The most commonly used measure in classifying obesity is the body mass index. Body mass index is obtained by dividing the weight in kilograms by the square of the height in meters. For example, the body mass index of a person who is 1.70 m tall and weighs 65 kg is calculated as 65 ÷ (1.72) = 22.5 kg/m2.

In the medical classification, those with a body mass index below 18.5 kg/m² are underweight, those with a body mass index between 18.5 and 25 kg/m² are normal weight, those with a body mass index between 25 and 30 kg/m² are overweight, those with a body mass index between 30 and 40 kg/m² are obese, and those with a body mass index between 40 and 40 kg/m² are overweight. Those whose weight is above kg/m² are called morbid obese. Obesity also:

degree (body mass index between 30 – 35 kg/m²)

degree (body mass index between 35 – 40 kg/m²)

It is also classified as degree (body mass index over 40 kg/m²).


Where in the body the fat tissue is collected is also very important. It is accepted that the fat accumulated around the belly is more dangerous than the fat accumulated in the hips and hips. For this reason, apple-shaped obese patients have a higher risk of heart disease, especially compared to pear-shaped obese patients.

However, there is an important point that should be noted. Once morbid obesity occurs, it is not possible to treat it with diet and exercise alone. Scientific studies reveal that even if morbidly obese patients can lose weight with diet and exercise, the majority of them unfortunately cannot lose weight permanently and the lost weight is regained. Currently, there is no drug treatment proven to be effective in the treatment of morbid obesity.

Surgical treatment of obesity is on the agenda for morbidly obese patients who cannot lose weight despite changes in lifestyle and eating habits, in other words, appropriate diet and exercise.

It has been scientifically clearly established which patients will benefit from morbid obesity surgeries and who should and should not undergo these surgeries. Patients with a body mass index over 40 kg/m2 constitute the most suitable patient group. Apart from this, those with a body mass index between 35-40 kg/m2 and diseases caused by obesity also benefit significantly from obesity surgery. In order to perform morbid obesity surgeries, which are serious surgical procedures, we also require patients to have tried dieting before. Of course, the characteristics we want are for the patient who is a candidate for surgery to be in a good mental state, to have a social and spiritual well-being to comply with the rules after the surgery, and to be motivated for this surgery.

It should be known that these surgeries are not plastic surgeries, but rather serious surgical procedures that carry a slight risk and some of which are irreversible. Our patients must be sure that their special conditions are evaluated correctly with scientific criteria.

What types of surgery are used in the treatment of morbid obesity?

We can divide the surgeries (Bariatric surgeries) performed in the surgical treatment of morbid obesity into two main types: 1) Restrictive surgeries, 2) Surgeries that are both restrictive and prevent the absorption of nutrients. While restrictive surgeries aim to reduce the amount of food consumed by the patient, malabsorption surgeries aim to lose weight by reducing the absorption of consumed nutrients. All of these surgeries are performed using the laparoscopic (closed) method.

There is also a non-surgical gastric balloon method in the treatment of obesity, which is passed through the esophagus and placed into the stomach by endoscopy. However, weight loss with this method is less than with surgical methods, and patients almost always return to their previous weight when the balloon is removed.

The most commonly used restrictive surgeries today are laparoscopic gastric banding, also known as gastric banding, and sleeve gastrectomy, also known as sleeve gastrectomy. In laparoscopic gastric band surgery, an inflatable adjustable prosthesis is placed around the stomach and the pressure of this prosthesis is adjusted with the help of a chamber placed under the skin on the abdominal wall. The aim of this surgery is to reduce the volume that the stomach can hold. The use of a foreign object and the fact that the patient sometimes requires frequent visits to the doctor to have the band swelling adjusted are important disadvantages. Depending on the tape used, side effects and complications, some of which may be life-threatening, may occur. The use of this surgery is decreasing all over the world. I personally do not use this method.

Laparoscopic sleeve gastrectomy surgery has recently gained popularity among surgeons. The aim of this surgery is to remove the large part of the stomach, which we call fundus and corpus, and turn the entire stomach into a thin tube. Thus, the patient becomes able to consume much less nutrients than before the surgery. One of the most important advantages is the decrease in the levels of the hunger hormone (Ghrelin) secreted from the removed part of the stomach. With the decrease in the hunger hormone, the patient begins to feel full much earlier after the surgery. This is an important factor contributing to decreased food intake after sleeve gastrectomy surgery. Another important advantage of laparoscopic gastric sleeve surgery is that it does not anatomically disrupt the continuity of the stomach - duodenum - small intestine. Moreover, it allows the addition of malabsorptive surgeries later, if necessary, in extremely obese patients.

The most commonly used malabsorption surgery is gastric bypass (Roux-en-Y bypass and mini gastric bypass) surgery. Apart from this, biliopancreatic diversion and duodenal switch surgery are also performed. The basic logic of all malabsorption surgeries is to reduce the amount of active use of the small intestine, that is, the amount of food passing through and being absorbed, in order to both restrict food consumption and prevent the absorption of consumed nutrients. These surgeries can have various different applications. All malabsorptive surgeries change the anatomy by disrupting the stomach - duodenum - small intestine continuity and are technically complex surgeries. After malabsorption surgeries, the patient usually needs to use long-term vitamin and trace element supplements.

Whether the patient needs obesity surgery and which surgery is the most appropriate option should be examined in detail by a General Surgeon and an Endocrinologist who specialize in these surgeries. In morbidly obese patients who undergo bariatric surgery, the problems caused by obesity are significantly eliminated in long-term follow-up. Figures 1 and 2 show the improvement rates in obesity-related health problems in male and female patients.

It is not right to talk about a clear age limit. It is necessary to make a separate decision for each patient, considering the patient's physiological age, underlying diseases, and the risks that surgery with general anesthesia may pose, rather than the chronological age. However, in general, we do not perform these surgeries very often on patients over the age of 65.

No way. This surgery is not suitable for people who have an underlying hormonal disease or who have gained weight during hormonal treatment and become obese, except in exceptional cases. Before performing this surgery on our patients, we want to make sure that there is no underlying hormonal disorder by performing an endocrinological evaluation.