Solving Problems of Obesity

The FINANCIAL — “According to recent statistics 70,000 individuals, which is roughly 4-5% of the population, face the problem of obesity in Georgia,” said Nikoloz Gvakharia, doctor-surgeon at Kuzanov Clinic.

Obesity has become a major problem globally especially in recent years. In Georgia the problem is also growing.

As research shows the death rate is 12 times more among fat individuals between the ages of 25-35 compared to slim individuals of the same age. Between the ages of 35-45 the figure is 6 times more. An increase of mass by even 0.4 kilograms increases the risk of death by 2% in individuals between the ages of 50-62.

“Obesity is a cause of many diseases such as type 2 diabetes, the dysfunction of heart and circulatory systems, arterial pressure, impotence and barrenness, and increases the rate of cancer fourfold,” said Gvakharia.

“When we started implementing operations concerning obesity at Kuzanov Clinic, cases were quite rare, only 4-5 patients applied annually. However, currently on average 3-4 patients visit our clinic per week with this problem,” Gvakharia declared.

“There are several reasons for such an increase in obesity. Firstly, modern life has brought with it a culture of fast-food – Khachapuri as well as Shaurma and other fatty meals are available at kiosks throughout the city. More of the population now eats unhealthy and high-in-calorie products, and drinks sweet beverages – Georgian lemonade, Coca-cola and Pepsi for example. Moreover, the average person’s dependence on their computer, mobile phone and TV means they are sitting for most of the day. All these factors lead to obesity which itself is a reason for many other diseases,” said Professor Iva Kuzanov, Kuzanov Clinic.

There are several ways to solve problems with obesity. If one does not want to face problems of obesity Professor Kuzanov’s advice is to eat small portions three times a day, eat healthy products and include more fruit and vegetables in one’s diet, to leave the city for the countryside over the weekend and what’s important – be physically active, briskly walk at least 6 kilometers per day.

However, if one still faces the problem of obesity even after taking in to consideration changes to their daily life and diet, there are several methods of curing it.

According to Gvakharia surgery is needed when the body mass index of an individual is more than 33, which is when an individual weighs 40 kilos more than his normal weight.

“If the individual has developed type 2 diabetes and has high blood pressure then surgery is necessary. The research showed that bariatric surgery is a cure for type 2 diabetes in more than 90% of cases,” said Gvakharia.  

Body Mass Index (BMI) is the formula that doctors use to estimate how much body fat a person has based on his/her weight and height. The calculation of one’s BMI is quite simple: divide your weight in kilograms by the square of your height in meters.

Check the result: underweight = <18.5, normal weight = 18.5-24.9, overweight = 25-29.9, obesity = BMI of 30 or greater.

According to Gvakharia if the BMI index exceeds 33 there is serious need for bariatric surgery to be done.

Modern bariatric surgery involves five different operations: intragastric balloon, stomach laparoscopy, sleeve gastrectomy, gastronic and biliopancreatic surgery. 

Approximately 100 bariatric operations have already been done at Kuzanov Clinic, out of which 44 were for an intragastric balloon, and 54 involving the other methods of surgery, out of which 36 operations were done by Sleeve method.

The price of such an operation is on average 12,000 GEL at Kuzanov Clinic.

There are many specialists involved in preparing and operating on a patient. As a rule, before an operation can go ahead the individual has to be viewed by several specialists such as a cardiologist, therapist, endocrinologist, endoscopist, and psychologist.

One way of losing weight is with an intragastric balloon, when a balloon is inserted into the stomach and forms part of it. This type of approach is usually used with patients whose normal weight is only exceeded by 30 kilos. The balloon has a short-term affect and should be taken out of the stomach after six months.

“An intragastric balloon is inserted in several cases: for the individual to eat less, also for severely obese patients to lose 7-8 kilos before another operation, and from an aesthetic point when an individual wants to lose 10-15 kilos. However, the balloon has a short term affect and practice shows that in more than 80% of cases the individual returns to their old weight,” Gvakharia declared.

The stomach laparoscopy operation is usually conducted on individuals who are 30-70 kilos overweight. With the regulated ring the stomach is divided in to two parts, one small one big. In the small part, whose capacity does not exceed 15 ml, food is accumulated, which with the help of the regulated ring slowly moves to the large part of the stomach. Consequently, the individual needs only 30 grams of food to feel full.

“If the patient does not follow the rules and eats more than 30 grams, then eventually the stomach will take the form of an hourglass,” Gvakharia noted.

“Sleeve gastrectomy is used on patients whose weight exceeds the norm by 40-70 kilos. The surgery includes creation of a tube type stomach. 80% of the stomach is cut away which means that after the surgery the starvation hormone is produced less,” declared Gvakharia.

Gastronic and biliopancreatic surgeries are done on individuals 60 kilos past their normal weight as well as for patients who suffer from bulimia.

“The rehabilitation process depends on the conditions of the patient as well as on the type of operation done. Usually it takes approximately 3-4 days before the patient leaves the clinic. A necessary part of the recuperation period is that the patient should be on his feet and able to start gentle activity 3 days after the operation,” said Gvakharia. 

“However, the post-operative period of recuperation is more difficult when the individual has had biliopancreatic surgery. There are special inventories and attributes needed for overweight patients’ rehabilitation and the process takes more time,” Gvakharia added. 

The loss of weight depends on the type of operation done and the original weight of the patient. On average our obese patients lose 35 kilos in the first year. The weight loss continues for 5 years, however the majority of weight is lost over the first 2-3 years.

“If a patient has had surgery, he should have special treatment for the rest of his life, medicine such as calcium salts, multivitamins, and iron supplements. Calcium should be taken for the rest of the patient’s life, the rest seasonally or according to prescription,” Gvakharia said.

After the initial operation to lose weight, there are other steps in shaping the body involving plastic surgery, and getting rid of extra skin.

“Liposuction is quite a popular operation at the clinic, mainly done on the thigh area.  Liposuction is a brilliant method of contour plastics; the operation is not done to lose weight but rather to reach a desired body shape. Liposuction can be done wherever an individual likes, including the breast, hand, and hips,” said Kuzanov.

“Surgery is also often done post-pregnancy, when the abdomen has been stretched and fat stored in that area. In such cases we do liposuction and abdominal plastic surgery together. The fat is removed and the abdomen shaped,” declared Kuzanov.

“As well as the fact that liposuction is a brilliant method of contour plastics in some cases it even removes 6-8 liters of fat, so you do not lose weight but have reduced the amount of fat,” Kuzanov added.