National report of treatment of morbid obesity and metabolic disorders from Turkey

Alper Celik, M.D.
Yeniyuzyil University Faculty of Medicine
Department of General Surgery,Istanbul / Turkey.

Slide-1*Approximately 66% of whole Turkish population is under obesity risk.
*The incidence of obesity is 24% for males and 31% for females.
*The highest incidence is observed in Southeastern part of Turkey (61%), followed by
mid-Anatolia (55%), Northern west (50%), and West parts (15%)*The percentage of normal weight adults is 13.6% in females and 20% males.
*The incidence of overweight children is 24% for females and 31% for males.
*The incidence of obesity among children below age 15 is 9% for females and 12% for males.

Slide-2*The prevalence of T2DM in adult population (35-70 y) is 14.7%*The prevalence of Glucose Intolerance in adult population is 9.6%.
*T2DM prevalence increases with age, 50 years being the cut-off point. After age 50, T2DM
prevalence reaches 30%.

Slide-3*We have a national bariatric and metabolic surgery society in Turkey.
*I perform both metabolic and bariatric surgery.
*For bariatric surgery purposes my indication is BMI over 40*For patients with T2 Diabetes or Metabolic Syndrome, BMI (unless over 20) is not alimitation in my surgical practice.

Slide-4*The annual number of bariatric operations is estimated to be around 500 cases.
*I performed 76 operations within 2 years on my own (7.6%).
Slide-5*There are no specified or certified bariatric surgeons in Turkey.
*The number of surgeons mainly doing bariatric surgery is around 10.

Slide-6*There is no credential system in Turkey and bariatric surgery is not regarded as aspecification.

Slide-6*There is no nationwide database for sharing the pre- and post-operative data of bariatricsurgery.

Slide-7*The average cost for bariatric surgery in Turkey varies between 5000 and 20000 USD,
depending on the type and location of the operative procedure.
*The government only pays 30-40% of the bill if the patient obtains a multidisciplinary
council approval. (The council mainly consists of endocrinologists!)

Slide-8*For patients with T2DM, I operate on all patients with a BMI above 20, if they meet themetabolic criteria for the operation.
*I did 4 revision bariatric surgeries. (1 anastomotic stricture, two band removals withsleeve and one band removal with BIB).
*I work at a private university and its private hospitals in Istanbul. We accept and operate
on overseas patients.

Slide-9*The main problem, also affecting my country from obesity pandemic is the so called“Coca-colonization”, which refers to global standardization of refined or saccharified
food.
*From my (surgical) aspect, the main problem is internists and endocrinologists who aretrying to discover America once again.
*The main need is education and social awareness.

Slide-10*Protection is more important than treatment. I personally believe that we should worldwide
keep away from refined and saccharified food. However, these products are easy to keep,
suitable for overseas transport and unfortunately, they are tasty.

*Each government should establish their policy for nationwide food supplies andconsumption of childhood food products.
*Turkish people like to eat bread with spaghetti and/or rice. I think that we should atfirst educate people, than we should raise a social awareness about the global food industry,metabolic syndrome and the importance of physical exercise.
*For those with already settled metabolic syndrome, the importance and affectivity ofsurgical treatment should be emphasized, with particular notation on the advantages oflaparoscopic surgery.

Slide 11
*From bariatric point of view, the importance of a team work has always been emphasized.
I have recently moved to a new institute in Istanbul and am trying to settle my own team.
*From metabolic point of view, I operate on T2DM patients with end-organ damage. I haveoperated on 46 non-obese, overweight or type 1 obese (BMI=30-35) patients with T2DM. I
believe that we should also emphasize and try to produce a global awareness for surgicaltreatment of Diabetes.