Bariatric Surgery – Specialists and Information

Bariatrics, from the Greek báros (heaviness, weight) and iatrós (physician), deals with the prevention and treatment of morbid obesity.

Often, conventional measures are no longer effective in helping severely obese individuals achieve lasting weight loss. In such cases, bariatric surgery is the only remaining option.

Specialists have various procedures at their disposal. These aim to reduce the size of the stomach or bypass it. This helps limit both the feeling of hunger and the amount of food consumed. As a result, the body metabolizes significantly fewer calories.

Typically, bariatric medicine encompasses a range of medical subspecialties that work together to help patients lose weight. These include, for example,

• endocrinologists,
• internal medicine specialists,
• radiologists, and
• surgeons.

The goal of bariatric surgery is to reduce the negative effects on metabolism and the body. The aim is to achieve permanent weight loss for the patient.

Consequently, the risk of secondary conditions, such as type 2 diabetes mellitus, is also reduced. Weight loss can also slow the progression of joint wear and tear.

The effectiveness of bariatric surgery has been demonstrated in numerous studies. However, a clear life-prolonging effect of the surgery has not yet been proven beyond a doubt. Furthermore, there are studies showing that men were about five times more likely to die within the first 30 days after surgery than women. Long-term mortality rates among men may also remain higher.

In bariatric surgery, the stomach is primarily surgically reduced in size. Various methods are used to reduce the stomach’s volume:

• sleeve gastrectomy,
• a gastric band, which constricts parts of the stomach,
• gastric bypass, and
• biliopancreatic diversion.

The latter two procedures bypass the stomach almost entirely and route food directly to the small intestine.

These surgical procedures are typically performed using the keyhole technique, i.e., minimally invasively. In specialized clinics, the procedures are also often performed with robotic assistance. In such cases, the DaVinci surgical system is used, which can perform the individual steps with greater precision than a surgeon.

The current bariatric guidelines list the following criteria for surgery:

• Patients with a BMI > 40 kg/m² who have no comorbidities
• Patients with a BMI > 35 kg/m² who suffer from obesity-related comorbidities such as diabetes, fatty liver disease, heart failure, or asthma

Another prerequisite for bariatric surgery is that the patient’s conservative weight-loss measures have been unsuccessful.

Surgery will not be performed if, prior to surgical planning, you, for example:

• psychiatric disorders, 
• bulimia,
• alcohol and/or drug addiction,
• cancer, or
• hormonal disorders, or
• if you are currently pregnant or planning to become pregnant.

After treatment or resolution of these conditions, you may be re-evaluated for eligibility for bariatric surgery.

The Role of the Mind

Obesity rarely results from purely physical causes. Psychological factors are almost always involved. This makes accompanying psychological support all the more important both before and after bariatric surgery. 

The surgery does not automatically mean that ingrained behavioral patterns will be shed at the push of a button. Before the procedure, patients are therefore always provided with a treatment agreement that states that long-term follow-up care is necessary to ensure the outcome.

After gastric bypass surgery, lifelong follow-up care and monitoring of progress are required. This is essential for achieving sustainable weight loss.

Bariatric aftercare includes

• regular weight checks,
• sufficient exercise, and
• exercise.

Regular lab tests help determine the need for dietary supplements and vitamins. This helps prevent potential deficiency symptoms resulting from the gastric bypass surgery.

These lab tests should be performed after six and twelve months. After that, they are conducted annually, depending on the type of surgery performed and any underlying medical conditions.

To ensure the success of the treatment, participation in support groups and screening for mental health conditions are also recommended.

Women who have undergone treatment should not become pregnant during the two years following bariatric surgery.

As a result of the significant weight loss, so-called “skin aprons” and “skin flaps” may form. These do not resolve on their own. In such cases, you can seek consultation with a plastic surgeon and undergo body-contouring reconstructive treatment.

For some patients, the cost of bariatric surgery is also a relevant issue; health insurance companies cover these costs only if the procedure is indicated in accordance with clinical guidelines. 

These criteria include a BMI of at least 35 kg/m² and proof of prior unsuccessful conservative treatment within the past two years. In addition, for a body mass index below 40 kg/m², at least one comorbid condition—such as type 2 diabetes mellitus or high blood pressure—must be present.

Specialized obesity centers typically offer assistance with applying for coverage of bariatric surgery costs. You can find recognized experts and contact information in the Leading Medicine Guide. 

Prices vary depending on the surgical technique.