For morbidly overweight (obese) people, their excess pounds are by no means just an aesthetic problem. This is because severe obesity favors the development of serious concomitant diseases such as high blood pressure, coronary heart disease, type 2 diabetes, dyslipidemia, stroke and cancer, even at a young age. Countless failed attempts to reduce their weight with diets and exercise leave those affected in despair.
Permanent reduction of extreme overweight
Surgical procedures are an effective alternative to conservative methods: When indicated, gastric banding or gastric bypass surgery results in a reduction of at least 50 percent of excess weight in nearly all patients treated. And these successes are not only long-term, but even lead to improvement or healing of concomitant diseases. “It’s not uncommon for our patients to weigh over 200 kilos. They can’t even sit on a bicycle, let alone ride one,” comments Prof. Dr. Rudolf Weiner, Chief Physician of the Surgical Clinic at the Sachsenhausen Hospital, Frankfurt/Main, on the often-used prejudice that overweight people should “just get moving” more. Sascha Oliver Herold, chairman of the Adipositaschirurgie-Selbsthilfe-Deutschland e. V., is also familiar with such advice: “With diets and exercise, you can certainly lose a few kilos, but usually only for a short time and in the end you are often heavier than before.” In severely obese patients (from BMI* > 35), conservative measures such as nutritional or behavioral therapy rarely bring significant success. “At best, we manage a weight reduction of 10 percent with them – with an initial weight of 200 kilos, that’s not much,” confirms the Frankfurt surgeon.
By shortcut to the fat reserves
When Sascha Oliver Herold first applied for bariatric surgery, he weighed 145 kilos. The health insurance company refused on the grounds that all conservative alternatives had not yet been exhausted. Six years later, gastric bypass surgery was approved. “But then with 209 kilos and a handful of concomitant diseases,” recalls 28-year-old Herold. “In gastric bypass surgery,” Prof. Weiner describes, “we use a staple suture to separate the stomach into a small forestomach and a remnant stomach. To the forestomach, we staple a loop of small intestine that effectively ‘bypasses’ the rest of the stomach and duodenum.” By shortening the digestive track, fewer nutrients are absorbed. This results in a reduced caloric intake, the body draws on its fat reserves and the patient loses weight. Sascha Oliver Herold lost 100 kilos in 2 years with the gastric bypass.
Small intervention with a big effect
Another very effective method is gastric banding. “We can perform this procedure very gently using the ‘keyhole technique,'” explains Prof. Weiner, “without major abdominal surgery, just small incisions for the instruments.” During the procedure, the doctor places a silicone band around the stomach like a belt just below the esophagus. This forms a small forestomach, which holds only about 20-30 ml (normal is about 2 liters). Even the smallest amounts of food are sufficient for the patient to feel full – he eats less, but more frequently. The band is connected by a tube to a reservoir that is sutured close under the abdominal wall and can easily be reached through the skin with a syringe. This allows fluid to enter a flexible cuff on the inside of the band, making the passage to the rest of the stomach narrower or wider without the need for further surgery.
Lasting health benefits
In Germany, less than one percent of obese patients have received surgical treatment to date. Yet obesity and its consequences place an annual burden on the healthcare system in the millions. Since obesity is not sufficiently recognized as a disease, health insurance companies reimburse the costs of surgery only in individual cases. However, current studies point to the long-term savings potential of bariatric surgery: in most patients, weight loss is accompanied by an improvement in their serious concomitant diseases. In many cases, these diseases, which would otherwise have to be treated with medication for the rest of the patient’s life and often lead to early retirement or premature death, even disappear completely. Since his operation, Sascha Oliver Herold has been taking dietary supplements to compensate for nutrients that his body does not absorb in sufficient quantities.He no longer needs medications he used to take regularly for his comorbidities.
