The success of obesity treatment is decided after the operation
Severe obesity with all the possible secondary diseases such as type 2 diabetes is one of the widespread diseases in the developed industrialised countries and the number of cases is increasing. Not only in the USA, but also in Europe, morbid overweight (obesity) is rampant. Both in Germany and Switzerland, more and more clinics are specialising in the medical and, above all, surgical treatment of heavyweight contemporaries. Accordingly, surgical procedures are performed more frequently in obesity surgery than they were a few decades ago. Stomach reduction, tube stomach or gastric bypass are the keywords for operations related to obesity. While in Germany, according to current surveys, there is an almost complete lack of professional aftercare, in Switzerland, for example, the Centre for Bariatric Surgery (ZfbC) also sets a good example in the aftercare of patients.
Without lifelong follow-up, the success of bariatric surgery is at risk
A stomach reduction, in whatever form, is the only way out of the vicious circle of obesity, secondary diseases, lack of exercise and even more obesity for many obese patients. In Germany, but also in Switzerland, clinics have specialised in surgical interventions for obesity and provide patients with at least short-term hope for change. However, in Germany in particular, this hope remains a mere expectation. Because even more important than the success of the actual surgical intervention is the subsequent aftercare. And in most cases, this will be necessary for a lifetime. Postoperative care for obese patients is by no means limited to the control of small scars or wound healing in the gastrointestinal tract. More importantly, after such an operation, patients have to change their whole life decisively. This starts with a new form of nutrition, continues with controlled nutritional supplementation, for example with vitamins, trace elements and protein, and ends with a new way of learning sensible exercise. Only a corresponding change in lifestyle habits can ensure the success of bariatric surgery in the long term and thus make the lives of overweight patients better.
All experienced medical specialists, nutritionists, physiotherapists and psychotherapists agree on this. However, there is a lack of concrete implementation of such follow-up treatment and further care in Germany. As the Norddeutscher Rundfunk NDR recently revealed in a contribution to the health magazine “Visite”, the concept of follow-up treatment is poorly neglected in Germany and virtually not established at all. One of the reasons for this is that the health insurance companies neither include such a lengthy to lifelong care for patients in their cost catalogue, nor do they seem to be interested in it. Anyone who has managed to get an overweight operation financed by German health insurance funds at all is often left alone and downright to fend for themselves afterwards.
Accordingly, few patients then find their way to nutrition counselling and further care. Until the body again sounds the alarm and all short-term successes of bariatric surgery are acutely endangered. Those who are financially well off will treat themselves to the necessary aftercare if they have sufficient insight and self-discipline. Those who are less well-off or do not even know how important further care is, do not act at all at this point due to ignorance or lack of financial mass and thus endanger not only the success of the overweight operation, but their health in general.
The German health system clearly has a duty here and must find ways to ensure that bariatric surgery does not turn into an odyssey through the clinical pictures of accompanying secondary diseases.
Switzerland sets a good example
It’s different in Switzerland. Here too, medical centres such as Swiss1Chirurgie, together with the Centre for Bariatric Surgery in Bern, have dedicated themselves to surgical interventions for morbid obesity. Unlike its German neighbours, however, the focus here is on the protracted nature of such interventions from the outset. Only patients who are willing to receive lifelong counselling and support are even considered for bariatric surgery. This is already addressed in the initial talks and is also consistently enforced after the interventions. Of course, always with the cooperation of the patients and all the professionals needed for this.
This methodology is also supported in principle by the Swiss health care system. Here it is clear that anyone who has to undergo bariatric surgery will need the support of the relevant specialists such as internists, nutritionists, physiotherapists and psychotherapists for a long time afterwards, if not permanently. This is the only way to ensure the long-term success of obesity surgery, which ultimately not only benefits the health of the patients, but also significantly minimises the follow-up costs due to a lack of follow-up care.such as internists, nutritionists, physiotherapists and psychotherapists.
It remains questionable whether this insight will be reached in Germany in the near future. While the health care system there mainly works on apparent undesirable developments and deficiencies, most obesity patients remain on their own, with or without bariatric surgery.
We have provided more information on the “Visite” report by NDR here http://bit.ly/ndrnachversorgung.
|Dr. med. Michèle Gasser
Dr. med. Claudia Meier
Dr. med. Yvette Ottiger
Dr. med. Stefan Schäfer
Dr. med. Rudolf Steffen
Dr. med. Jörg Zehetner
|Dr. med. Jörg Zehetner
MMM, FACS, FEBS (hon.)
PD Dr. med. Rudolf Steffen
Dr. med. Alejandro Metzger