Dr. Markus von der Groeben is a recognized specialist in surgery with a focus on visceral surgery and is considered a proven expert in the field of obesity treatment. Since 2018, he has been head of the Obesity Center at Muri Hospital in the canton of Aargau, where he works as a senior physician for visceral surgery and bariatrics. With extensive clinical experience and in-depth expertise, Dr von der Groeben has specialized in the treatment of severely obese patients and is now one of the leading specialists in Switzerland in this field. In his work, Dr. von der Groeben combines surgical expertise with a holistic understanding of the complex causes of obesity.
As a member of several renowned specialist associations, including the Swiss Medical Association (FMH), the Swiss Society of Surgery (SGC) and the German Society for General and Visceral Surgery (DGAV), he is actively involved in the further development and quality assurance of obesity therapy. He pursues a modern, patient-centered approach that includes conservative treatment options as well as surgical procedures.
The Obesity Center at Muri Hospital is interdisciplinary and offers a comprehensive range of treatments - from nutritional therapy and behavioural advice to surgical procedures such as sleeve gastrectomy or gastric bypass. The range is complemented by innovative drug options such as the so-called “weight loss injection”. Together with his specialist team, Dr. von der Groeben develops tailor-made treatment strategies aimed at achieving sustainable weight loss and improving quality of life.
Muri Hospital itself offers the ideal framework for high-quality medical care with its modern infrastructure, broad range of specialist medical services and strong interprofessional network. Its dedicated work makes a significant contribution to strengthening the understanding of obesity as a chronic disease and showing those affected effective ways to lead a healthier life.
The so-called weight loss injection - for example with the active ingredient semaglutide (Wegovy) - opens up new possibilities in the treatment of overweight and obesity. For many sufferers, it can be a useful addition to diet, exercise and behavioral therapy - especially when traditional measures alone are not enough. But what can the injection really achieve, for whom is it suitable and where are the limits? The editors of the Leading Medicine Guide were able to find out more about this in an interview with Dr. von der Groeben.
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Being overweight is no longer just an aesthetic issue - it affects health, quality of life and often also self-esteem. Many people struggle for years with diets, sports programs and lifestyle changes, but the desired success often fails to materialize. In recent years, however, a new option has become established in the field of obesity therapy: the so-called weight loss injection. Medications such as Ozempic or Wegovy promise to make losing weight much easier - by curbing the appetite and increasing the feeling of satiety. What sounds like a simple solution also raises many questions.
Before starting treatment with the so-called weight loss injection (Wegovy), the focus is on a detailed medical consultation.
Pre-existing conditions such as diabetes, cardiovascular problems or hormonal disorders play a role, as do previous diet attempts, current weight and mental state. The individual goals of the therapy are discussed together and realistic expectations are formulated. The patient is informed about how the medication works - namely by regulating appetite, delaying gastric emptying and improving blood sugar levels. It is also important to point out that this is not a miracle cure, but medical support as part of a comprehensive treatment concept.
“We are currently seeing very high demand for Wegovy therapy. We are literally being overrun because we are allowed to prescribe the drug and it is also covered by health insurance if indicated. The fact is that perhaps one in twenty patients is eligible for bariatric surgery. The vast majority would like to try Wegovy first - even if they have a high body mass index. It seems easier for many: one injection, eat a little less and you lose weight. This also works well, but surgery remains the more effective measure in the long term, especially with a very high BMI. In Germany, as far as I know, the body mass index has to be significantly higher for an operation to be approved and paid for at all. In Switzerland, the threshold for surgery is a BMI of 35 kg/m2, or even 30 kg/m2 if there is also type 2 diabetes mellitus that is difficult to control,” says Dr. von der Groeben and continues:
“If someone comes to me with, say, a BMI of 28 kg/m2 , I first explain to them exactly what is possible. In Switzerland, there are also clear criteria for Wegovy therapy: Either a BMI of 35 kg/m2 or more, or between 28 and 35 kg/m2 if there are additional conditions such as high blood pressure, prediabetes, diabetes or a lipometabolic disorder. We then carry out a large laboratory test on all patients. This means that we check the vitamins, thyroid levels, cholesterol, triglycerides and much more. If it becomes apparent that one of these concomitant diseases is present - such as arterial hypertension - I can apply to the health insurance company to cover the costs of Wegovy therapy. At the same time, I also inform patients about possible side effects. I have an information sheet explaining typical symptoms such as nausea, vomiting, abdominal pain or diarrhea. I also explain that pregnancy must not occur during treatment. And of course we also talk about rarer but more serious side effects such as pancreatitis. Once the costs have been covered, patients are given an introduction to the therapy. They receive training on what to watch out for, including side effects, and they attend nutritional counseling. This is obligatory. From the start of therapy with Wegovy, there are also clear targets: They must lose seven percent of their body weight within four months. And after a further six months, another five percent. These are targets that must be met for the therapy to continue. The health insurance company covers the costs for a total of three years. Whether you really do it for that long or perhaps stop earlier depends on the progress. For example, if someone reaches a BMI of 25, the health insurance company will no longer cover the therapy. Then the question arises as to whether you can continue without injections for the time being."
Especially when conventional measures such as diet, exercise and behavioral therapy alone have not brought the desired success, drug support can be useful. Ozempic and Wegovy both contain the active ingredient semaglutide, belong to the group of GLP-1 receptor agonists and act in a similar way in the body: They promote a feeling of satiety, delay gastric emptying and have a beneficial effect on blood glucose levels. However, the main difference lies in the dosage and therefore also in the area of application.
Ozempic was originally developed for the treatment of type 2 diabetes and is approved in correspondingly lower doses. It improves blood sugar regulation and can also lead to weight loss as a positive side effect. Wegovy, on the other hand, was developed specifically for obesity therapy. It contains a higher dose of semaglutide and is approved exclusively for weight reduction in overweight or obese people - even if they do not have diabetes.
“In recent years, the topic of weight reduction and the treatment of obesity has developed considerably. There is hope that patients can achieve a lasting change in their lifestyle through successful therapy and maintain their weight in the long term. However, as with many diet therapies in the past, it is a challenge to maintain the weight achieved once treatment is complete. As soon as the therapy ends, there is a risk that patients will gain weight again. The question of whether patients change their eating and exercise habits permanently depends on their attitude. A change cannot be achieved by an injection alone, but also requires a conscious decision to make a healthier diet overall and to remain active. In this context, nutritional counseling is an essential part of the therapy. If patients combine the therapy with appropriate counseling, there are certainly good results. In some cases, however, patients have to discontinue therapy due to side effects such as nausea, vomiting, abdominal pain or diarrhea. However, these side effects are relatively rare,” explains Dr. von der Groeben.
However, the obesity specialist emphasizes: “Surgical treatment is often recommended for patients with a higher BMI. A combination of drug therapy and surgery can be a sensible option, especially if drug therapy does not produce the desired results. In cases of extreme obesity, the use of Wegovy prior to surgery could be considered in order to reduce the patient's weight and facilitate the surgical procedure. In practice, however, this approach is not yet fully approved, although it would appear to make sense in many cases. Patients who have achieved weight loss with Wegovy could benefit from a lighter weight before surgery, as their liver size is reduced and the surgical procedure is simplified. However, there remains a question of cost and health insurance approval, which is why this combination is not yet widely used and approved.”
Successful and lasting weight loss requires an interdisciplinary approach which, in addition to drug treatment, also includes an adapted diet, regular exercise and psychological support.
“At our facility, we work together with a psychosomatist who acts as an internist and provides comprehensive care for the patients. We also offer psychological nutritional counseling, which I sometimes refer patients to. It would be ideal if we had another psychologist directly on our premises, which we are currently considering. The practice we work with is a private practice for psychiatry and psychosomatics and is located opposite our facility. It would be helpful to have another psychologist on site to be able to help patients even better, especially after they have had an operation. This is because when patients relapse into their old behavioral patterns, psychological rather than psychiatric support is often required in order to develop new coping strategies. We are currently working on integrating this option into our care, as we believe that this is very important for patients,” explains Dr. von der Groeben.
The use of GLP-1 receptor agonists for weight loss is a promising option, but it is associated with certain risks and side effects, especially with long-term use.
“There are certain risk factors where I am cautious and tend to hold back on using the therapy. One example is thyroid cancer, but patients with previous abdominal adhesions or a history of pancreatitis are also problematic. Such patients should be carefully evaluated before starting treatment. The most common side effects include nausea, vomiting and diarrhea. There are also some specific considerations for patients with kidney disease. In these patients, kidney function must be monitored regularly, especially if treatment with Wegovy results in severe adverse gastrointestinal effects. If chronic renal insufficiency is present, I would rather refrain from treatment. Caution is also advised in hemodialysis patients, as treatment with Wegovy is not ideal in such cases”, and comments on the dreaded yo-yo effect:
“I can't say much at the moment, as we've only been using the therapy for about a year. We don't yet have enough long-term experience in this period. In general, however, I assume that a yo-yo effect is possible. A period of three to four months, in which around 7% of body weight is lost, is still relatively short to really establish a sustainable lifestyle. In such a period, it is difficult to achieve enough change to lead to a more active lifestyle in the long term. It is important that patients understand that in addition to weight loss, long-term changes in diet and exercise habits are necessary to ensure success."
The increasing prevalence of weight loss injections such as Ozempic and Wegovy raises a host of ethical and societal issues relating to both medical care and the wider social and cultural implications.
In a culture that is heavily influenced by beauty ideals, the availability of such drugs could lead to an increased focus on weight loss as a means of improving personal worth. There is a risk that society will view people's weight even more as an indicator of their health, success or worth, which could affect many people's mental health and self-image. The pressure to be 'perfect' and to optimize the body could be intensified by the widespread use of these drugs, especially at a time when the cult of the body plays a dominant role in social media and other public forums.
Dr. von der Groeben comments: “There are indeed requests from very young people who are strongly influenced by social media and feel that they have a few kilos too many. In these cases, the wish is often expressed to use a weight loss injection such as Wegovy. We also receive referrals from GPs who do not follow the official guidelines but still send patients to us with this request. However, it is clear to us that we do not offer Wegovy therapy to patients with a BMI below 28 kg/m2. I reject the use of medication solely for weight reduction for aesthetic reasons, as a weight reduction of only 5 to 6 kilograms can usually be achieved without medication by adjusting the diet and avoiding sugary drinks. The high pressure to perform in terms of appearance is actually a big issue among young people these days, which is reinforced by social media,” he adds:
“In Switzerland, GPs sometimes start with Wegovy and allow patients to obtain the medication at their own expense. After one or two months of use, they then refer the patients to us. However, this presents us with administrative challenges, as we need to see evidence of weight loss after 16 weeks for the costs to be covered by health insurance companies. In some cases, a patient has come to us after 14 weeks and been refused reimbursement because she had not waited the prescribed 16 weeks. The health insurance companies require that the weight reduction be checked regularly, which involves a lot of administrative work. For this reason, I am not in favor of prescribing the drug at the patient's request without medical necessity, as this leads to additional bureaucratic hurdles."
Treatment with Wegovy offers a way to lose weight, but requires more than just injecting the drug. It is only successful with accompanying dietary advice and lifestyle changes. Dr. von der Groeben emphasizes that bariatric surgery remains the better long-term solution for severely overweight patients. He also criticizes the misleading labelling of food and calls for more education in schools on nutrition and exercise.
“The monthly cost of treatment with Wegovy is 183 francs, which is no small sum. It is important that patients understand that the therapy is not just about injecting the medication, but that accompanying nutritional advice and lifestyle changes are crucial for success. This has also been demonstrated by the patients who have been undergoing treatment at Muri Hospital for a year. Although many lose weight well, there are also patients who want to stop treatment due to side effects or the inability to continue injections. In my professional context as a surgeon, I do not see weight loss injections as a permanent solution for severely overweight patients. For these patients, bariatric surgery remains the only long-term option to achieve significant weight loss and improve health. Patients who are not extremely overweight can achieve good weight loss through medications such as Wegovy, but for really severe cases I think surgery is the more sustainable solution. There are patients who, after an informative discussion, consciously opt for surgery because they find the prospect of taking the medication for life too costly. They prefer a one-off operation and don't want to have to deal with medication on a permanent basis. The patients I operate on are usually people who have been overweight since childhood and have already tried many diets. These patients see surgery as a long-term solution. Bariatric surgery has proven to be very safe. Patients are usually only hospitalized for three days after surgery and can then go home. We have a very low complication rate. Aftercare includes regular checks to ensure that patients are getting their vitamins and nutrients, as there is an increased risk of deficiencies, particularly after gastric bypass. Patients are then given high-dose multivitamins to prevent deficiency symptoms, as certain vitamins and nutrients can no longer be properly absorbed after the operation,” states Dr. von der Groeben and also criticizes the food industry and the lack of information in connection with eating habits:
“There should be less sugar in food, as many products advertised as 'low-fat' or 'sugar-free' actually still contain too much sugar. Food labeling is often misleading, giving consumers the impression that they are consuming healthy products when in fact they are consuming a lot of sugar. This particularly affects products marketed towards children, such as sweets advertised with health-promoting additives like milk. Finally, we also need to put more emphasis on nutrition and exercise in schools. Cooking classes and more exercise could help children learn to eat healthily and stay active. Healthy eating is often more expensive and time-consuming, and quick, unhealthy meals are a convenient solution, especially for working parents. It is therefore important that society strikes the right balance between promoting healthy eating and accommodating the day-to-day lives of families.”
Dear Dr. von der Groeben, thank you very much for the comprehensive and clear explanation of weight loss injections!
