Dr Ivaylo Tzvetkov is a long standing member of International Federation of Surgery for Obesity with positive feedback from patients and colleagues. He is practicing safe and medical based and relevant to highest clinical international standards weight loss surgery. He has performed more than 780 Bariatric procedures in the last 12 years with 0.5% of complications. The preference of Dr Tzvetkov is Gastric bypass and mini / one anastomosis / bypass as weight loss procedures, however he offers tailored approach to individual needs of each patient for weight loss surgery. The low prices of offered weight loss surgery do not influence the quality of the healthcare service and Hospital environment, care and Follow up of the patients are the service provided is even better than the care offered in some West European Hospitals.

More than half of the European population is overweight [body mass index (BMI) >25 and <30 kg/m2] and up to 30% is obese (BMI>30 kg/m2). Overweight and obesity are associated with many comorbidities such as: insulin resistance/type 2 diabetes, dyslipidemia, hypertension, cholelithiasis, cancer, liver steatosis, gastroesophageal reflux, obstructive sleep apnea, degenerative joint disease, gout, and others. It has been demonstrated that weight reduction in short term (1–3 years) leads to a decline in insulin resistance, a better metabolic regulation in patients with diabetes mellitus, a reduction in blood pressure, and a less atherogenic lipid profile. Several investigations have reported impairments in specific domains of Quality of Life (QoL) in persons with extreme obesity. More specifically, these studies have suggested that both health-related (HR-QoL) and weight-related quality of life (WR-QoL) are dramatically impacted by extreme obesity. Encouragingly, both health-related and weight-related quality of life appear to improve following bariatric surgery. Some studies indicate that weight reduction in the severely obese is accompanied by improvements in Health Related -Quality of Life and that a dose-response relationship exists between the magnitude of weight loss and HR-QoL benefits. At present, surgical intervention is the only treatment yielding a more durable weight loss and an improvements in health status and in HR-QoL. In severely obese a Study after weight loss surgery showed over 10 years  that long-lasting weight reduction in the severely obese has a general long-standing positive outcome on HR-QoL.

According to IFSO / International Federation for Surgery of Morbid Obеsity/ there are a number of widely accepted criteria which make a patient suitable for Bariatric weight loss surgery:

Weight greater than 45kg above the ideal body weight for sex, and height.

BMI > 40 by itself or >35 if there is an associated obesity illness , such as diabetes or sleep apnoea

Reasonable attempts at other weight loss techniques

Age 18-65

Obesity related health problems

No psychiatric or drug dependency problems

A capacity to understand the risks and commitment associated with the surgery.

Pregnancy not anticipated in the first two years following surgery

There is considerable flexibility in these guidelines. Patients as young as 12 have been offered surgery. Sometimes a lower BMI between 30-35 is accepted if comorbidities exist.

One of the Lancet studies confirmed that obesity and overweight is a growing problem worldwide, even in countries that in the past have had problems with lack of food. The study analyzed the change in body mass index (BMI) from 1,698 studies among 19.2 million adults in 200 countries from 1975 to 2014. The researchers found that during this time period the average BMI increased from 21.7 to 24.2 kg/m2 among men and from 22.1 to 24.4 kg/m2 among women. Average BMIs among men were lowest (21.4 kg/m2) in central Africa and south Asia and highest in 29.2 kg/m2 in Polynesia and Micronesia. Among women, average BMIs were lowest (21.8 kg/m2) in south Asia to and also highest (32.2 kg/m2) in Polynesia and Micronesia. During the same time period, obesity prevalence more than tripled from 3.2% to 10.8% among men and more than doubled (6.4% to 14.9%) among women. By comparison, the prevalence of people are underweight, presumably from lack of enough food, decreased from 13.8% to 8.8% among men and 14.6% to 9.7% among women.

The other Lancet study showed a substantial worldwide increase in a major consequence of obesity, diabetes, since 1980 by analyzing 751 studies that included nearly 4.4 million people. As the study’s senior author Professor Majid Ezzati from Imperial College explained,“obesity is the most important risk factor for type 2 diabetes and our attempts to control rising rates of obesity have so far not proved successful. Identifying people who are at high risk of diabetes should be a particular priority since the onset can be prevented or delayed through lifestyle changes, diet or medication.” The study found that between 1980 and 2014, diabetes prevalence more than doubled from 4.3% to 9.0% among men and climbed by over 50% from 5.0% to 7.9% among women. This corresponded to the number of adults with diabetes worldwide nearly quadrupling from 108 million to 422 million. In 2014, northwestern Europe had the lowest diabetes rates. Polynesia and Micronesia had the highest (affecting nearly a quarter of adults), followed by Melanesia and the Middle East and north Africa. While not all diabetes cases are related to obesity, obesity is a major risk factor for the more common type of diabetes, Type 2 or adult-onset diabetes. And diabetes can have devastating health consequences such as heart problems, kidney disease and stroke. (Of course, obesity can result in many other health problems besides diabetes, such as cancer and heart disease.)