With the newly created Bariatric Curriculum, the ZfbC, Thun Abdominal Surgery and Swiss1Chirurgie prepare their patients even better for the upcoming obesity surgery. In a seminar, all questions regarding preparation and execution, anaesthesia and the time after the surgical intervention are answered and essential procedures are explained. More information and safety are the objectives of the Bariatric Curriculum, which was developed especially for the overweight patients.
Every operation is a serious procedure that always involves certain risks. This also applies to bariatric surgery, even if it can be carried out minimally invasively in large numbers, i.e. without large surgical openings of the abdominal wall.
Many patients have a great interest in knowing how such operations are carried out and what is actually done. This is less about the specific techniques and procedures. Rather, patients are interested in how such an operation is prepared, how it proceeds and what risks are to be expected. And it is also interesting how to behave after such an intervention.
In order to be able to cover this justified interest as far as possible, the Centre for Bariatric Surgery ZfbC, the Abdominal Surgery Thun and Swiss1Chirurgie, under the essential leadership of Dr. med. Sebastien Trachsel, have developed a Bariatric Curriculum, which can provide answers to the most important but also personal questions of patients. This will make a significant contribution to more information, education and patient safety.
What the Bariatric Curriculum does
Anyone preparing for obesity surgery has many questions. The better such questions can be answered, the greater the patient’s confidence in dealing with the upcoming operation. Patients can take part in this bariatric curriculum as early as two to three weeks before the planned surgery.
The short but very informative seminar explains which clinical procedures are required and how the anaesthesia will proceed. In addition, of course, there is the general information provided by the surgeon, so that after about two hours of seminar the patients are well prepared for their individual operation. Of course, this does not exclude personal counselling and care directly at the clinic. Rather, this is part of the preparation for the operation and helps to objectively classify concerns, fears and reservations. This is also helped by the fact that directly after the bariatric curriculum there is the opportunity to ask personal questions and receive the appropriate answers.
This is especially important for patients who are undergoing surgery for the first time or who have already had less positive experiences in other operations. Knowing everything that is coming is an essential part of obesity surgery, which is a not insignificant intervention in the future shape of one’s life.
This also means that the dietary changes required before and after the operation can be discussed in detail. This way, the patients already know what their special menu will look like in the clinic. Physiotherapeutic counselling and care are also part of the obesity surgery. How do you get up after the procedure? What should be considered in the movement? How is scar protection ensured? These are also questions of general and personal interest that should and must be discussed in the run-up to the operation.
The bariatric curriculum also includes thrombosis prophylaxis, so that our patients know in advance how they can set the points themselves and thus actively participate in the success of their obesity surgery.
The strength of the bariatric curriculum, which we have developed especially for our overweight patients, lies in the totality of counselling, care and support already two to three weeks before the surgical intervention.
We see more information, more security and more self-participation in the process as an important and essential contribution in the interest of our patients, whom we also want to prepare well for the upcoming operation and life afterwards with the Bariatric Curriculum in seminar form and by answering their personal questions.
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.
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.
From 01 January 2021, it will be possible to have obesity surgery from a BMI of 30+ with concomitant type 2 diabetes. One of the prerequisites is that diabetes can no longer be safely controlled by conventional means. Only a few specialist clinics are authorised to perform such operations. This also includes the clinics of Swiss1Chirurgie, which offer such procedures in the Helvetia Holding AG network. Learn more about the BAG’s decision.
Overweight surgery possible from BMI 30 with diabetes as of 2021
Being overweight is not something to be trifled with. All those affected know this just as well as we do as medical specialists. For years, the experts at Swiss1Chirurgie have been observing the development of obesity in modern industrialised countries. It is becoming increasingly clear that the proportion of overweight people is growing. Associated with this are not only the individual restrictions and complaints. Healthy societies quickly become sick societies through an oversupply of food at any time in any place and correspondingly wrong nutritional behaviour, whose lack is above all abundance.
So far, health insurers and medical organisations, together with politicians in Switzerland, have agreed that surgical interventions to reduce weight are only possible for a BMI of 35 or higher and are financed accordingly. It was completely ignored that a BMI of 35 or more is already an enormously high value, which is already associated with numerous secondary diseases and complaints. Such concomitant diseases not only complicate the lives of the patients themselves, but are often also a clear obstacle in the preparation and implementation of necessary obesity surgery.
From 2021 the threshold is BMI 30
In accordance with the interventions of the medical specialists and a close observation of the development, the politicians together with the medical profession have decided to lower the threshold value for bariatric surgery in the context of obesity surgery now to a BMI of 30, provided that the patients are affected by diabetes at the same time.
This long overdue decision will benefit patients who, despite being diagnosed with obesity and the corresponding symptoms, were previously not included in the group of patients for whom obesity surgery was an option.
This means that a wide range of conditions closely related to obesity can be treated much sooner and necessary and desired surgical interventions can also be carried out. This will have a lasting impact on the quality of life of people with a BMI over 30 and diabetes, and ultimately reduce the proportion of severely overweight people, along with the social and economic costs.
Advantages especially for humans
The decisive advantages of this decision now lie above all with those people who, with a BMI of 30 or more and diabetes, are already clearly affected by morbid obesity. Now the suffering of these people can be significantly shortened. This is also because it obviously does not make sense to wait for an enormously high BMI of 35 and more until a surgical intervention for weight reduction is made possible by the regulations.
A major advantage of this decision is that the extent of overweight and the associated concomitant and secondary diseases such as diabetes, cardiovascular diseases and arthrosis can be significantly reduced. The psychological suffering can also be significantly shortened and patients with a BMI of 30 or more with diabetes may now place themselves in the hands of the experienced specialists in obesity surgery. The Swiss1Chirurgie clinics are among the specialist medical clinics that will be authorised to perform surgical procedures to reduce excess weight from a BMI of 30 with diabetes from 01.01.2021.
Determine your BMI here and find out whether and under what conditions you belong to the circle of possible candidates for obesity surgery.
In addition, we recommend that all severely overweight people contact a Swiss1Chirurgie clinic. By doing so, you will take the first step towards a better, healthier future in 2021 and use the possibilities of modern medicine to improve your life.
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.
The gastric balloon – the best way to cheat yourself?
Why a gastric balloon is the worse alternative to bariatric surgery?
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.
How the gastric balloon works
The gastric balloon promises quick success in losing weight. Find out why this is only half the truth in the detailed article by the obesity experts at Swiss1Chirurgie.
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.
Self-deception with a system
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.
Bariatric surgery is the better methodology
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.
When the use of a gastric balloon can be useful
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.
Counselling ensures best treatment results
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.
Adipositas-Podcast.ch – Know what’s what
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.
Dr. med. Jörg Zehetner on the problem of obesity and what it means for those affected.
As part of the lecture series of Helvetius Holding AG, Dr. med. Jörg Zehetner, Professor USC, took a stand on the stigmatisation of overweight people and the resulting consequences for those affected. In his lecture in the Saaser-Stube Saas-Fee, the experienced physician, who also deals intensively with obesity problems, described the circumstances that obesity patients have to live with practically every day.
They are among us
At the beginning of the lecture, Dr Zehetner made it clear that practically everyone knows the overweight. In one’s own family, in one’s circle of friends or in the circle of colleagues, they exist everywhere and the number of those affected is constantly increasing. And the lives of patients with obesity are not easy.
Where stigmatisation begins
Look at the fat guy! Oh, she’s fat. The fat man should exercise more. Look what he’s got in his shopping basket, and he’s already fat enough.
This is how the stigmatisation of overweight people begins. Without asking why or wherefore, without taking into account how people are personally affected, they are consciously or unconsciously pigeonholed into a category in which they neither belong nor can free themselves from it. Besides the flippant remarks, there are also those that really hurt and don’t help the people concerned at all.
Reduce prejudices
Anyone who has studied the problems of obesity and adiposity in depth knows that those affected suffer greatly from their current life situation. A first step towards at least reducing this unfortunate situation would be to dismantle popular prejudices. It’s always the best moment for that.
The fight against obesity requires a professional network
Hardly any overweight person with a serious problem will be able to successfully face the disease alone in the long term. Even though overweight surgery is now a proven and successful means of fighting the extra pounds, it requires targeted networking before, during and after the medical intervention. For this purpose, a professional network has been established under the umbrella of Helvetius Holding AG, which provides advice, support and assistance to patients in all phases.
Large social alliance against stigmatisation necessary
The topic of obesity is present everywhere. Not only in everyday life, but also in the media, people are encountering this topic more and more frequently and intensively, in addition to the commonly known jokes and remarks about being overweight. From stigmatisation, the path to discrimination is usually a very short one. Obese people are associated with a conceptual world that is anything but pleasant or appreciative. Especially when you don’t know these people personally. This stigmatisation extends far into the personal and social lives of those affected. Even professional life is not excluded. To change this, a large social consensus is needed.
Steps out of stigmatisation
If the spiral of stigmatisation and discrimination against overweight people is to be broken, a clear line is needed. And this begins precisely where obesity is understood as a disease and thus also as treatable and curable. Only then can an active approach be made to these people, who can then actively face their problems themselves without having to continue to hide.
A further step would be to significantly rethink the approach to these patients. And in every area of life and in every encounter with overweight people. Only when the stigma is taken away from these people will they themselves be able to actively enter into the process of their recovery. Dignity, respect and tolerance are exactly the right keywords here.
It is important to also perceive overweight people as valuable members of our society and to recognise that they are not lazy, sedentary, unpleasant and low performers, but sick. And something can be done about diseases, including morbid obesity.
Define obesity as a disease
Anyone who takes a closer look at overweight and obesity will quickly be able to understand them as actual diseases. As with any organic disease, there are clear definitions and developments, but also therapeutic interventions that clearly speak for a clinical picture. A first indication of this is the division into different classifications of overweight, starting from the Body Mass Index, BMI.
Although obesity surgery is a helpful intervention, it does not by itself solve the problem. Being morbidly overweight is and remains a chronic disease that requires lifelong attention, but not disparaging stigmatisation.
More in-depth information on the topic is available in the video recording of the lecture (LINK) and directly on the Swiss1Chirurgie website.
