Who Can Have Gastric Sleeve Gastrectomy?

We frequently encounter the question 'To whom is sleeve gastrectomy surgery, also known as stomach reduction surgery, performed?' 'At what weight is sleeve gastrectomy surgery performed?' is the other form of the question.

We define obesity as the accumulation of fat tissue in the body above normal. Under normal conditions, the fat ratio in the human body should not exceed 32% in women and 26% in men.

Unfortunately, there is no device or method that accurately determines the body fat percentage. In this case, we use mathematics to calculate our body fat ratio approximately and use the body mass index (BMI) formula for obesity calculation.

Roughly, we can calculate our body mass index (BMI=Kg/m2) by dividing our weight by our height. Although it does not give accurate results in terms of estimating the proportion of body fat in those with excessive muscle mass, breastfeeding or pregnant women, the degrees of obesity are determined with this formula, also called body mass index:

• 18.5 and below Underweight
• 18.5 - 24.9 Normal Overweight
• 25-29.9 Overweight
• 30-34.9 1st Degree Obesity
• 35-39.9 . Grade 2 Obesity
• 40 and above. Grade 3 Obesity (Morbid Obesity)
• Those with a body mass index above 40 kg/m² (morbidly obese, i.e. severely obese).
• Patients with a BMI between 35-40 and extreme maria can also undergo surgery with the decision of the obesity doctor. Our health is at risk from first-degree obesity. If BMI is 40 and above, it is considered a disease that negatively affects the quality and duration of life and requires urgent treatment.
• In addition, surgery can be performed with the decision of the obesity doctor in patients with “new” type 2 diabetes and metabolic disorders due to obesity and with a BMI between 30 and 35.

Why does the increase in adipose tissue harm our body? Fat tissue, like our other organs, is made up of cells. The increase in fat in our body is not an increase in the number of fat cells, but rather the growth of these cells. Adipose tissue is also an endocrine organ, meaning that it sends certain substances into the bloodstream that affect all our other organs. When adipose tissue becomes excessive in our body, it releases excess fatty acids into the bloodstream and creates a chronic inflammation-like state. This can lead to insulin resistance initially and Type II diabetes in later years. 

According to a large study on how an increase in adipose tissue affects human health, involving nearly 900,000 adults, for every five units increase in body mass index above 25, the risk of death increases by 30%, regardless of age, with an average follow-up of eight years. According to the results of the same study, the risk of developing heart attack, diabetes and stroke also increases with an increase in body mass index. Another very interesting result of this study is that life expectancy is three years shorter even in individuals with first-degree obesity.

Obesity Surgery in First Degree Obesity

Well, since there is a shortening of life expectancy even in those with a body mass index between 30 and 35, that is, those with grade 1 obesity, perhaps we should revisit the decisions of the American National Institute of Health Consensus Conference in 1991. According to the decisions taken at this meeting, those with a body mass index of 40 and above and those with a body mass index of 35 and above with serious comorbidities were determined as suitable candidates for obesity surgery. These serious comorbidities include sleep apnea syndrome, serious lung disease, obesity-related heart disease, high blood pressure and diabetes. Even in the absence of these diseases, joint problems or body shape problems that would prevent employment were also listed among the reasons requiring surgical treatment.

Of course, today's increasing technology and laparoscopic surgery have greatly reduced the complication rates in surgeries. At the 1991 meeting, when it was decided that second and third degree obesity could be treated surgically, the benefit and harm ratios of those years were considered.  As we have mentioned before, due to today's increasing medical technology and decreasing complication rates, it has become necessary to reconsider the benefit and harm ratios. Since primary obesity shortens one's life expectancy by as much as three years, it cannot be ignored that it needs to be treated seriously. Obesity in the first degree also increases the rates of some other diseases that require continuous drug treatment and may lead to social isolation by reducing the quality of life of the person.

As a result, in today's conditions, obesity surgery is an option for patients with first degree obesity who cannot achieve permanent weight control with methods such as lifestyle change, diet and sports. Of course, the importance of performing bariatric surgery under appropriate conditions and by experienced teams increases even more at this point.