Dr Sylvia Weiner is the Head of Bariatric Surgery at Sana Klinikum Offenbach and enjoys an excellent international reputation. Her particular expertise in assessing quality of life following bariatric surgery makes her one of the leading experts in her field. Together with Dr Anne Freund, she founded the Obesity Academy, a leading institution in Kelkheim in the Taunus region of the Frankfurt-Rhine-Main metropolitan area, dedicated to the prevention and treatment of obesity.
With an experienced team of doctors and therapists, she offers a comprehensive program based on decades of expertise, comprising a wide range of information sessions, training courses and workshops. However, should surgery become necessary, Dr Weiner is an expert in bariatric surgery. She performs all standard procedures, such as the Roux-en-Y gastric bypass or sleeve gastrectomy, and also has extensive experience with endoscopic procedures such as the gastric balloon.
Dr Weiner places particular importance on post-operative care, drawing on her pioneering work in developing the ‘Bariatric Quality of Life Index’. These validated assessment tools help her to improve her patients’ quality of life in the long term. Through her ongoing research and dedication, Dr Weiner remains at the forefront of scientific developments and innovative surgical methods.
The editorial team at Leading Medicine Guide had the opportunity to speak with Dr Weiner and learn more about the unfortunately widespread condition of obesity and about the Obesity Academy, where people can truly find the help they need.
Obesity is a chronic condition characterized by excessive body fat and can have serious health consequences. It represents a growing global health problem. Worldwide, more than 650 million adults and 124 million children and adolescents are affected. This condition not only significantly impacts the quality of life of those affected, but is also a major risk factor for numerous serious diseases such as diabetes, cardiovascular disease and various types of cancer. In view of these alarming figures, it is crucial to develop and provide effective treatment strategies and comprehensive support systems for people with obesity.
“Unfortunately, there is an ever-increasing need for the care of obesity patients, many of whom undergo surgical treatment. However, patients first and foremost want to receive good advice, independent of a surgical obesity center. Many specialists are not particularly well-versed in the subject of obesity either, and so we have created the Obesity Academy, an institution where affected patients can be advised on all treatment options. This covers options within surgery, nutrition, behavioral therapy and drug therapy. We offer training courses on nutrition and behavior at the Academy. This is because, before starting any treatment, it is vital that any gaps in knowledge are filled and that the patient is well informed. Unfortunately, patients often underestimate how important this information ultimately is for achieving the desired outcome. In the outpatient sector, there are no training programs available for GPs, so with the Academy we have filled an important gap and can provide holistic care for patients with our in-house doctors,” explains Dr Weiner at the start of our conversation, adding further important information about the Academy:
“Our Academy program is also designed to ensure that patients seek information at an early stage. This is because many people go through an unnecessarily long ordeal, which is partly due to a lack of counseling services. People who feel they are too heavy or who have what they consider to be a ‘minor’ weight problem can also come to us. Anyone can book courses with us. Initially, this is a self-funded service (comparable to the cost of a hairdresser or beauty salon), but the invoice can be submitted to the health insurance provider for reimbursement. Fundamentally, these courses are a good investment, whether for prevention or to avoid potential complications arising from being overweight. We also provide clear information on drug therapies, such as ‘weight-loss injections’ (containing the active ingredient semaglutide), which must be administered under medical and laboratory supervision and should be accompanied by nutritional counseling. Here at the Obesity Academy, we believe in the empowered patient who can develop and play an active role – we see the patient as a partner.
Is there a genetic predisposition?
There are a large number of genes whose variants are associated with the risk of obesity. These genes regulate a wide range of physiological processes that influence body weight, including appetite control, energy expenditure, fat metabolism and the distribution of adipose tissue in the body. Some of these genes directly influence the tendency to gain weight, while others act indirectly, for example by influencing metabolism or regulating feelings of hunger and satiety.
“There are no reliable methods that can indicate a genetic predisposition to obesity. The evidence is minimal. Although there is a genetic component, it cannot (yet) be measured. A change in the body’s metabolism can be detected, but we cannot say with certainty which glands or hormones are responsible. An initial consultation with the patient does provide a few clues, but ultimately you have to take the bull by the horns and tackle the condition systematically with experienced experts,” explains Dr Weiner.
Psychological factors and personal eating habits play a crucial role in the development and treatment of obesity.
Stress, depression and eating habits are three key factors that can not only contribute to the development of obesity but also influence treatment outcomes. Stress is a common feature of modern life and can lead to unhealthy eating habits. Chronic stress can impair metabolism and increase cravings for unhealthy foods, which in turn promotes weight gain. In therapy, stress management training can help reduce stress and develop healthier coping strategies. Depression is another psychological factor closely linked to obesity. People with depression often face an increased risk of becoming overweight, as the condition can reduce interest in healthy eating and physical activity. Treating depression through psychotherapy and/or medication can therefore not only improve mood but also increase the chances of successful weight loss.
“Ultimately, the cause doesn’t matter – we have to treat obesity! Of course, there are environmental factors that contribute to obesity. The food industry also contributes to some people becoming increasingly overweight. In such cases, it is important to help the patient adjust their shopping and eating habits. Ultimately, however, obesity is a chronic inflammatory metabolic disorder that does not affect everyone to the same degree,” Dr Weiner explains.
Disordered eating habits such as emotional eating, binge eating and compulsive overeating are common side effects of being overweight. In therapy, behavior-based approaches such as cognitive behavioral therapy can be used to address the underlying eating patterns and promote healthier habits. A multidisciplinary approach is required to effectively integrate these psychological factors into therapy. A team of doctors, dietitians, psychologists and other specialists can provide comprehensive care that takes medical, nutritional and psychological aspects into account. A holistic treatment that addresses both physical and mental health can improve the chances of successful weight loss and long-term weight management.
In recent years, various new technologies and pharmacological approaches for the treatment of obesity have been developed, some of which are showing promising results.
Endoscopic procedures offer minimally invasive approaches to treating obesity. These include procedures such as endoscopic intragastric balloon therapy, in which a balloon is placed in the stomach to create a feeling of fullness. These techniques are less invasive than surgical procedures. “We can provide advice on this at the Academy. This is because the long-term results of these endoscopic procedures are not convincing. The treatment is also costly and time-consuming,” Dr Weiner makes clear.
Some promising drugs include GLP-1 receptor agonists, which are also used to treat diabetes, as well as preparations that influence the brain’s reward center to reduce the desire to eat. “These drugs mimic the effects of the body’s own messenger substances, which are produced in the small intestine and then act on various organs such as the liver, heart or stomach, thereby boosting the metabolism. Unlike a normal diet, your basal metabolic rate isn’t reduced, but you have less appetite and feel less hungry. This drug therapy is suitable for people who are overweight up to 100–120 kilos, depending on their height. If you take the medication, you can reach a normal weight within about three months, but you should continue to take a maintenance dose long-term. Here too, accompanying nutritional advice or stress management is advisable, which is why we offer the relevant accompanying courses at the Academy. We try to make things as simple as possible for patients at this stage. You can start by registering with us online, finding out more, and then perhaps signing up for the courses on offer. Once the patient is on board, the rest falls into place. Because the biggest hurdle for the patient is that initial step. And with us, that’s easy,” explains Dr Weiner emphatically.
Obesity is closely linked to an increased risk of a wide range of associated conditions, including diabetes, cardiovascular disease and certain types of cancer.
In the case of diabetes, excess fat tissue plays a role in the development of insulin resistance, which can lead to a rise in blood sugar levels. Weight loss through a healthy diet and regular physical activity can significantly reduce the risk of type 2 diabetes and improve blood sugar control.
“Cardiovascular diseases are a common consequence of obesity, as excess fat tissue can promote inflammation in the body, raise blood pressure and affect cholesterol levels. This increases the risk of heart attack, stroke, heart failure and high blood pressure, which can lead to premature death. Obesity is also associated with an increased risk of cancer. The long-term damage to joints can also be immense. Those who do not seek treatment for obesity can expect their life expectancy to be reduced by 10–20 years. Ideally, weight loss should take place before such joint damage occurs and before the first heart attack. The later treatment begins, the worse the consequences,” states Dr Weiner.
Bariatric surgeries, such as gastric bypass, sleeve gastrectomy and gastric banding, are not only aimed at reducing body weight but also have far-reaching effects on patients’ quality of life and well-being.
Dr Weiner first explains the steps taken prior to surgery: “Before surgical treatment can be carried out, a six-month conservative preparatory program involving dietary changes and behavioral therapy takes place. The various surgical procedures are then discussed, with the main methods being sleeve gastrectomy and gastric bypass. We explain everything to the patient at this stage. Once all preparations have been completed and the patient has also undergone a psychological assessment – which, incidentally, can be arranged directly through the Academy – the operation can be scheduled. The operation is minimally invasive, and the patient can go home as early as the second day. It is an almost outpatient procedure, carried out at the Sana Clinic by experienced surgeons. The Sana Clinic, my employer and also a partner of the Obesity Academy, is a center of excellence with the highest number of obesity surgeries in Germany (approx. 800 per year) and maintains a correspondingly high standard of safety.
Reducing body weight improves insulin sensitivity, which can help to control or even reverse diabetes. Blood pressure and cholesterol levels can also improve, reducing the risk of cardiovascular diseases such as heart attacks and strokes. In addition to the physiological improvements, many patients also experience a significant increase in their mental well-being. Weight loss can boost self-esteem and life satisfaction. The ability to move freely and without restriction can also contribute to increased self-confidence and better mental health. However, the experience following bariatric surgery is characterized not only by physical and psychological improvements, but also by challenges and adjustments. The process of weight loss and adapting to a new lifestyle can be difficult for some patients. This can involve emotional turmoil, difficulties in social adjustment, and challenges in adapting to new eating habits and exercise routines.
Post-operative care for patients following bariatric surgery is crucial to ensuring their long-term success and preventing potential complications. This care encompasses various aspects that work together to provide the best possible support for patients.
Following bariatric surgery, patients must learn to adapt to their new dietary habits. Nutritional counseling helps them ensure they receive adequate nutrients, avoid deficiencies and develop healthy eating habits in the long term. Psychological support is another important component of aftercare. Many patients go through an emotional adjustment process after surgery and may be confronted with feelings such as loss, grief, anxiety or uncertainty. Ongoing psychological support can help them cope with these challenges and improve their mental wellbeing. In addition, encouraging exercise and physical activity is of great importance. Regular exercise is vital for health and well-being following bariatric surgery and can help support weight loss and improve overall fitness.
“As part of further treatment following bariatric surgery, the patient receives additional educational support or individual counseling. For one to two years, the patient visits us at regular intervals so that we can assess their progress. After that, an annual outpatient check-up takes place. Patients who are severely overweight and undergo surgery lose approximately 70–85% of their excess weight within a year. Patients undergoing drug therapy lose approximately 20% in a year. People respond very differently to the treatments. A combination of surgery and drug therapy is also possible, and a second surgical procedure is a viable option, as a slight weight gain after around 5–10 years is quite normal. Ultimately, everyone’s body is different. The better patients are supported through their treatment, the more stable the results,” says Dr Weiner, adding one further wish:
“With the Obesity Academy, we have created a fantastic resource for patients with obesity. However, there should be such advice centers throughout Germany that operate independently of surgical clinics, so that patients can have easy access to a wide range of treatment options. If I could make a wish, it would be that we had centers throughout Germany so that everyone could access treatment at an early stage, even if they are only slightly overweight, and without being stigmatised. Because then so many people wouldn’t need to undergo surgery. Currently, there are around 30 million overweight people in Germany and approximately 1.4 million with a medical indication for surgery. “In any case, everyone who is overweight is welcome here!”
Thank you very much, Dr Weiner, for this important information about obesity and your Obesity Academy!
