Around 62% of men and 43% of women in Germany are currently overweight (= BMI > 25). Around 25% of all adults are considered obese (= BMI > 30). The number of overweight people has risen sharply in recent years, mainly due to a lack of physical activity and an unhealthy, high-calorie diet.
The so-called BMI (= body mass index) is a value calculated from height and weight (body weight [kg] / height squared [m²]), which is used in medicine to classify weight. A BMI between 20 and 25 is considered a medically healthy normal weight; a BMI of 30 or more is referred to as obesity. Obesity is divided into three grades:
- BMI > 30 = grade I
- BMI > 35 = grade II
- BMI > 40 = grade III
Long-term obesity often leads to concomitant diseases such as high blood pressure, lipometabolic disorders (such as an elevated cholesterol level) with cardiovascular risks or diabetes mellitus with long-term consequences such as damage to the kidneys, nerves, blood vessels and eyes.
Obesityis defined as severe overweight that is harmful to health @ BillionPhotos.com /AdobeStock
Stomach reductions are only performed on patients who are severely overweight (BMI > 35).
In addition, conservative (i.e. non-surgical) treatment should have been carried out for at least 24 months according to defined quality criteria and organic and otherwise treatable causes of obesity (such as hypothyroidism and other hormonal diseases) must have been ruled out.
Operations on the stomach generally fall within the field of visceral surgery and gastroenterology. Specialists in visceral surgery can specialize in stomach reductions for obese patients and thus become obesity surgeons.
There are specific obesity centers, i.e. clinics or departments that provide interdisciplinary care for patients with obesity, bringing together a wealth of experience under one roof.
The most common forms of stomach reduction are
Gastric bypass involves reducing the size of the stomach and shortening the small intestine @ sakurra /AdobeStock
A large part of the stomach is removed during gastric sleeve surgery. This procedure is purely restrictive, i.e. it reduces the volume of the stomach.
With gastric bypass, in addition to reducing the size of the stomach, the absorption distance (= the distance of the small intestine in which nutrients are absorbed) is shortened.
In gastric banding, a band is placed around the stomach, which is connected to a chamber under the skin with a tube. This makes it possible to fill the gastric band with more or less fluid as required, thus reducing or increasing the passage of chyme from the small forestomach through the band into the main stomach.
All three operations can be performed laparoscopically (keyhole technique), which causes significantly less wound pain after the operation and enables faster mobilization and earlier discharge from hospital.
Every stomach reduction involves a risk, albeit a small one. Perioperative risks (in the time surrounding the procedure) and possible complications include wound healing disorders or cardiovascular problems such as thrombosis.
Possible late complications include adhesions or incisional hernias. However, the risk of these late complications has been significantly reduced by the introduction of the laparoscopic surgical technique.
Overall, in overweight patients who meet the criteria for surgery, the surgical risks are considered to be lower compared to the long-term consequences of morbid obesity.
Post-operative medical follow-up care is required after each of these stomach reduction procedures. For example, vitamin B12 supplementation in the form of a three-month injection is always indicated after gastric bypass surgery and often after gastric sleeve surgery for the rest of the patient's life.
The position of a gastric band should be checked regularly by endoscopy ( gastroscopy).
For long-term weight reduction, a consistent change in diet under medical supervision is essential.
The effectiveness of bariatric surgery varies for each procedure, but has been proven by a large number of clinical studies. With weight reduction, accompanying diseases such as
- High blood pressure,
- diabetes mellitus or
- lipometabolic disorders such as an elevated cholesterol level.