WE NEED TO UNDERSTAND OBESE PEOPLE FIRST TO TREAT OBESITY
OBESITY IS NOT AN “END”, IT IS THE BEGINNING!
Surgery is the most preferred method in the treatment of obesity, and has been performed widely all over the world. Professor Yunus Yavuz M.D., a specialist on obesity and metabolic surgery, states that obesity is predominantly a psychological disorder and adds: “Surgery is not a magic wand that will solve all problems though. However, it is the beginning of a long journey.”
Interview: Kevser Devecioğlu
The prevalence of obesity and the ratio of obese population continue to increase every year worldwide. When it comes to obesity, we all instantly think of people who consume a lot of food and are overweight. However, obesity and metabolic surgery specialist Yunus Yavuz M.D. at the American Hospital points out that obesity is a complex disease which cannot be explained simply as overindulging in food; it is a lifelong illness that often has a very serious psychological background to it, and adds: “In order to really treat an obese person in a permanent way, it is necessary to understand them first.”
“Patients should feel that someone is thinking about them”
Prof. Yunus Yavuz, M.D. explains this by giving us little hints. Dr. Yavuz, who has been practicing “Bariatric Surgery”, one of the most frequently used methods in the treatment of obesity, for 25 years, says: “Obesity is calculated according to one’s body mass index. Although the surgical methods used in its treatment are now known to everyone, but nobody contemplates how an obese person will sit down and get up”.
When Doctor Yavuz started working in a hospital setting, his first task was to turn the seats in the waiting room into a long colorful seat with no armrests, which ran along the wall. The patient chair in his office is also a very large one without armrests. It is for one person or for three people. It works either way… “These people have been sitting in those chairs for years, trying to squeeze themselves into a ‘normal’ chair, which is embarrassing.” The story of an obese person starts right from there.” says Dr. Yavuz, who keeps a giant examination table in his office with a steel frame that can withstand 400-500 kilograms of weight in order to make patients feel comfortable.
The equipment he utilizes for examination, for example the blood pressure gauge, are also larger than normal. Equipment that have been chosen with the awareness that their bodies are larger, but are used without force or causing embarrassment. Dr. Yavuz points out that the careful selection of equipment and treatment of obese people also gives important clues to patients in choosing a hospital. Dr. Yavuz says “Everything starts from the seats in the waiting room. Patients should feel that someone cares about them. If you are take your job seriously, you should also pay attention to these details.”
Obesity occurs as a result of psychological traumas
Expressing that obesity is predominantly a psychological disorder, Professor Yunus Yavuz M.D. says that “Eating to get rid of the emotional problems or eating for relaxation and social reasons causes obesity. There are many psychological disorders underlying this condition. You can uncover these by conducting an in-depth diagnostic work up. Otherwise everything is bound to seem normal. Scientific publications today indicate that the incidence of psychological problems in this group is much more prevalent than in other patient groups.”
Obesity surgery is not a magic wand
Obese patients usually decide to get treatment either upon advice of a relative or by being influenced by the ‘before and after surgery’ photos they see online. “The adventure begins with this decision.” says Dr. Yavuz and lists the questions that need to be answered are as follows: “Is what I am doing right? Have I chosen the right surgeon or hospital? Does this treatment method work for everyone?”
Dr. Yavuz points out how patients tend to think of this procedure instead of finding answers the aforementioned questions: “I found the magic wand to solve all my problems in the world.” And he adds: “Imagine a person in the vortex. They cannot escape it while they keep getting heavier and becoming immobilized. The vortex pulls them down and the condition turns into a disease after reaching a certain weight. Surgery is a hand extended to take them out of the vortex. It’s just the beginning.”
Visit the Hospital Before Deciding
What are the criteria in taking the helping hand to escape this vortex? Dr. Yavuz notes that people mostly search for options on the internet, but they should avoid making decisions on the basis of social media ads and photos amidst all the info pollution, and turn to accurate sources for proper information instead. As he explains that setting off on a lifelong journey after making wrong choices in terms of surgeon and hospital, Dr. Yavuz reminds us that patients are entitled to visit a hospital and request detailed information on the procedure. He recommends paying attention to ‘corporate identity’ prior to deciding on a radical change in their bodies: “When they step into a hospital, they should pay attention to all the little details from the arrangement of waiting room seats, examination table and locations of restrooms to the medical equipment used. Has everything been arranged and selected with care? They should ask themselves all kinds of questions. Can the patient beds be inclined/reclined? Can I comfortably lie down on this examination table? Are the radiology units large enough to accommodate me? Is there a tomography machine in which I can fit? Does this hospital have an intensive care unit? Are the relevant staff members properly trained for emergencies etc.?”
Inquire about your doctor’s training in this field
Choosing your doctor is as important as choosing a hospital for a successful outcome. Noting that patients should inquire about their doctors in this process, Dr. Yavuz adds: “For example, if a doctor says that he has trained in America, patients should be able to ask ‘Can I see your board examination document? Could you please show me your certification to practice surgery in the USA?’”. They should be able to request to see such documents. It is important that the surgeon to perform this surgery has been specialized specifically in the field of obesity surgery. The doctor’s expertise on this subject, the background of the hospital on this matter gives important clues to the patient. Dr. Yavuz emphasizes that a doctor’s scientific publications, educational background and specific trainings can be checked in order to get an opinion about their level of expertise.
Not everyone can undergo surgery
A patient who decides to undergo obesity surgery has to go through various tests and examinations to see if they are eligible for surgery after choosing their surgeon and hospital. “Obesity surgery cannot be performed on everybody. You have to meet the criteria set by the World Health Organization as well as by endocrinology.” Dr. Yavuz describes the process they follow when a patient presents to American Hospital or Koç University Hospital, where he performs his surgeries: “We have multidisciplinary a council concerning this topic; a team that consists of physicians, surgeons and coordinators from all departments such as endocrinology, dietetics and nutrition, psychology, psychiatry, gastroenterology and cardiology. Each case is evaluated by them in line with the WHO criteria. For instance, we check if the patient has a risky comorbidity. We conduct the Scl-90 Psychological Symptom Screening Test and run through psychological criteria. We get to know the patient better through these tests. There is a decision process that lasts about 10 days. At the end of this process, we decide whether the patient is eligible for surgery or not. In general, at least 20% of patients turn out to be ineligible.”
Furthermore, well-structured diet-exercise programs and medical treatments must be attempted before proceeding with surgery. If these options fail, surgical intervention is considered, unless the patient suffers from severe psychological depression, substance abuse or any other severe condition. He emphasizes that surgery should not be performed without conducting a psychological evaluation first. “In the USA also, no clinic is allowed to perform obesity surgery without psychological evaluation.”
Lifelong postoperative follow-up
Unless a complication has occurred following surgery, a patient may return to their routine office work within about a week. The follow-up process begins prior to surgery. First off, a nutrition specialist makes dietary preparations and trains the patient as well as their family members on diet on postoperative day one. The patient has to see the dietitian every time they visit for a follow-up afterwards.
Usually, patients are discharged 3 days after surgery. They are requested to stay in İstanbul -the city where surgery takes place- for one week after the operation, so that they may be followed to address possible risks of complication. Once this first week has been left behind, they are required to visit for regular follow-ups scheduled for 3 months, 6 months and one year later, respectively. The interval between follow-up gradually increases the patient is eventually invited for 18-month and 24-month follow-ups. After 2 years, follow-ups become annual.
“While the patient loses weight in one year, this does not mean that everything has come to a close.” says Dr. Yunus Yavuz, “In case of failure to follow these patients, they might end up not losing enough weight or start regaining weight and fail. The worst thing that can happen in the long run is a surgery in vain. This happens in cases that are not followed well. Patients tend to replace addictions with others. After all, overeating is also an addiction. They can become addicted to sweets, alcohol and shopping. In this process, it is necessary to choose, manage and follow well. Otherwise, failure will be inevitable.”
Instagram is not a reliable reference!
Repeating once again that we should not consider obesity as a disease associated merely with weight problems, Dr. Yavuz points out that resolution of underlying psychological causes of overeating might result in the risk of is making a detour to the beginning and regaining weight. Selecting the right hospital and doctor -who can adequately follow a patient in the postoperative term- matter immensely when it comes to successfully concluding the process. Prof. Yunus Yavuz M.D. concludes with the following remarks: “Avoid making a choice without taking into consideration your doctor’s educational background, the hospital’s competence, how your condition is managed or how preoperative and postoperative processes are governed. By all means, avoid relying on Instagram as a reference point.”
Who is an “obese person”?
Body Mass Index (BMI) takes into account a person’s height and weight in order to determine obesity. Calculation is carried out by dividing the weight in kilograms by square of the height in meters. A person with a body mass index
(body mass index) value above 30 is considered obese, and a person above 40 is considered morbid obese.
We practice the same processes for international patients
Obesity and metabolic surgery specialist Dr. Yavuz states that not only patients residing in Turkey but also international patients are admitted for surgery and follow-up to American Hospital and Koç University Hospital in İstanbul. As described above, international patients also go through a multidisciplinary council evaluation and psychological screening, and the decision on surgery is made in accordance with the World Health Organization’s criteria. They are duly informed about postoperative process and asked to stay in İstanbul for at least one week for the initial follow-up. Dr. Yavuz stresses once again that surgery does not conclude everything, but on the contrary, everything begins with it. He adds that they constantly stay in touch with patients, and preoperative as well as postoperative follow-up can be easily arranged through the offices to be launched abroad, particularly in the UK.
World Health Organization 2018 – 2019 world obesity ranking
Cook Islands: 83%
Saudi Arabia: 34%
Operating as part of Koç Healthcare Institutions, American Hospital, Koç University Hospital, MedAmerican Ambulatory Care Center and Bodrum American Hospital are world-class non-profit hospitals that prioritize research and education. Our greatest advantage is our human resources of over 6.000 employees consisting of 1.135 physicians, 1.428 nurses and 3.484 administrative and supporting staff. In 2019, we treated approximately 580.000 patients at our healthcare institutions.