Dr. Bernhard Drummer, M.D., is the Chief of General Surgery at the Forchheim – Franconian Switzerland Hospital and has over 30 years of surgical experience. As a recognized expert in bariatric surgery, he helped establish the Upper Franconia Bariatric Center, which has been certified since May 2022 as a center of excellence for bariatric surgery by the German Society for General and Visceral Surgery. The range of treatments includes surgical procedures such as sleeve gastrectomy and gastric bypass, as well as the gastric balloon, which is inserted without surgery or anesthesia. In addition, the center offers a medically supervised, conservative weight-loss program.
Here, an interdisciplinary team comprising specialists in medicine, nutrition, exercise therapy, and psychology provides long-term support to patients—with a focus on establishing new lifestyle habits and preventing relapse. Dr. Drummer also has outstanding experience in minimally invasive surgery, particularly for reflux disorders. He has been performing all reflux surgeries using laparoscopic techniques since 1997. Traditional general surgical procedures—such as those for hernias, thyroid disorders, or other abdominal conditions—are also part of the range of services offered under his leadership. With his integrative and patient-centered approach, Dr. Drummer combines modern techniques with a deep understanding of patients’ individual needs—to achieve lasting results and a noticeable improvement in quality of life. The editorial team of the Leading Medicine Guide conducted a fascinating interview with Dr. Drummer on the topic of obesity.
Obesity, or morbid obesity, is one of the greatest health challenges of the 21st century. It increases the risk of cardiovascular disease, type 2 diabetes, high blood pressure, strokes, and certain types of cancer. According to the WHO, over 650 million adults worldwide are affected, and in Germany, the figure is about 25%. Causes include a long-term imbalance between calorie intake and expenditure, as well as genetic, hormonal, psychosocial, and environmental factors. While lifestyle changes such as a healthy diet and exercise are initially recommended, severe obesity often requires medical treatment. Surgical procedures such as gastric bypass or sleeve gastrectomy are frequently necessary to achieve lasting results. Obesity not only impairs quality of life but also places a burden on the healthcare system. Therefore, specialized, holistic treatment approaches are important—ones that promote long-term behavioral changes in addition to surgery. Modern bariatric surgery offers promising treatment options through multidisciplinary approaches.
When an overweight patient consults a doctor, the doctor first takes a thorough medical history to determine the causes and possible risk factors for the excess weight.
“As a rule, a patient seeking weight loss does not come directly to me or to one of my colleagues in bariatric surgery. Of course, there are exceptions—for example, when someone who is severely obese and has acute, life-threatening comorbidities seeks our help and rapid medical intervention is necessary. In such cases, the patient is referred immediately to a surgeon. But under normal circumstances, this direct approach would not be advisable. First, it’s important to properly assess the patient in order to determine which weight-loss options are most suitable. To do this, the patient is first referred to our bariatric coordinator. She gets an overview of the individual situation: What is the patient’s weight? What comorbidities are present? What is the main problem? For this purpose, patients also receive a special brochure containing all the necessary information. The collected data is then discussed in our so-called “Obesity Team”—an interdisciplinary team consisting of a diabetes counselor, a dietitian, the obesity coordinator, and at least one surgeon, who consult together. This allows us to decide on a case-by-case basis whether the best course of action is a conservative approach—that is, nutritional therapy—or whether surgical intervention should be considered. When a patient says, “I’m too overweight; I want to make a change,” we first send them—unless it’s a medical emergency—a handbook via email or in person containing all the important information. This allows them to prepare and gather initial key details. The patient then brings these documents to the initial consultation, during which we work together to determine what is actually feasible and sensible. Many people don’t really know exactly what’s happening to their bodies—they just know they’ve gained weight. However, to get a complete picture, we need detailed information. Otherwise, even the first steps would take hours,” explains Dr. Drummer at the start of our conversation, going on to describe the services the Adipostiaszentrum Oberfranken offers regarding the dietary changes that are usually necessary:
“When it comes to nutritional therapy, we have a well-established nutrition team. This includes, among other things, cooking classes and both in-person and online nutrition counseling. As a rule, patients keep a detailed food diary for two to three weeks: What do they eat, what do they drink, and in what quantities? We analyze this data—for example, we examine calorie intake, the proportion of carbohydrates, or other notable patterns—and then discuss it during a face-to-face or virtual consultation. We offer programs such as Optifast and other structured approaches. Our goal is always an individualized, so-called “tailored approach” to treatment—that is, a customized therapy plan. Every patient is different, which is why we must assess each case differently to determine the best course of action. Of course, it’s possible to make money primarily through surgery, but that must never be the primary consideration—and it isn’t for us either. After all, performing surgery prematurely on a patient who isn’t truly a suitable candidate is unlikely to yield successful long-term results. Another important factor is the patient’s mental health. In many cases, there is a psychological link to obesity—this aspect must not and will not be overlooked in our approach.”
In the long term, obesity has a negative impact on the quality of life and life expectancy of those affected in many ways. First, excessive body fat leads to a variety of comorbidities that affect both physical and mental health.
Common comorbidities of obesity include type 2 diabetes, caused by insulin resistance, which significantly increases the risk of cardiovascular disease. High blood pressure contributes to atherosclerosis, heart attacks, and strokes—leading causes of death. Excess body weight puts strain on joints, particularly the knees and hips, causing osteoarthritis, pain, and limited mobility. The risk of colorectal, breast, and uterine cancer is also elevated. Respiratory diseases such as obstructive sleep apnea syndrome lead to poor sleep, daytime sleepiness, and cardiovascular problems. Liver diseases, particularly nonalcoholic fatty liver disease (NAFLD), can progress to cirrhosis. In addition, obesity has a significant impact on mental health.
“We work with specialized psychologists whom we have integrated as permanent partners. We do not perform any surgery without first conducting a psychological or psychiatric evaluation. This assessment by a specialist is a crucial step in the entire treatment process. Obesity—just like anorexia—cannot be treated solely through physical means. Psychological factors almost always play a significant role. Anyone who tries to ignore this runs the risk of failing to achieve long-term therapeutic success. Unfortunately, it happens time and again that patients undergo surgery prematurely without sufficient consideration of the psychological component.
In such cases, short-term weight loss may occur, but lasting results are usually not achieved, and many patients go on to develop health problems again. That is why we rely on a multidisciplinary approach. For us, this includes not only psychological care but also a structured exercise program. Surgical measures alone fall short—obesity requires a holistic approach. At our center, we have a strong team of dedicated specialists from various fields who work hand in hand. Surgery should always be the last resort in the course of treatment. Anything else would not make medical sense—and is often driven more by economic considerations. For us, however, our responsibility to the patient is the top priority,” emphasizes Dr. Drummer.
The treatment of obesity encompasses a variety of approaches that vary depending on the severity of the condition, the patient’s individual circumstances, and any comorbidities. The selection of the appropriate method depends on various factors, such as BMI (body mass index), the presence of comorbidities, and the patient’s willingness to work on their lifestyle.
For patients in whom conservative measures do not yield the desired results and who suffer from severe obesity (BMI over 40 or over 35 in the presence of comorbidities such as diabetes or high blood pressure), surgical procedures may be considered. The most common procedures include gastric bypass and sleeve gastrectomy. These procedures aim to reduce the volume of the stomach in order to limit food intake and achieve a feeling of fullness more quickly. So-called metabolic surgery, which primarily affects metabolism, may also be an option, especially when comorbidities such as type 2 diabetes are present.
Dr. Drummer describes the criteria that are important for selecting the right surgical procedure: “When choosing between a sleeve gastrectomy and a gastric bypass, individual eating habits play a central role. Patients who consume a lot of sugary foods generally benefit less from a sleeve gastrectomy, since this procedure reduces stomach volume but does not significantly alter digestion or nutrient absorption. In such cases, a gastric bypass may be more appropriate. In this procedure, not only is the stomach significantly reduced in size, but a portion of the small intestine is also bypassed, which significantly limits nutrient absorption.
The presence of hormonal causes, such as adrenal gland disorders, or psychological stressors must also be taken into account in treatment planning. Only on the basis of a thorough interdisciplinary assessment can a treatment plan tailored to the individual be developed. Preparation often takes place over several months as part of a structured program that integrates medical, nutritional, psychological, and exercise therapy elements. This approach also aligns with the multimodal concept (MMK) required by health insurance providers. While extremely high BMI values may constitute a primary indication for surgery, the center generally ensures that all patients undergo these preparatory steps. Rushing into surgery without thorough preparatory work is not considered effective. The choice of the appropriate surgical procedure depends in every case on the patient’s eating habits. Patients who tend to consume large portions of hearty, carbohydrate-rich foods and who do not suffer from heartburn or have a hiatal hernia may be candidates for sleeve gastrectomy. The key factor is always structured assessment within a specialized center, where an interdisciplinary team develops a treatment plan tailored to the individual patient.”
In preparation for bariatric surgery, weight loss medication using so-called GLP-1 analogs is also playing an increasingly important role, particularly in the form of the so-called “weight-loss injection,” known under brand names such as Wegovy.
“In everyday clinical practice, the injection is certainly used as part of surgical preparation for patients with Class 3 obesity. The goal is preliminary weight loss—approximately 10 to 20 kilograms—to reduce surgical risk. Less intra-abdominal fat means more space in the abdominal cavity and better visibility and maneuverability during the procedure, which has a positive effect on the safety and execution of the surgery. Alongside this medical application, however, there is also a growing number of people who are only moderately overweight and who use the medication for a limited period—for example, as part of a three-month treatment regimen. This is often used by people who hope it will provide motivation and a jumpstart for a lifestyle change. From a medical standpoint, there is in principle no objection to such short-term use, provided there are no contraindications.
Many people experience an increased sense of self-efficacy due to reduced food intake, which in turn can lead to positive behavioral changes—such as increased physical activity. At the same time, however, the limitations of this drug therapy must also be noted. A lasting effect only occurs if lifestyle habits are also permanently changed at the same time. Without an accompanying change in diet and exercise habits, discontinuing the medication often leads to the so-called rebound effect, in which the lost weight is regained.
This effect is comparable to other temporary aids, such as the gastric balloon, whose effects also cease as soon as they are no longer used. In addition, potential side effects are being monitored. More recently, for example, there have been reports of possible visual disturbances associated with the use of GLP-1 analogs, although such findings are currently still undergoing further scientific investigation. “The weight-loss injection can be a useful addition as part of a comprehensive treatment plan for severe obesity—particularly to minimize risks prior to surgery. However, as a standalone measure without accompanying behavioral changes, its benefits remain limited,” Dr. Drummer makes clear.
In terms of the complexity of bariatric procedures, the sleeve gastrectomy and gastric bypass are quite comparable from a surgical perspective. Both procedures have long been part of the standard surgical practice at specialized centers. Gastric bypass has a slightly higher overall complication rate than sleeve gastrectomy, but this is easily manageable in everyday clinical practice.
“A sleeve gastrectomy can generally be performed safely regardless of the patient’s physical constitution. Gastric bypass surgery is more challenging in extremely obese patients, where the available surgical space is severely limited. In such cases, a sleeve gastrectomy is often performed first to minimize the risk. After an initial successful weight loss, the procedure can then be converted to a gastric bypass at a later date.
This two-stage approach is particularly beneficial for severely obese patients. A conversion to a bypass may also be necessary in cases of severe symptoms, such as intense heartburn, following a sleeve gastrectomy. Both procedures—sleeve gastrectomy and gastric bypass—are performed with roughly equal frequency. There are other, less common methods, but these two main procedures generally provide an effective and sustainable treatment. Initial weight loss is essential as part of the preoperative preparation for severely obese patients, particularly those with extremely high body mass index (BMI) values of 70 or higher.
For example, a gastric balloon may be used to achieve moderate weight loss. In addition, patients follow a protein-rich diet phase lasting several weeks, consisting of carbohydrate-free shakes. The goal is to shrink the liver and reduce intra-abdominal pressure, thereby improving the conditions for a procedure with fewer complications. “This individually tailored approach—the so-called ‘Tailored Approach’—forms the basis for safe and effective bariatric surgery,” Dr. Drummer explains.
Following bariatric surgery—such as that performed on a severely obese patient with an initial weight of approximately 180 kilograms—an intensive phase of weight loss begins.
“Often, a sleeve gastrectomy is performed initially and later converted to a gastric bypass if the conditions allow for it. In the first year after the procedure, weight loss of about 25 to 30 kilograms can generally be expected, although individual variations can be considerable. Structured postoperative follow-up care is essential following the surgery. This includes regular nutritional counseling and medical checkups. Since the procedure alters nutrient absorption, patients must take certain vitamin and mineral supplements for the rest of their lives. Regular blood tests, monitoring of general health, skin assessments, and observation for possible symptoms of deficiency—such as hair loss or fatigue—are essential. Close monitoring helps prevent malnutrition and health complications.
Another risk lies in the psychological stability of those affected. Personal crises—such as family problems, breakups, or bereavement—can cause patients to relapse into old patterns. Turning to overeating as an emotional coping mechanism is not uncommon,” says Dr. Drummer, adding:
“Obesity is a chronic condition that requires lifelong therapeutic support. Successful weight loss through surgical measures alone is not enough if the underlying eating behaviors or lifestyle habits do not change in a sustainable way. Many patients have settled into an inactive and unhealthy lifestyle over the years, one that is difficult to break. Behavioral therapy provided by psychologists is therefore a central component of any treatment. The goal is to identify ingrained routines and establish new, healthier behaviors. Lasting treatment success can only be achieved through a complex interplay of surgical intervention, psychological support, nutritional counseling, and exercise therapy.”
The food industry plays a significant role in the context of obesity and diet-related diseases. Today’s abundance of highly processed, sugar- and fat-rich products contributes significantly to the rise in obesity among the population. Whereas in the past, many households cooked their own meals and food was considered a valuable commodity, today food has in many cases become a mass-produced, fast-consumable product—inexpensive, widely available, and aggressively marketed. This shift has profound effects on eating habits, particularly among children and socially disadvantaged groups.
Dr. Drummer is very critical of this: “What is particularly problematic is that many products specifically targeted at children are marketed as healthy—for example, by highlighting their milk or vitamin content—even though they are actually notable primarily for their high sugar and fat content. Parents who are overwhelmed by the flood of conflicting messages can hardly tell what is actually healthy and what is not. Especially among those with lower levels of education, there is often a lack of critical perspective toward such advertising messages, leading to supposedly good decisions being made based on misinformation.
Furthermore, many educational institutions lack systematic nutrition education and practical programs—such as cooking classes—that teach children at an early age how diverse and enjoyable healthy eating can be. While some initiatives do exist, they are mostly part of nonprofit projects or driven by private initiatives. Comprehensive, mandatory integration into the school curriculum is largely absent. Added to this is the influence of the food industry itself, which is driven by powerful economic interests. Lobbying plays a significant role in this regard. Many health policy measures—such as the introduction of a sugar tax or stricter advertising regulations for children’s products—are stalled by economic pressure or implemented only inadequately. Advertising campaigns often do not formally target children but rather adults—for example, by combining children’s voices or cartoon characters with adult testimonials.
In this way, legal requirements are circumvented without losing their impact on the child audience. A societal shift in mindset is needed—one that begins in preschool and is consistently carried through the entire education system. Only in this way can healthy eating habits be established in the long term. Unfortunately, health considerations often take a back seat to economic interests in the food industry. The responsibility for healthy eating cannot therefore rest solely with consumers. Without political measures, social engagement, and structural changes, many people—especially children—remain at the mercy of a system that systematically promotes obesity and unhealthy lifestyles.”
Upper Franconia Obesity Center
The Upper Franconia Obesity Center at the Forchheim Clinic – Franconian Switzerland has over 25 years of experience in treating severe obesity and is recognized as an established center of excellence. Its current certification confirms the high quality standards in diagnostics, multimodal therapeutic approaches, and interdisciplinary care. Recertification is coming up soon—an important step toward ensuring continued compliance with and further development of medical and organizational criteria. This ensures that the center will remain a reliable partner for holistic and sustainable obesity care in the future.
An appeal to severely obese individuals to seek treatment can only be effective if it does not come solely from outside sources. It is crucial that the motivation to change comes from within. Neither pressure nor well-meaning advice alone will lead to success. Rather, it is a long, often arduous journey that involves consciously confronting one’s own situation and being willing to change.
“A conversation with a trusted person—ideally someone with medical or psychological expertise—can be helpful in this process. Change can only succeed if it is understood, desired, and driven by the individual themselves. That is why direct appeals—such as ‘Get surgery,’ ‘Eat less,’ or ‘Do something for your health’—usually fall on deaf ears. Anyone who decides to undergo treatment must embark on this path out of conviction. In reality, this often doesn’t happen until symptoms have become severe or all other coping strategies have failed—sometimes only after years. At the same time, the number of people with obesity has been rising significantly for years. This applies not only to adults but also to children and adolescents. The causes lie in the oversupply of industrially produced, high-sugar foods and in an increasingly sedentary lifestyle.
Just a few decades ago, it was taken for granted that people would spend most of the day outdoors—today, many children spend their free time in front of screens. For many, the digital world has become a substitute for real-life experiences. Quality of life is increasingly defined in virtual terms: a video game on a console that simulates climbing Mount Everest replaces an actual hike. This shift is also evident in everyday observations: whereas children used to play outdoors for hours on end, today parents often stand by and intervene as soon as a little dirt or sand comes into play. This overprotection and indoor lifestyle go hand in hand with a decline in physical activity and a changed body image. Contact with nature, a sense of one’s own body, and self-directed movement—all of these are increasingly taking a back seat,” laments Dr. Drummer, adding:
“In light of this societal trend, the question of long-term well-being is becoming increasingly pressing. Although life expectancy is significantly higher today than it was 60 years ago, a longer life does not automatically mean a healthier one. Obesity not only impairs physical health but also quality of life—even if many affected individuals barely notice this loss because their daily lives have long since adapted to the limitations. Obesity treatments are not short-term measures but long-term processes that require a stable environment and thorough education. Comorbidities such as reflux or hiatal hernias are also frequently treated concurrently to achieve the most sustainable outcome possible. However, one thing remains crucial: Every path out of obesity must begin in the mind. Medical support can be extensive—but without the inner resolve to change one’s own life, it remains ineffective.”
Thank you very much, Dr. Drummer, for the informative insights into the widespread condition of obesity!
