Obesity is one of the most serious health problems of our age. Although all obese people want to lose weight, they have serious difficulties in deciding what to do due to the experiences they observe in their environment.
Unfortunately, since the health sector has entered into a product and service competition by standardizing everything, we encounter many unsuccessful results in obesity treatment. It is often ignored that each patient’s condition is unique and should be evaluated accordingly. Sleeve Gastrectomy, gastric balloon or gastric botox services are purchased like canned goods in the market by remote phone, text message or through sales representatives. Patients are often decided on OBESITY treatment without detailed examination and questioning by the physician, without evaluating laboratory results and without performing an endoscopy. The person who will perform this procedure (General Practitioner, Specialist Physician, Associate Professor or Professor or, even worse, none of these) is often not questioned. It is not taken into consideration whether they have had basic medical training and experience in these procedures in the past, and whether they have published their current experiences in an impartial, academic, peer-reviewed and prestigious journal (Because for a physician, the most important and most important reference is an academic publication).
Surgical techniques (Gastric Sleeve Surgery, By-Pass Surgery) and endoscopic techniques (Gastric Balloon, Gastric Botox) are frequently used in the treatment of obesity. In fact, when the right patient is selected and the applications are performed by experienced physicians, each technique is extremely successful. However, there are so many details that need to be considered when applying each technique that the possibility of encountering either bad results (reversible or irreversible), complications, or unsuccessful procedures that do not reach a result increases after the treatments that will be applied without knowing and/or taking them into consideration.
What are the main rules to consider before starting obesity treatment:
- Age of the patient
- Height, weight and body fat index
- Gender
- How many years has he been obese and at his current weight?
- Knowing the weight loss methods and diets used in the past, if any.
- Thyroid hormone values
- Blood sugar (hunger and fullness)
- Insulin resistance
- HbA1c value (blood sugar index of the last 6 months)
- Whether or not he/she has had digestive system surgery in the past
- Psychological background of the patient
- Social environment in which he lives
- Microbial structure of the digestive system
- Whether pregnant or breastfeeding
- Whether there is any active bleeding, tumor or suspicious lesion in the endoscopic examination (Endoscopy is definitely necessary for this)
- Whether there is a dysfunction in the stomach outlet (pylorus) in the endoscopic examination
- Medicines used
- Job
- Working conditions
- Whether or not she is planning a pregnancy in the near future
Applying the obesity treatment that the patient desires without taking the above issues into consideration and without technical guidance from the physician does not always yield the desired results.
In daily practice, the dialogues we often have with patients are exactly like this: “Doctor, I want to have a gastric balloon, how much does it cost and in which hospital do you perform it?” When I am faced with this question, I answer frankly so as not to be rude. In fact, the patient asking this question is not aware of the issues that need to be examined that I mentioned above and will act according to the cheapest price that will be given to that person. However, we try to explain as many technical details as possible to suitable patients and when we explain them, the patients understand the mistake they made and understand that the right method should be decided together. In fact, when we decide together, the most correct, fastest and cheapest method emerges on its own. In this way, the patient loses the weight they target without difficulty, and as a result, both the patient and the doctor are happy. It will always be more correct for the patient to consider doctors as a reliable health consultant rather than a person who sells a product or service.
As in all treatments, the thing that determines success in OBESITY treatment can be summarized as TOTAL QUALITY. If you ask what total quality is; we can count the experience of the doctor, the experience of the auxiliary health personnel, the physical conditions of the health facility, the standardization of the materials used, etc.
In our clinical studies, we observed that if the structure called PYLORES, which controls the stomach outlet, is functional, the results are successful regardless of which obesity treatment is applied considering the patient’s condition. In other words, I can say that the most important technical secret in the success of all OBESITY treatments is whether the PYLORES function is taken into consideration .
We definitely evaluate the PYLORS function in all patients as a result of the endoscopic examination we perform, in addition to all other details. If the pylorus is functioning normally (fully closing / Normotonic), there is no problem in applying the selected treatment. However, if the pylorus is hypotonic (partially closing) or does not close at all (Atonic), we first perform endoscopic PYLORS REVISION in these patients, restore function to the pylorus, and then apply the obesity treatment that has been decided. When we do this, the results are seriously pleasing.
(Note: You can access our articles published in international medical journals on the importance of pyloric function in obesity treatment by clicking the links below)
https://link.springer.com/article/10.1007/s11695-020-04556-7
Assoc. Prof. Dr. Murat KANLIÖZ
General surgery specialist