Bariatric Surgery

Obesity surgery is a speciality of visceral surgery and is also called bariatric surgery. This medical specialty includes all surgical measures to combat obesity. Interventions in obesity surgery are in most cases only performed on the stomach tract, but in individual cases they can also extend to the intestinal tract.

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Bariatric surgery for overweight and obesity - Further information

Definition and prevalence of obesity

The term obesity refers to an excess of body fat that can lead to health consequences. The calculation basis for weight is the body mass index (BMI). The normal BMI for adults ranges between 18.5 and 24.9 kg/m2, a BMI between 25 and 29.9 kg/m2 is referred to as overweight, and a BMI above 30 kg/m2 is referred to as obesity.

The prevalence of overweight and obesity has been increasing continuously for many years. Both being overweight and obese are associated with an increased risk of diseases such as diabetes mellitus and cardiovascular diseases, especially if the BMI is 25 or more. Conservative treatment should be used if the BMI is above 30 kg/m2 or between 25 and 29.9 kg/m2 and if there are also weight-related health problems such as shortness of breath, performance problems, joint problems or metabolic disorders (e.g. diabetes, metabolic syndrome).

What should be considered when treating overweight (obesity)?

In addition to simply losing weight, it is important to stabilise your weight in the long term. Each treatment should be based on a so-called basic program, consisting of a combination of dietary change, exercise and behavioral therapy. In the case of severe forms of obesity, which involve major health risks due to secondary diseases and in which a change in diet, exercise and behavioral therapy cannot achieve sufficient weight loss, additional medication or surgical therapies (bariatric surgery) should be considered.

However, surgical therapy should only be performed if a conservative (non-surgical) therapy lasting 24 months has not brought sufficient success or if the patient has a BMI of more than 35 kg/m2 or a BMI of more than 35 kg/m2 with severe weight-related secondary diseases (diabetes, joint wear, cardiovascular diseases). In Switzerland, patients with a BMI of 35 may already undergo bariatric surgery.

What needs to be considered before performing bariatric surgery?

A surgery always involves certain risks, so the decision must be carefully considered. The decision is always made by the doctor and the team of the obesity center together with gastroenterologists, nutritionists and the patient. As a rule, the first point of contact is the general practitioner who, ideally, knows and suggests a colleague specialising in bariatric surgery - who usually works in an obesity centre.

After the surgery and the initial post-operative treatment, the follow-up, long-term treatment will continue to be carried out by the obesity specialists, especially when it comes to maintaining the weight reduction achieved by the surgery in the long term. It is crucial that even in the case of bariatric surgery, the patient always has a major part to play in the success of the treatment.

For example, the patient has to change his or her lifestyle which includes a balanced diet through a radical change in diet, a change in eating habits and sufficient exercise. It is therefore important that those affected are motivated and fully informed about bariatric surgery, its opportunities, but also its risks and possible long-term consequences. This usually requires multiple consultations that leave enough time to make a balanced decision.

Bariatric surgery should always be performed in specialized clinics - e.g. in an obesity center - where the entire spectrum of bariatric surgery is offered, so that the patient can make a good personal choice. The decision as to which procedure of bariatric surgery is suitable for the individual patient depends, among other things, on the BMI, the personal risk of the patient, additional illnesses and the wishes of the patient. A dietary consultation prior to the surgery would be ideal. The aim of the consultation is to analyse the eating behavior and to change the diet.

Which examinations should be performed prior to a bariatric surgery?

Prior to the surgery, a detailed anamnesis should take place in addition to a detailed consultation and information session. A thorough physical examination, including an ultrasound of the abdomen, is also indispensable. As a rule, an additional gastroscopy is carried out, during which the esophagus and duodenum can also be examined (esophageal gastro-duodenoscopy). Other physical causes of overweight or obesity, such as hypothyroidism, should be ruled out prior to an obesity surgery. In addition, BMI and body fat distribution should be accurately documented.

It has proven beneficial to reduce weight as much as possible through dietary changes and regular exercise prior to obesity surgery, because this is associated with better and more effective long-term results. A detailed examination of the cardiovascular system should also be carried out, since a surgery always puts a strain on the cardiovascular system and obesity, which has existed for some time, can be accompanied by diseases of the cardiovascular system. In addition, an examination by a lung specialist can be carried out.

Laboratory examinations are also part of the routine prior to bariatric surgery. In addition, an interview with a psychologist and even a detailed examination by a psychiatrist is necessary prior to the surgery, as overweight or obesity can be accompanied by certain psychological ailments or diseases. Also, about one in four patients who decide to undergo bariatric surgery is affected by a so-called binge eating disorder, which leads to excessive uncontrolled attacks of eating.

What options does bariatric surgery have to offer?

Possible bariatric surgery procedures are based on two basic principles. One principle is the limitation of possible food intake, so the procedures that follow this principle are also called restriction procedures. The second principle is based on the idea of limiting food intake by reducing the amount of food that enters the body. These procedures are known under the term malabsorption.

The aim of the first principle, restriction, is to significantly reduce the intake of solid foods, regardless of their quality and type. The following mechanisms are effective in malabsorption: reduction of the intestinal surface through which food can be ingested; acceleration of the gastrointestinal passage, also with the aim of reducing the amount of food that can be ingested during the passage of the food paste; and deficient digestion by eliminating digestive juices.

The most frequently used restrictive bariatric surgery procedures include the gastric band and the gastric sleeve. Malabsorptive procedures include biliopancreatic diversion (BPD), in which a reduced residual stomach is connected to a short loop in the small intestine that does not release digestive juices, and gastric bypass.

Is liposuction also a procedure in bariatric surgery?

Liposuction is a procedure used in plastic surgery that can be performed to remove excess fat deposits in certain limited areas (locally). Liposuction is not suitable for the treatment of overweight or obesity, both of which affect the whole body. Plastic surgery may be needed only after successful weight loss to remove excess skin, firstly from an esthetic point of view, but more importantly to eliminate the risk of skin infection.

What are the risks of bariatric surgery?

In compliance with safety recommendations, bariatric surgery is associated with a relatively low risk. Sometimes untreated obesity shows a significantly higher mortality rate. Nevertheless, bariatric surgery should be performed in specialised clinics or centers where experienced surgeons familiar with bariatric surgery work.

Are the costs of bariatric surgery covered by health insurance funds?

In order for the health insurance fund to cover the costs of bariatric surgery, the following requirements must be met:

  1. The patients suffers from grade III obesity, i.e. a morbid overweight with a BMI higher than 40, or a grade II obesity, i.e. a morbid overweight with a BMI higher than 35 in combination with other serious diseases associated with obesity (e.g. high blood pressure, diabetes II, sleep apnoea).

  2. Prior to surgery, a conservative (non-surgical) therapy lasting 12 to 24 months consisting of nutrition, exercise and behavioral therapy (possibly an additional drug therapy) was carried out under medical supervision and a further conservative therapy is not deemed promising.

  3. The patient is aware that bariatric surgery always represents a risk and that a lifelong aftercare (e.g. taking vitamins and trace elements) may be necessary after surgery.

  4. Those affected are willing and motivated to change their lifestyle (especially their eating and exercise habits) after surgery.

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