The surgical evaluation includes a detailed examination of the patient's medical history and a physical check-up. The following points must be clarified:
- Is there a pathological overweight?
- Are there co-existing diseases?
- Have conservative interventions for weight reduction already been carried out?
- What is the risk of bariatric surgery?
- What goals are to be achieved with the operation?
- Which surgical procedure is suitable for this?
- Is regular aftercare guaranteed?
Any contraindications for bariatric surgery must also be clarified:
- no or insufficient conservative therapy attempts
- malign diseases
- acute psychiatric diseases
- chronic substance addiction (alcohol, drugs, medication)
- advanced cirrhosis of the liver
- lack of cooperativeness of the patient
- existing pregnancy
Of course, the current BMI is also determined during the initial examination. However, this is not the only decisive factor for the therapy decision; obesity-associated diseases such as diabetes mellitus type 2, high blood pressure, heart disease, depression and psychosocial abnormalities (e.g. eating disorders) must also be taken into account in the therapy decision. For this reason, the Edmonton Obesity Staging System (EOSS) is used to assess the so-called disease burden of obesity in addition to the BMI. The EOSS consists of five steps:
Step 0
There is obesity, but there are no obesity-related risk factors, no physical symptoms, restrictions or impairments of well-being.
Step 1
There is at least one obesity-related risk factor of low clinical severity (e.g. abnormal fasting blood sugar level), mild physical symptoms (e.g. shortness of breath after climbing stairs) or mild impairment of well-being.
Step 2
At least one manifest obesity-related disease is present, e.g. diabetes mellitus type 2, high blood pressure or anxiety disorder.
Step 3
The patient has already suffered complications due to obesity: Heart attack, cardiac insufficiency, complications due to diabetes mellitus type 2 (e.g. kidney problems) as well as considerable impairment of well-being.
Step 4
The patient suffers from the severe consequential damage of obesity, severe psychosocial disorders and serious impairment of well-being.
Overall, surgical evaluation is a relatively time-consuming affair, which usually requires several outpatient appointments in a centre for obesity surgery.
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.
Hüttl TP, Stauch P, Wood H, Fruhmann J (2015) Bariatrische Chirurgie. Aktuelle Ernährungsmed 40: 256–274
Sharma AM, Kushner RF (2009) A proposed clinical staging system for obesity. Int J Obes 33: 289–295
