News: Focus on bariatrics

The success of obesity treatment is decided after the operation

Severe obesity with all the possible secondary diseases such as type 2 diabetes is one of the widespread diseases in the developed industrialised countries and the number of cases is increasing. Not only in the USA, but also in Europe, morbid overweight (obesity) is rampant. Both in Germany and Switzerland, more and more clinics are specialising in the medical and, above all, surgical treatment of heavyweight contemporaries. Accordingly, surgical procedures are performed more frequently in obesity surgery than they were a few decades ago. Stomach reduction, tube stomach or gastric bypass are the keywords for operations related to obesity. Whereas in Germany, according to current surveys, there is an almost complete lack of professional aftercare, in Switzerland, for example, the Centre for Bariatric Surgery (ZfbC) also sets a good example in the aftercare of patients.

Without lifelong follow-up, the success of bariatric surgery is at risk

A stomach reduction, in whatever form, is the only way out of the vicious circle of obesity, secondary diseases, lack of exercise and even more obesity for many obese patients. In Germany, but also in Switzerland, clinics have specialised in surgical interventions for obesity and provide patients with at least short-term hope for change. However, in Germany in particular, this hope remains a mere expectation. Because even more important than the success of the actual surgical intervention is the subsequent aftercare. And in most cases, this will be necessary for a lifetime. Postoperative care for obese patients is by no means limited to the control of small scars or wound healing in the gastrointestinal tract. More importantly, after such an operation, patients have to change their whole life decisively. This starts with a new form of nutrition, continues with controlled nutritional supplementation, for example with vitamins, trace elements and protein, and ends with a new way of learning sensible exercise. Only a corresponding change in lifestyle habits can ensure the success of bariatric surgery in the long term and thus make the lives of overweight patients better.

All experienced medical specialists, nutritionists, physiotherapists and psychotherapists agree on this. However, there is a lack of concrete implementation of such follow-up treatment and further care in Germany. As the Norddeutscher Rundfunk NDR recently revealed in a contribution to the health magazine “Visite”, the concept of follow-up treatment is stepmotherly neglected in Germany and virtually not established at all. One of the reasons for this is that the health insurance companies neither include such a lengthy to lifelong care for patients in their cost catalogue, nor do they seem to be interested in it. Anyone who has managed to get an overweight operation financed by German health insurance funds at all is often left alone and downright to fend for themselves afterwards.

Accordingly, few patients then find their way to nutrition counselling and further care. Until the body again sounds the alarm and all short-term successes of bariatric surgery are acutely endangered. Those who are financially well off will treat themselves to the necessary aftercare if they have sufficient insight and self-discipline. Those who are less well-off or do not even know how important further care is, do not act at all at this point due to ignorance or lack of financial mass and thus endanger not only the success of the overweight operation, but their health in general.

The German health system clearly has a duty here and must find ways to ensure that bariatric surgery does not turn into an odyssey through the clinical pictures of accompanying secondary diseases.

Switzerland sets a good example

It’s different in Switzerland. Here too, medical centres such as Swiss1Chirurgie, together with the Centre for Bariatric Surgery in Bern, have dedicated themselves to surgical interventions for morbid obesity. Unlike its German neighbours, however, the focus here is on the protracted nature of such interventions from the outset. Only patients who are willing to receive lifelong counselling and support are even considered for bariatric surgery. This is already addressed in the initial talks and is also consistently enforced after the interventions. Of course, always with the cooperation of the patients and all the professionals needed for this.

This methodology is also supported in principle by the Swiss health care system. Here it is clear that anyone who has to undergo bariatric surgery will need the support of the relevant specialists such as internists, nutritionists, physiotherapists and psychotherapists for a long time afterwards, if not permanently. This is the only way to ensure the success of obesity surgery in the long term, which ultimately not only benefits the health of the patients, but also significantly minimises the follow-up costs due to a lack of aftercare.

It remains questionable whether this insight will be reached in Germany in the near future. While the health care system there mainly works on apparent undesirable developments and deficiencies, most obesity patients remain on their own, with or without bariatric surgery.

We have provided more information on the “Visite” report by NDR here http://bit.ly/ndrnachversorgung.To the TV report

 
Michèle Gasserstrong, MD,
Dr Claudia Meierstrong, MD,
Dr Yvette Ottigerstrong, MD,
Dr Stefan Schäferstrong, MD,
Dr Rudolf Steffenstrong, MD,
Dr Jörg Zehetner Seilerstrasse 8
3011 Bern
Switzerland
Tel.: +41 31 310 15 99
Fax: +41 31 310 15 98
E-Mail: bc@hin.ch		 Jörg Zehetner, MD
Professor (USC)
MMM, FACS, FEBS (hon.) PD Dr med. Rudolf Steffen
Specialist FMH for Surgery Dr. med. Alejandro Metzger
Specialist FMH for Surgery Schänzlihalde 1
CH-3013 Bern
T +41 (0)31 312 61 12
F +41 (0)31 312 61 11

04 March is World Obesity Day

Every year at the beginning of March, there is a day dedicated to the topic of obesity as World Obesity Day. Certainly, this is not a holiday for those affected, but at least it is the day when there is a good reason to think about obesity in general and the stigmatisation associated with it in particular.

This year the focus is “Male Obesity”. This cannot simply be categorised as “gluttony” or “self-indulgence”. Male obesity has as many causes as it has manifestations. It primarily affects men from middle age onwards, who (like women) are undergoing a particular type of metabolic change.

Particularly as we get older, the body strives to store food reserves as fat reserves for developmental reasons, in order to provide for possible shortages. Especially for men who consume fewer calories than they take in due to their occupation or limited exercise, this quickly leads to unwanted excess weight. Organic processes in particular play an important role here, which cannot be “switched off” so easily.

In a special video, I personally addressed the importance of World Obesity Day. This is also due to the fact that obesity is now more common worldwide than malnutrition. The actual problem is mainly to be observed in the western industrialised countries, since it is precisely here that there is an ever-increasing surplus of food – practically at all times.

The obesity rate in the USA, for example, is around 35-40 per cent of the population, which is a fact that should not be underestimated. This means an overweight of at least 20 kilograms, or a BMI of 30 or more. This is also the case despite the surgical intervention options, although these methods in particular can now be classified as very safe and successful. Nevertheless, the rate of surgical interventions needed in this particular area is far too low.

World Obesity Day is not simply about informing the public and professional colleagues accordingly. Rather, I see it as important to educate people about the modern treatment options of bariatric surgery. The primary aim is always to help patients according to their individual starting situation.

Information on the topic of obesity

It is important to understand that obesity is always associated with concomitant diseases. Diabetes, Bluthochdruck, Schlafapnoe, hoher Cholesterinspiegel – all dies manifestiert sich in der Umgebung von Fettleibigkeit. But there is also another aspect that has emerged, especially in recent years. The point is that people who are overweight are simply stigmatised. At school, at work and even in private life, overweight people are described as lazy, fat, greedy, careless and lazy about exercise. This puts additional stress on those affected and does not help to tackle the problem in a targeted and conscious way. Significant overweight has been defined as a disease since 2013 at the latest. This puts morbid obesity in the same category as diseases such as diabetes, high blood pressure and many other chronic diseases.

The stigmatisation of obesity is extremely dangerous for patients, as they then withdraw and cannot address their actual problem in a targeted and active way. Professional treatment, counselling and support is the surest way out of obesity.

World Obesity Day can help break down prejudices

Everyone is challenged to exercise some restraint in their contact with morbidly obese people, both in their choice of words and in their behaviour. To this end, World Obesity Day can create better awareness. The problem should not only be addressed on this day of the year. But such a day can help to create more sensitivity for the problems of overweight people instead of leaving them to their fate with stigmatisation and devaluation.

Why specifically “men who are overweight”?

Yes, women also suffer from morbid obesity. But men do it in a special way. There are now “curvy models” for women, but not for men. And men by nature already tend to eat the slightly larger portions, even if that seems to be gradually declining. The world view was and still is such that a belly is always subconsciously associated with prosperity. Also in modern industrial societies. The dangers are usually conscious, but are only realised when they are actually there.

In addition, after a certain stage of life at the latest, men do not have this special view of their appearance that many women have. The actual problem is not recognised, or is recognised only very late, and is then gladly accepted as natural. This means that they don’t have to go to the doctor and the obesity surgeon is an unknown quantity for many of those affected. Therefore, men in particular must be sensitised to actively face this problem. World Obesity Day provides an excellent opportunity to do this.

The COVID19 virus and obesity – a dangerous combination

Since the beginning of 2020, and probably even before, the COVID-19 virus, which is considered dangerous, has been rampant throughout the world. The pandemic development summarised under the collective term Corona crisis has far-reaching consequences for all life in the world – also in Switzerland. Even if the infection figures and the number of deaths caused by COVID-19 are currently declining, the virus has not gone away. It is still there. And in many countries there is and growing fear that a second high wave of infection can be expected in autumn at the latest.

 

Assess risk groups correctly

In principle, it can be assumed that almost anyone can be infected by the Corona virus. Across age groups, social boundaries and income groups, the virus can affect anyone. Protective measures such as social distancing, wearing mouth and nose masks and maintaining good hand hygiene can significantly reduce the risk of infection, but not eliminate it.

With the statistical collection and evaluation of data on the course of the Corona pandemic and its spread, certain risk groups have been defined whose risk of infection is clearly and measurably above average. Currently known risk groups include

  • In general, all persons aged 65 and over
  • People with high blood pressure
  • Adults with chronic respiratory diseases
  • Diabetics of both levels
  • Men and women with diseases and therapies associated with a weakened immune system
  • all people with cardiovascular diseases and
  • cancer patients.

Many of these diagnoses also apply to severely overweight people who have a BMI of over 40 and are thus classified as severely obese.

Obesity and corona form a dangerous combination

Interesting and at the same time worrying is the combination of obesity and an infection with the COVID-19 virus. After all, chronic obesity is often associated with risk factors such as high blood pressure, fatigue, diabetes, a weakened immune system, cardiovascular problems and a lifestyle that is accompanied by little exercise in the fresh air.

In this constellation, very overweight people are particularly often found in the risk groups for corona infection. This means that significantly obese adults in particular are at substantially greater risk of infection.

What we recommend to patients with obesity

In the dangerous connection between obesity and the risk of corona infection described above, we recommend that people who are significantly overweight receive accompanying advice and care from a specialist, for example from the obesity surgery doctors in the Swiss1Chirurgie and Centre for Bariatric Surgery (ZfbC) clinics. Here, people are aware of the entire problem of obesity, especially in connection with the COVID19 virus, and can give the decisive tips.

In addition, affected patients are advised to seek treatment at the Swiss1Chirurgie obesity centres before the expected arrival of the second wave of infection. In addition to thorough diagnosis and advice on individual treatment options for morbid obesity, the specialists at Swiss1Chirurgie and ZfbC offer comprehensive advice on preventive options for sufferers with regard to possible COVID-19 disease.

Focus on dietary and lifestyle changes

Given the particular vulnerability of overweight people with a BMI of 40 or more, it is strongly advised that they immediately change their entire diet and lifestyle to a healthier option. What is so easy to put into words here poses great challenges for most of those affected.

Therefore, specialist counselling and care is an option that should definitely be used, not only with regard to the risk from the COVID19 virus. This is because overweight people in particular often have an accumulation of risk factors that favour both infection with the corona virus and a comparatively more problematic course of the disease.

Irrespective of the current corona pandemic, we strongly advise overweight people to seek specialist advice, treatment and care, for example in the Swiss1Chirurgie obesity surgery clinics. Not only does this effectively counteract the risk of a severe course of COVID-19 infection, but it is also a promising first step towards a healthier future overall.

Grade III obesity as a risk factor for a more severe course of COVID-19

is officially on the list as of today: Annex 6 of the COVID Regulation 2, adaptation of 14 May 2020, item 7

To the list

Communication from: Federal Department of Home Affairs FDHA Federal Office of Public Health FOPH Public Health Division Prevention in Health Care Section