Aftercare in the focus of obesity surgery

Interview with Dr Steffen, ZfbC

In an in-depth interview, Dr Steffen from the Centre for Bariatric Surgery ZfbC discusses the importance of follow-up care for overweight patients. In addition to the actual bariatric surgery, structured aftercare is of enormous importance. Only if those affected are actively involved in the process throughout their lives is sustainable success possible. A detailed article on the interview and the interview with Dr Steffen himself can be found here.

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Aftercare in the focus of obesity surgery

Anyone who talks about bariatric surgery, such as stomach reduction or the formation of a tube stomach, must also talk about professional aftercare and further treatment for patients.

This is exactly what Dr Steffen from the ZfbC, Centre for Bariatric Surgery, does in the featured video interview. With over 30 years of experience and 3,600 stomach operations performed himself in the field of obesity surgery, Dr Steffen is one of the leading luminaries in this medical speciality in Switzerland.

Evaluation of the risks

Whether gastric banding, gastric bypass, stomach reduction or other techniques, there is always a certain risk of relapse for the treated patients. It is precisely the reduction of the recidivism rate, ZfbC, when it comes to professional aftercare following obesity surgery. Dr Steffen makes this unmistakably clear.

Obesity treatment is a lifelong process

It should also be clear that after an initial operation for the majority of those affected, there will be further interventions to ensure the success of obesity surgery. At the same time, this means that in the majority of cases, surgery alone will not be enough for the rest of one’s life. Accordingly, it is important to accompany and care for the patients continuously and individually in the aftercare.

Children in obesity surgery

According to Dr Steffen, children are not excluded from the problem of morbid obesity. Fat children usually also become fat adults, so that early intervention can make sense if there is an appropriate indication. It is important to note that the rules and regulations for bariatric surgery must also be observed for minors.

Follow-up care is the decisive success factor

Dr Steffen believes that ongoing follow-up care is more important than the timing of the surgical intervention. From experience, he knows that many patients do not take proper care of themselves after an initial overweight operation has been performed. However, it is also the professional colleagues who must be held accountable, as they do not always focus on special aftercare in their further care. Here, the ZfbC can definitely fill treatment gaps. One should understand morbid obesity similarly to an incurable disease, so that a good strategy for lifelong aftercare must be presented here as well. What Dr. Steffen cannot understand is the fact that he repeatedly encounters patients who are left alone in their problem situation after obesity surgery and are not sufficiently perceived.

Accordingly, the ZfbC would also like to open up to patients who have not been treated in a Swiss1Chirurgie clinic or an affiliated clinic. Here, anyone who complains about a wide range of problems after bariatric surgery should get a sympathetic ear and professional support. What definitely does not work is that patients are simply left to their own devices after obesity surgery with reference to their diet programme. This contradicts every ethical and medical claim.

It should also be clear in this context that anyone who cannot successfully deal with their excess weight before an operation will not be able to do so without help even after the operation has taken place.

Understanding aftercare as a standard

For Swiss1Chirurgie, structured aftercare is part of the standard in obesity surgery. Even though this is unfortunately not the case everywhere, the experts at Swiss1Chirurgie, together with the ZfbC, attach great importance to professional and structured aftercare in the best interests of the patient. This is the only way to ensure initial success, to identify problems in time and to build on the long-term success of the therapy. Anything else doesn’t make much sense.

It is also worth noting that deficiency symptoms can always occur due to the way the different treatment methods work. Such processes must of course be monitored and controlled to show patients how to compensate for certain deficiencies such as calcium deficiency or vitamin deficiency.

Follow-up care for overweight patients is a team effort at ZfbC. In addition to Dr Steffen himself, other specialist colleagues also devote themselves to the patients’ problems in special aftercare consultations. Around 8,000 patients are now being cared for. In the regulations, the Federal Office of Public Health requires follow-up over five years. However, the experts at Swiss1Chirurgie know that, in fact, lifelong follow-up of patients is sensible and necessary. Here, the legislative requirements obviously fall short.

Complications can occur at any time

The problems of the individual patients are very different. The aftercare must be correspondingly individualised. Some of the problems are real complications such as chronic abdominal pain, persistent diarrhoea, deficiency symptoms, vomiting or other functional problems. In principle, every affected person must expect that some kind of problems will occur over a short or longer period of time. Even if this ultimately does not affect everyone, it is still a clear proportion of patients who have to deal with certain problems after obesity surgery.

Alcohol and obesity

As Dr Steffen clearly explains, alcohol has a special effect on obesity and even more so on patients treated accordingly. In his opinion, alcohol has just as high a caloric value as pure fat, in addition to the typical symptoms of intoxication. Accordingly, it makes little sense or is even counterproductive for overweight patients to consume alcohol beyond a low level. The best thing would be to abstain completely from alcohol. This is also the aim of good aftercare.

With every intervention, the risk increases

Regarding the general risks in obesity surgery, Dr Steffen emphasises that laproscopic surgery as such is first of all extremely safe and associated with only a few risks. The first operation is always less risky than every subsequent one, although it also depends on how experienced the surgeons are in the respective clinics. Much more common are the complications that can occur after the procedures. First and foremost are deficiency symptoms, digestive problems and problems in the area of the oesophagus. This must always be expected after obesity surgery, which is why lifelong aftercare is also sensible and recommended. This must also be clear to the general practitioners and is already addressed in the first educational discussion.

Obesity and Corona

Currently, the corona virus plays a significant role in society as a whole. Those who are overweight must expect a more severe course after an infection due to their physical constitution. If overweight people already have breathing problems, these will certainly be even greater with COVID disease, even more so with assisted or artificial ventilation. It is difficult to decide not to operate on overweight people now, as they will then be much more affected in the event of an infection later on.

The role of general practitioners

The first way for overweight people who want to improve their situation is always to see their family doctor. The latter will then make a referral to the specialists in the given case. Here, the Swiss1Chirurgie clinics are recommended as competence centres for bariatric surgery. The family doctor could also be the first point of contact for appropriate information to the patient. In addition, we as Swiss1Chirurgie offer a comprehensive information service for all those affected. This ranges from our special consultation hours to the detailed and extensive information on the internet and via our app. However, information about any site or place on the internet is always associated with the risk of getting the wrong information. Here, Dr Steffen likes to refer to the pages of Swiss1Chirurgie, which, in contrast to any forums or chat rooms, provide extremely professionally correct, comprehensive and structured information.

Beer belly – men and the trivialisation of overweight

Whether at the football pitch or in the bar, men don’t hide their beer belly, but the 10-15kg overweight is proudly carried in front of them. No one should make fun of it, but the topic must be addressed and discussed with sensitivity. People like to keep quiet about their supposed beer belly, even at the doctor’s, even at physiotherapy or during sports.

“Male obesity”. This cannot simply be categorised as “gluttony” or “self-indulgence”. Male obesity has as many causes as it has manifestations. It primarily affects men from middle age onwards, who (like women) are undergoing a particular type of metabolic change.

Recording from 3.9.2021 ” Saaserhof” in Saas-Fee Overweight: Beer Belly & Love Dumbbells as a Danger? by J. Zehetner, MD

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Particularly with increasing age, the body strives for developmental reasons to store food reserves as fat reserves, so to speak, in order to provide for possible shortages. Especially for men who consume fewer calories than they take in due to their occupation or limited exercise, this quickly leads to unwanted excess weight. Organic processes in particular play an important role here, which cannot be “switched off” so easily.

While there is often talk of dieting and smaller portions, the topic of alcohol and alcohol consumption is talked down, ridiculed and negated, especially among men. However, liquid foods such as beer and wine contain many hidden calories that are not readily counted. The energy drinks that have become fashionable, various shakes and also protein shakes (although healthy) are also energy suppliers and usually high in calories. Fruit juices and smoothies in particular are easily consumed on the side without thinking about how much sugar is being consumed.

Obesity is now more common than malnutrition worldwide. The real problem is predominantly to be observed in the western industrialised countries, since it is precisely here that there is an ever-increasing oversupply of food at all times. The obesity rate in the USA, for example, is around 35-40 percent of the population, which is a fact that should not be underestimated. This means an overweight of at least 20 kilograms, or a BMI of 30 or more. This is also the case despite the surgical intervention options, although these methods in particular can now be classified as very safe and successful. Nevertheless, the rate of surgical interventions needed in this particular area is far too low.

The topic of beer bellies – as the starting point of the discussion – is not only about informing the population and professional colleagues accordingly. Rather, I see it as important to educate about the modern treatment options of bariatric treatment methods up to surgery. The primary aim is always to help patients according to their individual starting situation.

Information on the topic of obesity

It is important to understand that obesity is always associated with concomitant diseases. Diabetes, high blood pressure, sleep apnoea, high cholesterol – all these manifest themselves in the environment of obesity. But there is also another aspect that has emerged, especially in recent years. The point is that people who are overweight are simply stigmatised. At school, at work and even in private life, overweight people are described as lazy, fat, greedy, careless and lazy about exercise. This puts additional stress on those affected and does not help to tackle the problem in a targeted and conscious way. Significant overweight has been defined as a disease since 2013 at the latest. This puts morbid obesity in the same category as diseases such as diabetes, high blood pressure and many other chronic diseases.

The stigmatisation of obesity is extremely dangerous for patients, as they then withdraw and cannot address their actual problem in a targeted and active way. Professional treatment, counselling and support is the surest way out of obesity.

Everyone is challenged to exercise some restraint in their contact with morbidly obese people, both in their choice of words and in their behaviour. Even if it’s “only” about the supposed beer belly.

Why specifically “men who are overweight”?

Yes, women also suffer from morbid obesity. But men do it in a special way. There are now “curvy models” for women, but not for men. And men by nature already tend to eat the slightly larger portions, even if that seems to be gradually declining. The world view was and still is such that a belly is always subconsciously associated with prosperity. Also in modern industrial societies. The dangers are mostly conscious, but are only realised when they are actually there, visible and sometimes already tangible.

In addition, after a certain stage of life at the latest, men do not have this special view of their appearance that many women have. The actual problem is not recognised, or is recognised only very late, and is then gladly accepted as natural. This means that they don’t have to go to the doctor, and the obesity surgeon is an unknown quantity for many of those affected. Therefore, men in particular must be sensitised to actively face this problem.

What starts with a beer belly that is not taken seriously often ends in an overweight catastrophe, unless the right steps are taken in time, for example to a Swiss1Chirurgie clinic.

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