Why obesity often requires surgery
It is an "increasing" problem - and in the truest sense of the word: every fourth German is considered too thick, and the trend is rising. "One of the reasons is that food can be obtained anytime, anywhere, even in large quantities and at a relatively low price," says Professor MD Thomas Carus. "On the other hand, you hardly have to move today if you do not want to. You sit at home on the sofa, eat chips and watch movies for hours. You do not even have to go to the cinema anymore," says the head of the surgery, who heads the Asklepios Westklinikum in Rissen, the center for obesity, which is called "obesity in jargon".
From a body mass index (body weight in kilograms divided by height squared) of more than 40, a patient is considered morbidly obese. "Concrete example: A woman who is 1.70 meters tall and weighs 130 kilograms is morbidly obese," says the physician whose heaviest patient weighed in at 320 kilograms. Of course, the equipment in the operating room must be designed for this, because a conventional table only carries patients up to 135 kilograms.
But what happens before an operation? "A rigorous diet. It must first be tried in a conservative way to drastically reduce the weight," says surgeon Carus, who habilitated in Dresden at the University Hospital Carl Gustav Carus - named after a famous ancestor. "Every kilo less helps! Because although no one dies of obesity, but thousands of concomitant diseases. The risk of having a heart attack or stroke and developing diabetes is extremely high. One can say: If the body mass index is over 40, one lives on average ten to 15 years less."
However, losing weight is not easy, the fight against the kilos a marathon of discipline. Most of his patients - 20 a week sees Carus in the Obesity Center in cracks - would have tried all kinds of diets. "Some take off wonderfully even in a spa clinic, but back in the wild, the yo-yo effect beats mercilessly." Therefore, an accompaniment to the diet is essential, the expert said. "The current model is designed for six months and is based on three pillars: nutritional counseling, exercise therapy and behavioral therapy." However, the balance makes little hope: Not even half of all patients manage to lose so much weight in this time that surgery no longer necessary.
So is the gastric band left? "No, we just build them out," says the cracker and laughs. In the 1990s, this was the operation of choice, but today many of the gastric bands installed at the time made mechanical problems. "In addition, the system is too easy to cheat. You can still pour gallons of cola or drink chocolate. Although the stomach is encased by a foreign body, but preserved in full size and waiting for delivery."
Meanwhile, the so-called hose stomach has prevailed worldwide. "The stomach is reduced in this fairly easy, about 30-minute keyhole surgery, so that the patient later feels a stretch stimulus after a few bites, the saturation begins faster." A good quarter of the original weight lose most patients after. However, personal responsibility is also the key to success here. "Because of course you can with a lush, greasy food, the tube stomach to break easily," warns the passionate kite-surfer, who likes to go to the Baltic after a long day in the clinic, "again for two hours on the board to rise".
In obese patients with diabetes that is difficult to control or heartburn, the gastric bypass is often chosen instead of the tube. "However, this procedure alters the metabolism and is complicated in the aftercare, because one relies on food supplements."