Obesity – it’s the disease of the century. It’s an epidemic that has been crippling society and the global economy, and it is one of the world's most devastating public health problems. With the global obese population eclipsing those underweight and nearly one in every three people now overweight, the world's health is deteriorating at alarming rates. On March 4, World Obesity Day is marked around the globe to bring awareness to this disabling disease. Despite the common belief that Turks are fit and enjoy a healthy diet thanks to Mediterranean cuisine culture, nowadays over 75% of the population is overweight, and this figure continues to rise.
Fueled by unhealthy eating habits and inactivity, the disease has not only been clearly linked to an increased risk of various types of cancers but also life-threatening illnesses such as diabetes and cardiovascular problems. Leading a sedentary life mostly spent glued to the TV or to our phones as well as consuming ready-made fast foods and sugar-added soft drinks are without a doubt among the most important factors behind the recent surge in obesity cases worldwide.
But is it possible to protect ourselves against this growing epidemic? Is it not just a choice or a lack of will? Are surgical options always the answer? The head of the Department of General Surgery at Maltepe University's Faculty of Medicine Association Dr. Uğur Deveci answers the 10 most frequently asked questions about obesity.
1 – Who is most at risk?
To determine whether someone is scientifically considered obese or not, one must first look at their body mass index (BMI) – a simple and widely used measure to gauge total body fat in adults based on height and weight. This figure is calculated by dividing a person’s weight in kilograms by the square of their height in meters (kg/m2).
According to this measure, those with a BMI under 18.5 are considered underweight, those with a BMI of 18.5 to 24.9 are normal or at a healthy weight, those with a BMI between 25 and 29.9 are overweight, and those above 30 are classified as obese. Deveci said that those with a BMI over 40 were morbidly obese (a severe form of being overweight that causes a dramatic reduction in life expectancy), making them candidates for weight-loss surgery, i.e. bariatric surgery such as gastric bypass or lap band surgery.
A person who is about 161 cm, the average height for a Turkish woman, is considered overweight at a weight of 75 kilos and severely obese above 105 kg. A person who is 172 cm, about the average height for men, is deemed obese at 92 kg and severely obese at 122 kg. (Important note, BMI is not the only indicator of health; athletes may not fit within the "healthy weight" range.)
2 – Are genes to blame?
You could be destined to be overweight if both of your parents were overweight, research shows. Deveci said parents with a healthy weight had about a 10% chance of having a child who is obese while this number skyrocketed to 80% when both parents were obese. Deveci said that although genetic factors played a major role in the development of obesity, environmental factors such as diet, lifestyle and culture were just as influential.
3 – Is tech the enemy within?
Although our comfort and quality of life have greatly improved with the advancement of technology, Deveci said that cars, elevators and online shopping have been so convenient and time-saving that there is actually very little reason to move or leave the house anymore, causing most of us to move less and less each day.
4 – Is fast food a contributor?
Deveci said the changes in food production and presentation in the last century have been causing people's metabolisms and metabolic balances to change.
"Individuals who get hungry frequently and quickly and eat fast food to curb that hunger will inevitably gain weight. The increase in the consumption of processed ready-made foods instead of natural homemade foods is contributing to obesity,” he said.
5 – Why the rise in child obesity?
Statistics show that one out of every four children in Western countries is overweight. And although you may think children are generally more active than adults in their daily lives, they tend to get more caught up in their technological devices such as phones, gaming consoles and TV, in turn reducing their daily movements.
Underscoring that people who spend a lot of time watching TV or on their phones or computers spend less energy overall – in other words, burn fewer calories – and this situation is especially true for children nowadays, Deveci said obesity rates in children and young adults are running parallel to those of older adults.
6 – Why is Glycemic Index (GI) so important?
The Glycemic Index (GI) is a scale that ranks the number of carbohydrates in food from 0 to 100, based on how slowly or quickly they cause spikes in blood glucose levels. Foods with a higher GI (70>) will be digested, absorbed and metabolized quicker and cause a faster and more sudden rise in blood glucose levels, triggering more insulin to be produced. While not all high GI foods are necessarily unhealthy, those who are diabetic or those watching their weight are advised to consume more low GI foods (<55) to help keep them fuller for longer and stave off hunger pangs.
Pointing out that over-consuming high GI foods is an important factor contributing to obesity in all age groups, Deveci said: “Such foods, especially soft drinks and bakery products, which cause excessive amounts of insulin to be released in the body, make you hungrier in a shorter period of time. Obesity is higher in economically developed countries than in developing countries. In developing countries, individuals have higher energy expenditures and they also consume more homemade foods due to economic reasons. Whereas in developed countries, high GI foods are consumed more often and individual energy expenditure is lower in the general population."
7 – Are obesity and cancer linked?
Underscoring obesity's already-established links with illnesses such as stroke, osteoarthritis, metabolic syndrome, diabetes, respiratory problems, sleep apnea, hyperlipidemia, and hip and knee joint problems, Deveci said obesity has also been proven to play a key role in coronary heart disease.
“There is a strong link between 'central obesity' (excess accumulation of fat in the abdomen) and hypertension. It is also known that obesity can dramatically increase cancer risk. According to the Turkish Public Health Association data, the number of cancers attributable to obesity in Turkey for the year 2014 was close to 6,000. It has also been proven that cancers associated with obesity affect women more, and that breast and uterine cancers, colon tumors and prostate cancer are more common in obese people. This risk decreases with weight loss," he said.
8 – How to go about treatment?
According to Deveci, patients should first be screened for any underlying causes that lead to obesity, as health issues such as hyperthyroid, insulin resistance and adrenal gland disorders could lead to overeating and cause uncontrolled weight gain.
“These possible causes should be treated if spotted and the patient’s diet and lifestyle should be adjusted accordingly. If there are no underlying disorders detected, diet and lifestyle adjustments are the first line of treatment. Drug treatments are usually reserved for more severe cases where BMI exceeds 27 and the patient has been unable to make adjustments. Still, the drugs alone will not solve the problems and will need to be used with proper adjustments to behavior, diet and activity levels," Deveci said.
9 – Is bariatric surgery risky?
Deveci said laparoscopic surgeries have proven successful in curing obesity.
Patients with a BMI of 35 or greater are eligible for bariatric surgery, with the patients' medical history also playing a role in the decision.
“It is not right to say surgery is the best treatment for obesity. The best treatment is the one that is determined based on the patient’s condition,” he said, adding that the decision for surgical treatment is taken by a board of doctors.
Stressing that such medical procedures should not be thought of as plastic surgery, Deveci said surgery is only considered the last resort for obesity-related conditions, adding that the changes in patients’ appearance are just a bonus that comes with it, helping them psychologically post-op.
10 – What to expect post-surgery?
Warning that surgical treatment is not just some magical solution as people tend to believe, Deveci urged persistence in lifestyle and dietary changes for the treatment to last. Deveci said it is a must for patients to continue exercising dietary discipline after surgery as failure to do so will revert the patient’s condition back to pre-surgery levels. He also said patients should be assisted by dieticians, obesity surgeons and experts on metabolism after surgery to ensure success.
If a patient sheds a lot of weight, he or she may have excess skin after surgery. That's where cosmetic surgeries come into play. About a year and a half after the weight loss, such aesthetic procedures can be performed so the patient can move comfortably and the body regains its standard form.