STRONG OVERWEIGHT

In addition to the wrong eating behavior (high-fat meals, irregular intake of food), the lack of exercise is crucial for weight gain. Numerous social factors and factors that characterize our culture support the rapid spread of morbid obesity, which the World Health Organization (WHO) believes is an epidemic. These include the increasingly passive use of leisure time (computer, TV), the advertising strategies used by the food industry for high-energy foods and sweets, the growing prevalence of fast food and convenience foods, the permanent oversupply of goods, but also food as a substitute for a lack of integration and attention as a result of increasing professional involvement and competition as well as social tensions. In a few cases, metabolic diseases or the use of certain medications can cause or promote obesity.

The role of genetic factors has been intensively researched for years and cannot be definitively answered at this time.

If the described changes persist for a longer period of time, numerous irreversible changes in the organism occur that require permanent treatment and significantly reduce both the quality of life and the life expectancy of those affected. Due to the stigmatization of overweight (beauty ideal) practiced by the environment, patients often become lonely, which leads to social disintegration and, in addition to personal consequences, also has serious social consequences.

The connection between morbid obesity and some malignant tumor diseases (breast cancer, uterine cancer, colon cancer, prostate cancer) is regarded as established.

Increasing physical activity is another building block for reducing excess weight, but here, too, long-term success can only be assumed if habits are fundamentally and permanently changed. According to available experience and studies, the drug therapy for (rapid) weight loss proclaimed in particular in the media is accompanied in almost all cases by side effects, some of which are severe, and is rarely as successful as promised. It is not an alternative to the above strategies.

The most important and only promising conservative treatment option is the consistent prevention of obesity, starting in childhood. Ultimately, surgical intervention is the last resort for morbid obesity. This is now also recognized by leading nutritionists.

The presence of an interdisciplinary team (metabolic physician, bariatric surgeon, anesthesiologist, intensive care physician, psychologist) is crucial in order to provide the patient with all-round competent care. This basic prerequisite is given at all times by the very close cooperation with the colleagues of the metabolic center specialized in the treatment of obesity, the highly competent team of anesthesia and intensive care medicine and the cooperation with the psychologists. All patients are discussed together with all specialists at an interdisciplinary obesity board prior to surgery. At the time of hospital admission, the diagnostics are supplemented and completed by some examinations necessary for the operation (laboratory, ECG, X-ray of the lungs, pulmonary function test).

The (controllable) gastric band causes a pure restriction. It is passed around the upper part of the stomach, also using a minimally invasive technique, creating a small “pre” stomach. The width of the gastric band can be controlled by a so-called port system inserted under the skin. By implanting a gastric band, the size of the food portions is greatly limited by mechanical means; in addition, a rapid feeling of satiety is achieved. The average weight loss is about 50% of the excess weight and good compliance (cooperation) of the patient is essential.

The operation can usually achieve a weight loss of 50-70% of excess weight in 2 years, assured long-term results on the method are still pending. In some cases, after gastric banding implanted in the past, it is necessary to remove the gastric band and apply gastric bypass in the same operation, especially in case of lack of weight reduction or renewed stronger weight gain.

All interventions require both a surgeon experienced in laparoscopic and especially in bariatric surgery as well as appropriate surgical-technical requirements.

n the 3rd day after surgery, another X-ray control is performed. This is followed by the gradual build-up of the diet. Any drains inserted during surgery are removed. The patient is visited twice a day by the surgeon to discuss any questions or problems. At the same time, the colleagues of the Metabolic Center and the Nutritional Counseling Center are closely involved in the care of the patient. Once the food buildup is complete, patients can be discharged, usually on the 7. until 8th day after surgery can be discharged home. After one week, another outpatient check-up is performed in our practice. Here, too, questions can be clarified and initial impressions regarding the surgical result can be discussed.