The conservative treatment of obesity, consisting of dietary, exercise and behavioural therapy and possibly drug therapy, often does not show sufficient and lasting effects. Surgical therapy for obesity, on the other hand, has proven to be very effective and sustainable, is safe and cost-effective. It not only leads to a considerable weight reduction, but also to a significant improvement in obesity-related diseases such as diabetes mellitus type 2, high blood pressure and sleep apnoea syndrome. In type 2 diabetes mellitus, the improvement in blood sugar levels already occurs immediately after surgery, irrespective of weight reduction. With increasing weight reduction, quality of life and life expectancy increase.
Bariatric surgery
Bariatric surgery is a branch of surgery that deals with procedures designed to facilitate a reduction in body weight. Most bariatric procedures are performed endoscopically via small incisions inside the abdomen. The most common weight loss procedures performed in Germany are the gastric sleeve and gastric bypass surgery.
Obesity surgery
Obesity surgery is a bariatric procedure whose primary goal is weight reduction. Through a sustainable weight reduction, an improvement in obesity-related concomitant diseases or their prevention and an improvement in the quality of life can be achieved.
Metabolic surgery
Metabolic surgery is understood as bariatric surgery as above, but here the indication is primarily for improving the metabolic situation in a pre-existing diabetes mellitus type 2. Weight loss is a welcome side effect but is not the primary goal of the procedure. For other diseases associated with obesity or metabolic syndrome, such as high blood pressure, there is currently insufficient data to provide the indication for metabolic intervention primarily because of these diseases.
Quality management (Germany)
Obesity surgery should only be performed in clinics that are certified as a centre for obesity surgery or are seeking certification. Centres for obesity surgery should be limited to the following procedures:
- patient age between ≥ 18 and < 65 years
- patients without severe concomitant diseases (ASA* ≤)
- patients with BMI < 60 kg/m²
- standard obesity surgery procedures: gastric sleeve, gastric banding, proximal Roux-en-Y gastric bypass and omega-loop gastric bypass.
Patients outside these criteria, more demanding operations and primary metabolic interventions for the treatment of type 2 diabetes mellitus will be performed at a centre for obesity and metabolic surgery with special expertise:
- any patient age, especially <18 or ≥ 65 years (cf. obesity centre)
- risk patients with severe concomitant diseases (ASA* >3)
- patients with BMI ≥ 60 kg/m²
- in addition to standard obesity surgery, difficult bypass operations, conversion operations and redo operations
- primary metabolic interventions (for BMI < 40kg/m² in cooperation with a physician experienced in diabetology)
In addition, the responsible surgeon should have the expertise of at least 300 obesity or metabolic surgery procedures, which also include difficult correction or transformation procedures.
If obesity surgery or metabolic procedures are planned for children or adolescents, these should only be carried out in cooperation with a paediatric clinic with experience in the treatment of obesity, suitably qualified specialist staff and an intensive care unit suitable for children and adolescents.
Bilbiography sources:
Deutsche Adipositas-Gesellschaft, Deutsche Diabetes Gesellschaft, Deutsche Gesellschaft für Ernährung, deutsche Gesellschaft für Ernährungsmedizin (2014) Interdisziplinäre Leitlinie der Qualität S3 zur „Prävention und Therapie der Adipositas“. AWMF-Register Nr. 050/001. Klasse: S3. Version 2.0
Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Chirurgische Arbeitsgemeinschaft für Adipositastherapie (CAADIP), Deutsche Adipositas-Gesellschaft (DAG), Deutsche Gesellschaft für Psychosomatische Medizin und Psychotherapie, Deutsche Gesellschaft für Ernährungsmedizin (2010) S3-Leitlinie: Chirurgie der Adipositas.
Fried M, Yumuk V, Oppert JM, et al. (2013) Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery. Obes Facts 6: 449–468
Hüttl TP, Stauch P, Wood H, Fruhmann J (2015) Bariatrische Chirurgie. Aktuelle Ernährungsmed 40: 256–274
Mingrone G, Panunzi S, De Gaetano A, et al. (2012). Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 366: 1577–1585
Runkel N, Colombo-Benkmann M, Hüttl TP, et al. (2011) Bariatric Surgery. Dtsch Arztebl Int 108: 341–346
Weiner RA (2015) Adipositas – Wann ist der Chirurg gefragt? Dtsch Med Wochenschr 140: 29–33
