Obeziteye Genel Bakış
Özet
Dünya Sağlık Örgütü tarafından yüzyılın salgını olarak tanımlanan obezite, multifaktöriyel etiyolojiye sahip, anormal ve aşırı yağ birikimiyle karakterize karmaşık bir hastalıktır. Vücut kitle indeksi (VKİ), bel çevresi ve bel-kalça oranı gibi antropometrik ölçümler obezite sınıflamasında ve kardiyovasküler risklerin belirlenmesinde aktif olarak kullanılmaktadır. Önlenebilir ölümlerin sigaradan sonra ikinci en sık nedeni olan bu hastalık; genetik, kültürel, çevresel faktörler, fiziksel aktivite azlığı ve endokrin bozukluklar gibi pek çok nedenden kaynaklanmaktadır. Çok yönlü tedavi stratejileri gerektiren obezitenin yönetiminde; kalori açığı oluşturmayı hedefleyen sürdürülebilir beslenme programları ve metabolik fonksiyonları iyileştiren fiziksel aktiviteler temel basamakları oluşturur. Psikolojik destek ve bilişsel davranışçı terapiler hastaların yaşam tarzı değişikliklerine adaptasyonunu ve motivasyonunu artırırken, Türkiye'de onaylı liraglutid ve orlistat gibi farmakolojik tedaviler de diyete uyumu kolaylaştırmaktadır. Ameliyatsız endoskopik yöntemler arasında midede yer kaplayarak doygunluk sağlayan mide balonu ve mide boşalmasını geciktiren mide botoksu yer alır. İleri derece obezite vakalarında veya komorbid durumlarda ise altın standart olarak kabul edilen laparoskopik ayarlanabilir mide bandı, Roux-en-Y gastrik by-pass, sleeve gastrektomi ve duodenal switch gibi cerrahi müdahaleler uygulanarak kalori ve emilim kısıtlanması yoluyla kalıcı kilo kaybı hedeflenmektedir.
Obesity, defined as the epidemic of the century by the World Health Organization, is a complex disease characterized by abnormal and excessive fat accumulation with a multifactorial etiology. Anthropometric measurements such as body mass index (BMI), waist circumference, and waist-to-hip ratio are actively used in the classification of obesity and the determination of cardiovascular risks. This disease, which is the second most common cause of preventable deaths after smoking, stems from many factors such as genetic, cultural, environmental influences, lack of physical activity, and endocrine disorders. In the management of obesity, which requires multifaceted treatment strategies, sustainable nutrition programs aiming to create a caloric deficit and physical activities that improve metabolic functions constitute the fundamental steps. While psychological support and cognitive behavioral therapies increase patients' motivation and adaptation to lifestyle changes, pharmacological treatments approved in Turkey, such as liraglutide and orlistat, facilitate adherence to the diet. Non-surgical endoscopic methods include the intragastric balloon, which provides satiety by occupying space in the stomach, and gastric botox, which delays gastric emptying. In cases of advanced obesity or comorbid conditions, surgical interventions considered the gold standard, such as laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy, and duodenal switch, are performed to achieve permanent weight loss through caloric and absorption restriction.
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