Obesity and sport
2 patients talk about their operation and their experiences
Pathological overweight? Obesity? Is sport still possible here? What is it like after obesity surgery?
Ariane and Tanja tell us about their journey from being overweight to surgery, the advantages and disadvantages, the importance of aftercare, and what they do now in terms of sport.
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.
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.
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 Seilerstrasse 8 |
Dr. med. Jörg Zehetner Professor (USC) MMM, FACS, FEBS (hon.) PD Dr. med. Rudolf Steffen Dr. med. Alejandro Metzger Schänzlihalde 1 |
The Centre for Bariatric Surgery (ZfbC) and Swiss1Chirurgie specialise, among other things, in patients who are seeking comprehensive medical help with accompanying care due to a serious and morbid obesity problem. Prof. Dr. Jörg Zehetner, as the leading mind behind the ZfbC and Swiss1Chirurgie, knows that the path from severely overweight patients to a happier and fulfilled life is not an easy one. For decades, he has treated and cared for patients who nevertheless take this long journey. Clear progress can be seen just as much as an occasional relapse into old habits and the difficult fight against obesity and the prejudices associated with it.
Dr Jörg Zehetner has also been able to count Sina Gossweiler among his patients for several years. Many people know the young woman from the show “Deutschland sucht den Superstar” (DSDS), where the Wattenwil native was able to convince with a magnificent voice, and also got into the recall, but not further. The young singer is also known for her fight against obesity, which she finally took up with the professional help of the ZfbC after some back and forth and repeated self-diets.
A gastric bypass operation was finally the right and appropriate way for her to move into a weight-wise and also psychologically lighter future. It was clear from the beginning that this journey does not end with the surgical intervention, but in fact requires follow-up care in a professional environment throughout life. Sina has fought this battle successfully so far and now feels visibly more comfortable in her own skin. In addition to learning healthy eating habits, as well as exercise and sport, she has now reached a healthy weight.
And in terms of music, too, the signs are pointing to success. Even though the DSDS recall almost exactly a year ago didn’t lead any further, the likeable musician is now standing there with her head held high. With their first single “Everything I Want To Be” they got off to a great start in the charts. As Sina Lark, the self-confident young woman makes her commercial debut in the music business and can already enjoy a great deal of attention.
Not only did her new song run for the first time as Song of the Day on SRF 3 at the beginning of February 2020, but a live performance on 14.02.2020, between 19:00 and 20:00 on the station will also show how consistently and with what passion Sina is looking for the way to the top and has now perhaps even already found it. Then she will present two songs live on the SRF 3 programme “Punkt CH”. Her new single will also be presented as “Hit of the Day” on 14.02.2020.
If you take both the gastric bypass operation and the musical path together, it becomes clear that Sina Gossweiler has already taken the long road very successfully as Sina Lark. This gives the soon to be 21-year-old woman from the canton of Bern even more strength to continue on her path now more than ever. On the one hand, this path leads downwards when it comes to weight. On the other hand, it is also the ascent into a new life that Sina has paved for herself with her musical talent. The fact that both directions always involve a lot of effort, challenges, stamina and also the odd setback is impressively demonstrated by Sina Gossweiler’s still young story.
In the end, it is up to each individual to decide how to deal with his or her own problems. Getting the best help at the right time also proved to be a real stroke of luck in this particular case.
People are more interested in their health and use different sources to inform themselves about healthy lifestyles but also about diseases and their symptoms as well as treatment options. Especially widespread diseases such as obesity (morbid overweight) or reflux diseases (for example chronic acid reflux) are moving further into the focus of public interest and thus also opening the doors to media such as radio or television.
Swiss1 Surgery, led by Prof. Jörg Zehetner, has long been committed to professional public relations and welcomes all measures and ways to promote social awareness of such diseases. Jörg Zehetner sees the stigmatisation of affected women and men as a problem that prevents many patients from undergoing appropriate medical examinations. Ultimately, this leads to a vicious circle, which is associated with a long path of suffering and rarely leads to an improvement in the lives of those affected, usually not at all. Old but also new widespread diseases are not only a problem for those affected themselves. The economy and society as a whole are also affected when rising case numbers lead to more incapacity to work, occupational disability, disability to work and, ultimately, rising health insurance costs.
With a lot of commitment, Jörg Zehetner has therefore now spoken out on the radio as part of his efforts to be heard more in public. On 17 August 2020, as part of the podcast series “Medical Knowledge”, the topic of oesophagectomy (resection of the oesophagus) was a focal point on which the specialist physician at the Hirslanden Klinik Beau Site positioned himself. When and why an oesophagectomy may be indicated was explained very clearly by Jörg Zehetner in just two minutes.
The very next day, 18 August 2020, Jörg Zehetner could be heard again on Radio Bern1. This time on the topic of obesity, which is becoming more and more important as a disease in Switzerland and all other highly developed industrialised countries in the world. Here, too, Jörg Zehetner took a clear position on those affected and, with his many years of experience as a visceral surgeon, spoke about the classic methods of treating morbid obesity.
Here too, Jörg Zehetner impresses with his ability to present the essential treatment options in just two minutes.
Listen to the two podcast contributions from Radio Bern1 in full length here:
https://swiftcdn6.global.ssl.fastly.net/projects/5f3e31531d258/index.html?cb=abhioqr529cv93v8xj8x8
It should be noted that these short podcasts cannot replace a comprehensive and thorough diagnosis and counselling. If you think you are confronted with one of these two problems, contact one of the Swiss1Chirurgie clinics. A visit to the website www.swiss1chirurgie.ch can also be helpful. Extensive content on the subject areas is offered here. In addition, all contact details for Prof. Jörg Zehetner and the Swiss1Chirurgie clinics can be found there.
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.
New information page for patients: www.nachsorge.ch
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
Those who suffer from morbid obesity look for quick solutions. The use of a gastric balloon promises such a quick solution. However, such a gastric balloon is nothing more than a “crutch” in the treatment of obesity. The obesity experts at Swiss1Chirurgie, the Centre for Bariatric Surgery ZfbC and the Gastroenterology Group Practice Bern know this. In the detailed article, the benefits of bariatric surgery are contrasted with the rapid effects of a gastric balloon. Here is the full report.
Those who suffer permanently from severe overweight and feel stigmatised by their social environment often look for quick solutions to reduce their body weight. People affected by obesity and the associated concomitant and secondary diseases want effective measures and treatments to change their life situation. The so-called gastric balloon promises such a quick remedy. Without any surgical intervention, without restrictive diets, in the wrong perception and even without a change in exercise behaviour, a quick weight reduction could be achieved with a gastric balloon. But the first impression is just as deceptive as the first successes.
The gastric balloon is usually inserted into the stomach by means of gastroscopy and filled with a saline solution in the same procedure. Recently, some centres have also been promoting a “swallowable” version – the balloon is swallowed and filled via a tube – without the need for a gastroscopy. This installs a foreign body in the stomach that significantly reduces the stomach volume available for food intake.
As a result, a feeling of satiety is produced even after eating comparatively small amounts of food, but this can be very deceptive. Because of this early onset of satiety, many patients think they can lose weight quickly, easily and permanently with the intragastric balloon without surgery. However, this is often accompanied by complaints such as nausea and frequent vomiting, which indirectly help to lose weight in a rather unpleasant way.
In fact, there are reports that the gastric balloon can be used to lose ten to 25 kilograms over a reasonable period of time. It should be remembered, however, that efficient weight loss attempts are less about quantity and more about the quality of the food. Anyone who consumes very high-calorie drinks, fatty foods or a lot of sugar-heavy food to satisfy their needs after the insertion of a gastric balloon will not automatically achieve success even with the reduced mass. Without a consistent change in diet and exercise, attempts to lose weight are hardly successful in the long term, even with the gastric balloon. Especially since a gastric balloon can only ever be used temporarily.
Experts in the treatment of obesity speak of self-deception with a system when favouring a gastric balloon for weight reduction. After all, such a gastric balloon is a foreign body in the stomach and at best something like a crutch in the treatment of obesity. And a crutch is not a leg on which you can stand safely.
It is also worth considering that the gastric balloon is not a permanent solution. Depending on the quality, such a gastric balloon can remain in the stomach for a maximum of 3, 6 or, more recently, 12 months and must then be removed. Although a new intragastric balloon can be placed immediately, this only continues the actual self-deception.
From the reports of those affected, it can also be learned that in addition to some good successes, a large number of negative experiences can also be registered. This ranges from persistent nausea to spontaneous vomiting to an unpleasant feeling of fullness, which does not contribute to the patients’ well-being. If the intragastric balloon is worn for the recommended maximum period of six months, there is a risk that the balloon will lose the saline solution, which in itself is not tragic. Much more dangerous is that the then flaccid envelope of the balloon can migrate into the intestine and lead to a dangerous intestinal obstruction.
Given the problems associated with the use of a gastric balloon, bariatric surgery is the better option in the vast majority of cases in patients with BMI over 30 kg/m2 with diabetes, or in patients with BMI over 35 kg/m2 without diabetes. The preferred methods are stomach reduction by forming a tube stomach or gastric bypass. Such interventions aim to consistently and permanently reduce the volume of the stomach or to virtually bypass the stomach. Both methods involve surgical procedures, but these are now performed as minimally invasive laporoscopic operations. In addition to the bariatric operations, further therapeutic offers are provided with the aim of achieving and securing long-term success in weight reduction. This means that in the vast majority of cases, surgical intervention is the better, more reliable and permanently more successful way to treat morbid obesity in the long term.
Even if a gastric balloon does not appear to be a target for long-term weight reduction, it can still be a sensible temporary solution in individual cases. For example, if a surgical intervention is not (yet) an option because of a very high excess weight. Then the gastric balloon can help to achieve a weight reduction that makes surgery possible. But that’s all.
If we consider once again that the intragastric balloon is basically a foreign body that can only be used temporarily and is ultimately only a “crutch” for weight loss, the intragastric balloon is ruled out as a long-term and efficient solution to the problem of obesity.
Anyone who is confronted with the physical, social and psychological impairments caused by morbid obesity should seek specialist medical advice and professional care. A good place to start may be the Swiss1Chirurgie clinics, the Centre for Bariatric Surgery ZfbC or the Gastroenterology Group Practice in Bern. Here, patients are advised in detail, individually and openly about the chances, risks and possibilities of permanent weight reduction. Obesity experts are always concerned with long-term solutions and less with quick but less reliable success.
In a special consultation at Swiss1Chirurgie, patients also learn in which rather rare cases the temporary use of a gastric balloon in preparation for bariatric surgery can be useful. At the same time, however, it is always made clear that the use of a gastric balloon can never be the permanently helpful solution to a pathological obesity problem.
With the obesity podcast, you can find the latest and essential information on obesity, its origins, development, consequences and treatment options at adipositas-podcast.ch. Here, real experts talk about the causes and development of morbid obesity, which, with its manifestations such as overweight, cardiovascular diseases, shortness of breath, organ diseases, diabetes, limited mobility and performance as well as social stigmatisation, severely restricts the lives of those affected. On adipositas-podcast.ch we always want to inform you professionally and comprehensively and at the same time show you ways to break the vicious circle of obesity.
One can accept obesity as a seemingly inevitable fate and surrender defencelessly to the dire consequences. But in the same way, obesity can also be understood in its development and ways can be found to return to a self-determined, happy and desirable life. What is your path?
Listen to experts from Swiss1Chirurgie, the Centre for Bariatric Surgery or the Gastroenterological Group Practice Bern and learn what obesity is, what it means for an individual’s life and which paths lead out of the disease. In this way, you will gain valuable knowledge that can significantly accompany your own path out of obesity. Testimonials from patients and sufferers and the knowledge of obesity experts will help you find your own way out of the fatal obesity career and lead a healthier and happier life.
Adipositas-Podcast.ch – Know what’s what
