Over the past few decades, obesity has transitioned from being a health concern to a full-blown epidemic, affecting billions of people worldwide. The consequences are far-reaching, encompassing not only the immediate health effects but also the broader implications for quality of life, healthcare expenditures, and societal well-being. It is no longer a challenge confined to a specific age group, as it affects children, adolescents, and adults alike. According to the World Health Organization (WHO), obesity has nearly tripled since 1975 and almost 2 billion adults are overweight of those over 650 million are obese. Therefore, the WHO called for immediate action by introducing in 2011 "WHO Global Strategy on Diet, Physical Activity and Health" calling all participant nations to make a national-level strategy to improve the diet and physical activity patterns of their citizens. The BIM (Body Mass Index) index is a numerical value calculated from a person's height and weight. It is used as a simple and quick method to categorize individuals into different weight categories, such as underweight, normal weight, overweight, or obese. In the BMI classification system, individuals falling into the "Overweight" category have a BMI ranging from 25 to 29.9. Moving beyond this, those classified as "Obese" have a BMI of 30 or higher, and this condition is associated with a higher level of excess body weight.


 
A patient who decides to consult a professional should keep in mind that obesity is a complex condition that goes beyond simple overeating. Patients dealing with obesity typically have a multifaceted condition influenced by genetics, metabolism, hormones, psychosocial factors, and even potential disruptions in the central nervous system. What's particularly challenging is that the underlying causes of this condition are not well understood and can vary from person to person, complicating traditional treatment approaches, which often yield limited success. There are various methods to achieve weight loss, including dietary changes, exercise, medications, and bariatric surgery. Among these, bariatric surgery has been demonstrated in numerous studies to be the most effective long-term solution for weight reduction, leading to improvements or even the complete resolution of associated health issues. 

Parallel to the introduction of techniques that are more effective and have less risk of complication, more and more people are resorting to bariatric surgery. The number of bariatric operations has increased from less than 10,000 operations in 1998 to nearly 200,000 operations per year and the number is still increasing each year. 

Why Bariatric Surgery in Turkey?

Turkey has become a popular destination for bariatric surgery for several reasons, making it a favorable choice for many individuals seeking weight loss procedures. Especially Istanbul become the center for health tourism. 70 percent of people coming to Turkey for bariatric surgery choose to have their operation in Istanbul.

High-Quality Healthcare Facilities: Turkey has invested significantly in its healthcare infrastructure, with many modern and well-equipped hospitals and clinics. Many of these facilities are accredited and staffed by highly trained medical professionals. 

Experienced Surgeons: Turkey has a pool of experienced bariatric surgeons who have performed a substantial number of weight loss surgeries. Many of them have received training and certifications from reputable international organizations. While the Average professor in Turkey is likely to perform more than 3000 surgeries in most European countries this number is less than 1000.

Cost-Effective: One of the most significant advantages of undergoing bariatric surgery in Turkey is the cost. The overall cost of bariatric surgery in Turkey is often significantly lower than in Western countries, including the United States and parts of Europe. This cost-effectiveness extends to not only the surgical procedure but also pre-operative and post-operative care, making it an attractive option for medical tourists. 

No Waiting Lists: In many countries with publicly funded healthcare systems, there can be long waiting lists for bariatric surgery through the national health service. In Turkey, private hospitals and clinics often offer more immediate access to surgery, which can be crucial for individuals who want to proceed with their weight loss journey promptly. 

Medical Tourism Infrastructure: Turkey has developed a robust medical tourism industry, providing support services such as transportation, accommodation, and translators to international patients. This makes the process more accessible and less stressful for patients traveling from abroad. 

Strategic Location: Istanbul's geographical location bridges Europe and Asia, making it easily accessible from many countries. Its well-connected airports and transportation
 
If these factors have attracted your attention, please feel free to fill out the form below to have more insight. 

How Much Bariatric Surgery Costs in Turkey?

The cost of bariatric surgery in Turkey can be substantially lower than in many Western countries. Prices may range from $2,500 to $9,000, depending on the type of surgery and the provider. Prices go above $5000 only in the hospitals that have 5-star hotels like luxury infrastructure. In comparison, this price is between €8,000 to €15,000 in Germany between £6,000 to £15,000 in England, and between $15,000 to $35,000 in the USA.

Types of Bariatric Surgery

There are various surgical approaches, which can be categorized into three main groups: restrictive procedures, malabsorptive procedures, and a combination of both. Restrictive procedures limit a patient's food intake without directly interfering with digestion. In contrast, malabsorptive procedures aid weight loss by disrupting the digestion process, resulting in poor food digestion and absorption. Some purely malabsorptive surgeries are no longer recommended due to their potential to cause nutritional deficiencies. All these procedures aim to reduce calorie intake. Bariatric surgeries can be performed either through open surgery or laparoscopic methods. Each type of bariatric procedure comes with its own set of advantages, disadvantages, and risks. It's essential to carefully consider the potential benefits and risks of each procedure to cater to individual patient needs and preferences. Consulting with other specialists to discuss surgical options and potential risks is advisable. Surgeons should have a thorough understanding of both past and current procedures.

Although many methods have been used some of them became outdated. There are three modern methods that are widely used and below you can check details and comparisons of each of them.

Adjustable Gastric Banding (Lap-Band)

Mechanism of Action: Lap-Band is purely restrictive. It involves placing an adjustable band around the upper part of the stomach to create a small pouch. The band can be tightened or loosened over time to control food intake. 

Weight Loss: Weight loss with a Lap-Band is typically slower and less dramatic compared to RYGB or sleeve gastrectomy. 

Effect on Comorbidities: While it can lead to improvements in comorbidities, the effects may be less pronounced than with RYGB or sleeve gastrectomy. 

Long-Term Outcomes: Long-term success depends on the patient's ability to adhere to dietary guidelines and follow-up visits for band adjustments. 

Potential Complications: Complications can include band slippage, erosion, and problems with the access port used for adjustments. Some patients may not achieve the desired weight loss. 

Reversibility: Lap-Band is reversible, and the band can be removed if needed. 

Sleeve Gastrectomy

Mechanism of Action: Sleeve gastrectomy is a restrictive procedure where a portion of the stomach (about 80%) is surgically removed, leaving a smaller, tube-like stomach. 

Weight Loss: It leads to significant weight loss, with patients typically losing around 60% to 70% of excess body weight. 

Effect on Comorbidities: Like RYGB, sleeve gastrectomy is effective in improving or resolving obesity-related comorbidities. 

Long-Term Outcomes: Long-term success is well-documented, and patients tend to maintain their weight loss over time. 

Potential Complications: Complications can include staple line leaks, strictures, and, although less common than with RYGB, potential nutritional deficiencies. 

Reversibility: Sleeve gastrectomy is not reversible because a portion of the stomach is permanently removed. 

Roux-en-Y Gastric Bypass (RYGB)


Mechanism of Action: RYGB combines both restriction and malabsorption. It creates a small pouch at the top of the stomach and reroutes the small intestine to connect to this pouch, limiting the amount of food that can be consumed and reducing nutrient absorption. 

Weight Loss: RYGB often results in significant weight loss, with patients typically losing around 60% to 70% of excess body weight.

Effect on Comorbidities: It is highly effective in resolving or improving obesity-related comorbidities such as type 2 diabetes, hypertension, and sleep apnea. 

Long-Term Outcomes: RYGB has shown good long-term weight maintenance and health improvement in many patients.

Potential Complications: Potential complications include dumping syndrome (nausea, sweating, and diarrhea after consuming certain foods), nutritional deficiencies (vitamin and mineral deficiencies), and gastrointestinal issues. 

Reversibility: While possible, reversal is complex and not commonly performed. 

It's important to note that bariatric surgery is not a quick fix, and it requires significant lifestyle changes, including dietary modifications and increased physical activity, to achieve and maintain successful weight loss. Consulting a dietitian is crucial after the surgery. Most of the surgeons in Turkey make a partnership with a dietitian and they include a certain period of diet consultancy to their prices. Other than dietitians, psychological consultancy also plays an important part, and it is suggested that a patient should consider psychological support both in the process of making a decision to have surgery and after the surgery. Get a FREE consultation from the best hospitals in Istanbul, just fill out the form and start your journey!

Diet Before Bariatric Surgery 

Before undergoing bariatric surgery, it is crucial to adhere to a specific preoperative dietary plan, commencing 14 days before the procedure. This pre-operative diet serves multiple purposes, including shrinking your liver size, preparing the body for surgery, and minimizing potential complications. Failure to comply with this dietary regimen could result in a more challenging operation. During this period, your diet should predominantly consist of clear liquids, such as water, broth, clear fruit juices without pulp, and sugar-free gelatin. It is imperative to avoid solid foods, as they can impede stomach emptying and heighten surgical risks. In some cases, your surgeon may recommend clear protein supplements to preserve muscle mass and ensure essential nutrient intake. Additionally, you will typically be instructed to fast from clear liquids several hours before the surgery.

 

Diet After Bariatric Surgery 

The postoperative diet plays a pivotal role in both short-term recovery and long-term success following bariatric surgery. While specific dietary guidelines can vary based on the surgical procedure and individual needs, some universal principles apply. Initially, in the immediate postoperative phase, patients are typically placed on a clear liquid diet, which includes water, broth, clear fruit juices without pulp, and sugar-free gelatin. This phase aims to maintain hydration while facilitating the healing of the surgical site. Subsequently, patients progress to a full liquid diet, incorporating items like protein shakes, yogurt, milk, and creamed soups. The diet then advances to pureed foods, including options like baby food, and well-blended soups, characterized by a smooth consistency devoid of solid fragments. Further progression involves soft foods which should be well-cooked and easy to chew. Ultimately, patients transition back to a regular balanced diet, albeit with smaller portion sizes and potential restrictions on high-calorie, high-sugar, or high-fat foods. 

 

Life After Bariatric Surgery: Possible Complications and Lifestyle Changes

Bariatric surgery is a transformative procedure that offers hope and health benefits to those struggling with obesity. However, like any major surgical intervention, it comes with a set of potential side effects and considerations that individuals must be well-informed about. Ensuring proper nutritional intake is crucial during this period. Managing dietary habits to avoid the discomfort of dumping syndrome, which involves symptoms such as nausea, sweating, and diarrhea, can be achieved by steering clear of trigger foods and embracing balanced meals. Digestive issues and the possibility of exacerbating gastroesophageal reflux disease (GERD) also warrant consideration, as they may require dietary adjustments and medical management. Also, there is a correlation between hair loss and bariatric surgery, but you should not worry too much about it because it is mostly temporary. This condition is often referred to as "telogen effluvium" and can occur due to several factors related to rapid weight loss and nutritional changes that commonly follow bariatric procedures. As the body adjusts to the new nutritional status and weight loss stabilizes, many individuals will see their hair regrow and return to its previous condition.

Consistent follow-up care through scheduled appointments ensures monitoring of progress and addresses any emerging complications or concerns. Moreover, recognizing the potential emotional and psychological impacts of the surgery, such as body image issues or mood disorders, highlights the need for holistic support, which may involve mental health professionals. Ultimately, bariatric surgery signifies a lifelong commitment to health, demanding mindful eating, physical activity, and ongoing medical supervision to enhance the quality of life for individuals on this transformative path.

This article is not authored by a medical professional; however, it provides a concise overview of various medical procedures sourced from academic papers within the field of medicine. While it does not substitute for expert medical advice, it offers a valuable summary of the information found in scholarly literature, making it a useful resource for those seeking a general understanding of these medical procedures. It is essential to consult with qualified healthcare professionals for in-depth and personalized medical guidance.

References

  1. The SAGES Manual: A Practical Guide to Bariatric Surgery Author(s): Ninh T. Nguyen, Eric J. DeMaria, Sayeed Ikramuddin, Matthew M. Hutter Year: 2008
  2. Bariatric Surgery: Technical Variations and Complications Author(s): Mervyn Deitel (auth.), Michael Korenkov (eds.) Publisher: Springer-Verlag Berlin Heidelberg, Year: 2012
  3. Review of Obesity and Bariatric Surgery: Essential Notes and Multiple Choice Questions Author(s): Subhash Kini; Raghavendra Rao Publisher: Informa Healthcare, Year: 2012
  4. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
     

Frequently Asked Question

What are the best vitamins to take after bariatric surgery?
Vitamin D, and vitamin B12 are recommended by experts.
How much does bariatric surgery cost?
Cost of the surgery can vary depending on the procedure and the institution. In Turkey it is between 2500-9000 euros.
What is the best alcohol to drink after bariatric surgery?
Choose low-calorie options and drink in moderation. Also keep in mind that doctors would recommend not to drink any alcohol for at least 6 months.
How long is the waiting list for bariatric surgery?
Unlike many European countries in Turkey there is no waiting list for bariatric surgery.
What are the 3 types of bariatric surgery?
Sleeve gastrectomy, gastric bypass, and adjustable gastric banding. These are the most modern and effective types of bariatric surgery.
How to stop hair loss after bariatric surgery?
Ensure you are getting adequate protein in your diet. Protein is essential for hair growth. Take recommended vitamin and mineral supplements, as prescribed by your healthcare team, to prevent nutrient deficiencies that can contribute to hair loss.
Which bariatric surgery is most successful?
The success of bariatric surgery depends on several factors, including individual patient characteristics, goals, and medical history. There is no one-size-fits-all answer to which bariatric surgery is the most successful, as each procedure has its own benefits and considerations.
How much weight do you have to lose before bariatric surgery?
There is no clear answer to this question but regardless of the amount necessary, losing weight before bariatric surgery can make the procedure safer and more effective.
What BMI is suitable for bariatric surgery?
The criteria for bariatric surgery eligibility often depend on body mass index (BMI) among other factors. Generally speaking, the following BMI guidelines are used to determine suitability for bariatric surgery: 1. A BMI of 40 or higher, which is classified as “severely” or “morbidly” obese. 2. A BMI between 35 and 39.9, along with at least one obesity-related comorbidity such as diabetes, hypertension, or sleep apnea. Some guidelines and surgeons may also consider patients with a BMI between 30 and 34 if they have significant obesity-related health issues, although this is less common and may depend on individual case assessment. It’s worth noting that BMI is just one factor. A comprehensive medical evaluation including factors like age, overall health, medical history, and psychological readiness is also usually required before approving someone for bariatric surgery.