Often the last resort for obesity: gastric surgery

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Obesity surgery is often the last resort for sufferers

Interventions such as gastric band, gastric gastric or gastric bypass operations for those who are extremely overweight are considered controversial. Nevertheless, the number of interventions against obesity is increasing, and with it the costs for health insurance companies. According to DAK-Gesundheit, expenditure on gastric surgery has more than doubled since 2008. Many doctors advocate therapy as an effective measure against obesity and its dangerous comorbidities and complications.

Costs for surgery due to obesity are borne by health insurance companies with a BMI of 40 or more, according to the Robert Koch Institute (RKI), according to which two thirds of men (67 percent) and more than half of women (53 percent) are overweight in Germany. Around a quarter suffer from severe overweight (obesity). According to the evaluation of health monitoring, women from educationally disadvantaged backgrounds are particularly affected by obesity. The World Health Organization (WHO) defines three levels of severity for obesity: grade one is for a body mass index (BMI) of 30.0 to 34.9, grade two is for a BMI of 35.0 to 39.9, and grade three a BMI of 40.0 or higher. The BMI for normal weight is 18.5 and 24.9.

Gastric band, gastrointestinal or gastric bypass operations are only carried out in cases of severe obesity and are in no way an alternative to a diet. Rather, sufferers usually have numerous diets behind before deciding on such an intervention. The health insurance covers the costs from a BMI of 40. If the patient suffers from concomitant diseases such as diabetes or high blood pressure in addition to being overweight, the operation can also be covered from a BMI of 35. Basically, the health insurance companies only pay if a weight loss attempt under medical supervision has failed, which must include a diet, behavioral training and an exercise program.

Stephan Herpertz from the Clinic for Psychosomatic Medicine and Psychotherapy at the Ruhr University Bochum strongly advises patients against private financing of the operation. In addition to the costs of the intervention, expensive follow-up treatments may be necessary, he explains to the news agency "dpa". "Emergency treatment for complications can quickly ruin money."

Obesity harbors the risk of dangerous concomitant diseases "Obesity is a fatal disease that can lead to serious concomitant diseases such as diabetes, high blood pressure, stroke and heart attack", says Jürgen Ordemann, head of the Center for Obesity and Metabolic Surgery at the Charité in Berlin "There is hardly a way to get rid of this disease with conventional therapies." While critics speak of a cost explosion and hasty decisions for life-changing operations, Ordemann points out that the increasing number of interventions can be attributed to this that these surgeries were successful and that most other therapies failed in very obese people.

Three Different Procedures for Obesity Surgery In Germany, those who opt for weight loss surgery have the choice between gastric band, gastric gastric bypass and gastric bypass surgery. Together with the attending doctor, the appropriate surgical procedure is selected, which depends on various factors. "There is no general recommendation for a specific procedure," explains the Ordemann. The lifestyle, the extent of overweight, comorbidities and the patient's wishes are decisive.

The gastric band is less effective than the other two methods and is used less and less. However, it can be advantageous to remove the gastric band afterwards. In the other two procedures, the stomach is surgically reduced. In the case of gastric bypass surgery, part of the intestine is also bypassed so that less food can be consumed. "Certain hormones that control hunger and satiety are formed in the stomach itself and are reduced by partial removal," explains Ordemann. "This changes the hunger and satiety mechanisms, which leads to obese people eating less."

Patients with gastrointestinal and especially gastric bypass surgery usually experience the greatest weight loss after the procedure. However, both interventions also result in lifelong check-ups and follow-up care, as well as nutritional supplements with minerals and vitamins.

Patients usually have numerous diets before an operation for obesity. Before an obesity operation is approved by the health insurance company, various doctors have to give their opinions. Family doctor, surgeon, psychotherapist and, if necessary, other specialists must check whether the procedure is promising. Herpertz advises sufferers to contact an obesity center. "This is the best way to ensure that patients receive the comprehensive pre- and post-treatment that is required for such an operation."

Many of these centers want fewer obstacles to obesity surgery for patients. "Most of the patients who come have already been through countless diets," Christine Stier from the Center of Excellence for Obesity and Metabolic Surgery at the Sachsenhausen Hospital in Frankfurt am Main explains to the news agency. "Obesity surgery is not a lifestyle operation, but one crystal-clear therapy, the effectiveness of which has been well proven by studies, "emphasizes Stier. Surgical weight loss could significantly reduce the risk of serious complications such as diabetes, cancer, heart attack and stroke. "Certainly this is not a hundred percent solution, and it is also not the push of a button to make the patient slim," explains the expert. "It is a life-changing procedure that requires a lot of discipline from the patient." (ag)

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