Obesity is a major health problem worldwide and has reached an epidemic proportion in the western and eastern society. Evidence continues to accumulate that obesity is a major risk factor for many diseases and is associated with significant morbidity and mortality.

The most widely accepted measure of obesity is the body mass index (BMI). This number is calculated by dividing a patient’s mass (kg) by his or her height (m2).

A normal BMI is considered in the range of 18.5-24.9 kg/m2.

A BMI of 25-29.9 kg/m2 is considered overweight.

A BMI of 30 kg/m2 or higher is classified as obese; this classification is further subdivided into class I, II, or III obesity.

Considering other factors (eg, total muscle mass, waist circumference) besides the BMI may be important. For example, an extremely muscular individual may have an elevated BMI without being considered overweight. Waist circumference has been shown to be an excellent indicator of abdominal fat mass. A circumference of greater than 88 cm (35 in.) in women or greater than 102 cm (40 in.) in men strongly correlates with an increased risk of obesity-related disease.

Bariatric surgery or Gastric Bypass Surgery is currently the only modality that provides a significant, sustained weight loss for morbidly obese patients, with resultant improvement in obesity-related comorbidities.

 Etiology

Obesity is a complex, multifactorial chronic disease influenced by the interaction of several factors, such as genetic, endocrine, metabolic, environmental (social and cultural), behavioral, and psychological components. The basic mechanism involves energy intake that exceeds energy output.

Epidemiology:

The number of overweight individuals in the world is estimated at 1.7 billion. In the United States, the problem is at epidemic proportions. As much as two-thirds of the population in the United States are overweight, and half of the people in this group can be classified as obese.

 Bariatric Surgeries

One of the treatments for obesity is a surgery that is usually performed by laparoscopic techniques. People with BMI between 25 and 30 need no surgery and will return to ideal weight with a proper diet and exercise. Some people with BMI above 30 and most above 35, are allowed to laparoscopic and endoscopic procedures. Failure to follow a healthy lifestyle or inherit obesity will have unavoidable risks, and this will have a profound effect on patients’ physical health. Pressure from body mass to sensitive bones such as the knee and ankle can make walking difficult for these patients and even disable them. After overweight exceeds a certain level in these patients, diet and regular exercise may no longer be effective and patients should try other ways to lose weight. The problems that this disease has for people are divided into physical and mental categories. Apart from diabetes, hypertension and heart disease, most overweight/Obese people are also at risk for bone diseases and knee/ankle arthrosis. Apart from this, various mental illnesses also threaten these people. Diseases such as depression and mental distress completely threaten these patients and may even affect their social relationships. Some patients with a special diet and exercise achieve proper physical health, but for others, the only way to treat obesity is through obesity surgery. Obesity surgeries can work by eliminating 50 to 60 percent of patients’ weight by doing their best for only six months. Of course, this is only possible with a special diet and constant exercise after each surgery. Other benefits of obesity surgery include many improvements in diseases such as type 2 diabetes and hypertension. These surgeries give individuals the ability to control these diseases by applying specific changes in the physiological structure of the stomach and intestine and they can minimize drug used related to their overweight. These surgeries can help these people gain confidence, influence their social relationships and make significant changes in their lives. Obesity can result in lots of diseases like cardiovascular, type 2 diabetes, severe pain in back, kinds of cancer and losing life expectancy. Bariatric surgeries include some cure for losing weight and there are several kinds of it.

These surgeries may perform in two ways:

Type 1: Decrease the size of the stomach. Moreover, you can strict and reduce the amount of food that makes you feel full.

Type 2: This type accompanied by shortening or bypassing the intestine to decrease the amount of food or calories absorption.

One of the most frequent Types of bariatric surgery is given as following:

• Gastric Bypass

This type of bariatric surgery depends on reducing calories absorption by creating some changes in small intestine and stomach. After the surgery, the food you eat won’t meet some part of your stomach and small intestine that absorb calories and you pass on a number of calories. You should be in general anesthesia. In a gastric bypass, your stomach also gets smaller. Actually it will be divided into two parts; one small part and another will be larger. And the food you eat goes and fills the small top part. In this very small part of your stomach can be placed just 28 gr food, so you feel full soon and it makes you lose weight. The second action is the bypass. Bypass means that the specialist joins that upper smaller part of your stomach to a part of your small intestine and this procedure make your body absorb fewer calories. The whole of this surgery takes 2-4 hours.

Gastric bypass can be performed in two ways: open surgery that is accompanied by a big incision in your abdomen or laparoscopically way that uses a camera (called laparoscope) that is placed in your abdomen and shows staffs under your skin. The benefits of laparoscopy are low risk of infection, less recovery and hospitalized time, fewer scars and etc.

Gastric Bypass Surgery

• Surgery time: On average from one and a half to two hours.
• Hospital stays: Normally three days.
• Recovery time: About two weeks. Since the surgery is done laparoscopically, recovery time is much shorter. Depending on your job, you will be able to return to work in as soon as one or two weeks (desk job) or two to four weeks (if your job requires certain physical activities). You will have a restriction of not lifting more than 10 pounds for a month and a half after the surgery.

 Suitable candidates for gastric bypass surgery:

• People who are prone to gastric bypass surgery are as follows:
• People with a BMI> 30 and an acute medical condition who can benefit from the effects of weight loss (such as diabetes or high blood pressure).
• People with a BMI above 40 and no other medical problems.
• People who have health problems due to their obesity.
• People with mobility problems due to obesity.
• People who suffer from depression or low self-esteem due to obesity.
• People who do not have suitable weight for their major surgery.
• People who have tried diet and exercise and have not achieved the desired result.
• Those who want to commit to a new and healthier life.
• People who have a positive outlook on action.
• Those who have real goals for their surgery.

WEIGHT LOSS SURGERY IN IRAN: ALL YOU NEED TO KNOW

Weight loss surgery is a popular procedure in Iran. According to a report in 2017, more than 7000 bariatric surgeries are annually performed in the country. Iran is also a great destination for foreign people who want to get a safe and affordable bariatric surgery.

Having a bariatric surgery done in Iran has a lot of merits: highly-skilled surgeons, affordable costs, hospitable people, great places to visit, and so on. Since the safety and efficacy of a weight loss surgery is the most important factor, choosing a well-qualified surgeon is of the central importance.