential complications.

C. Postoperative Care and Lifestyle Changes:

1. Postoperative Care:
a. Hospital Stay: The length of hospital stay varies depending on the type of surgery.
b. Dietary Changes: Gradual transition from liquids to solids with the guidance of a nutritionist.
c. Physical Activity: Encouraged as part of the recovery process.

2. Lifestyle Changes:
a. Dietary Modifications: Following a balanced and nutrient-rich diet to support weight loss and prevent nutritional deficiencies.
b. Regular Exercise: Incorporating regular physical activity into daily routines.
c. Behavioral Changes: Adopting healthy behaviors to maintain long-term weight loss.

D. Risks and Complications:

1. Common Risks:
a. Infection: Risk of infection at the incision site.
b. Bleeding: Possibility of bleeding during or after surgery.
c. Blood Clots: Formation of blood clots, especially in the legs.

2. Long-Term Complications:
a. Nutritional Deficiencies: Malabsorption surgeries may lead to deficiencies in vitamins and minerals.
b. Dumping Syndrome: Rapid emptying of stomach contents into the small intestine, causing nausea and weakness.
c. Gastrointestinal Issues: Changes in bowel habits, including diarrhea or constipation.

3. Follow-Up Care:
a. Regular Monitoring: Follow-up appointments with the bariatric team for ongoing monitoring of health and weight loss progress.
b. Nutritional Supplements: Taking prescribed nutritional supplements to prevent deficiencies.

E. Success and Effectiveness:

1. Weight Loss Success:
a. Significant Weight Reduction: Patients often experience substantial weight loss within the first year post-surgery.
b. Improvement in Obesity-Related Health Issues: Positive impact on conditions such as diabetes, hypertension, and sleep apnea.

2. Factors Affecting Success:
a. Patient Compliance: Adherence to postoperative guidelines and lifestyle changes.
b. Type of Surgery: Different procedures yield varying levels of weight loss.
c. Individual Variability: Response to surgery varies among individuals.

F. Conclusion:

Obesity surgery is an effective option for individuals struggling with severe obesity and related health issues. However, it is crucial to undergo a thorough evaluation, choose the most suitable procedure, and commit to postoperative care and lifestyle changes. The success of obesity surgery depends on various factors, including patient compliance, the type of surgery, and individual variability. Regular follow-up care is essential to monitor progress and address any complications.