In the Advent season and especially after the Christmas holidays, the media reports reliably revolve around the topic of losing weight. What is lost in sight is that obesity for many people is not a short-term and not an exclusively aesthetic problem, but is often part of a complex clinical picture. This is often associated with high blood pressure or type 2 diabetes, which significantly exacerbate existing health problems.
Obesity, also known as obesity, is a serious health problem for many people, which can lead to a significantly reduced life expectancy.
Those affected receive help through professional and interdisciplinary treatment, such as that offered by the University Obesity Center Mittelhessen (UAZM) at the University Hospital Gießen and Marburg at the Gießen site.
In an interview with the RHÖN health blog, private lecturer Dr. Thilo Sprenger, Head of Section Obesity and Metabolic Surgery, and graduate nutritionist Dr. Annette Hauenschild on the overall concept of this center, conservative options for weight loss, possible operations – and success stories.
Dr. Sprenger, many obese patients will come to you and ask about an operation right away. When does it make sense?
Dr. Sprenger: There are clearly defined rules in Germany that you have to observe before operating. Important factors that influence the decision are body weight, body mass index (BMI) and the secondary diseases which are present in most cases and which are associated with obesity, i.e. are directly related to obesity.
Which values are decisive here?
Dr. Sprenger: An operation can be performed from a body mass index of 35, but then at least two obesity-associated secondary diseases must be present. These would be, for example, type 2 diabetes, high blood pressure, obstructive sleep apnea syndrome or musculoskeletal complaints. From a body mass index of 40, the indication for surgery can be made even if there are no secondary diseases, if conservative measures have not led to success. First of all, there are the formal criteria.
And the other criteria are …
It is important that we offer holistic obesity therapy here at the University Hospital Gießen and Marburg. So we are not necessarily, and certainly not primarily, focused on operating.
In addition, we also treat people who are overweight, but not yet very overweight, i.e. morbidly obese. In principle, we offer every patient who comes to us a tailor-made therapy concept that is based on the patient’s individual situation.
How do you reach those affected?
Dr. Sprenger: Sometimes the patients come to us directly at the clinic because their illness often limits their quality of life and, in many cases, they increasingly have to take medication. Many people focus on this aspect. First of all, high blood pressure and diabetes don’t hurt. Here the alarm bells ring for the family doctor or the diabetologist and they refer the patient to us. Effective obesity therapy is then the most causal treatment there is for metabolic syndrome. The fact is that for many patients who are already taking blood pressure or diabetes medication in young adulthood, the statistical life expectancy drops significantly.
What measures can help apart from an operation?
Dr. Annette Hauenschild: Our obesity center offers a wide range of programs, in addition to behavioral therapy and nutritional advice.
Most of those affected expressly do not lack knowledge about proper nutrition. Often it is more a problem of implementation. People usually know exactly what they are doing wrong. The problem, however, is that they keep slipping into certain behaviors. So the fridge is opened in the evening after coming home, as a reward, so to speak.
What are you doing about it?
Dr. Hauenschild: The aim of our program is to uncover these recurring behaviors, to recognize them for oneself, and then to find ways and strategies to find out from these patterns. A key aspect of our program is also the long-term support of each of our patients. It runs for a whole year, the participants come to us every week for twelve months. For example, as part of nutritional advice, we go shopping together. It is also important that we work together in groups of ten to 15 participants. In this way, our patients support each other and can, if desired, be cared for for a lifetime. Many accept this offer.
What do most of your patients suffer from?
Dr. Sprenger: When they come to us, most patients already suffer from so-called morbid obesity grade 3, i.e. a body mass index of over 40. If the patients are motivated to do so, previous conservative measures have not had a sufficient effect and no counter-arguments from on the medical side, it often makes sense to operate.
How complex is such a surgical procedure?
Dr. Sprenger: The operations are minimally invasive, that is, without major incisions, using what is known as the “keyhole technique”. As with any other abdominal surgery, there are risks, but the complication rates are very low in centers with a high level of medical expertise. A desired weight loss can be observed in almost all cases. We can assume that our patients lose around 80 percent of their excess weight as a result of the operation.
How does it work technically?
Dr. Sprenger: It is important to know that the fat is not sucked off. Instead, with the operation, we completely change the route of food through the gastrointestinal tract and thus the patient’s metabolism. Within months, the body burns 40, 50 or sometimes even up to 100 kilograms, depending on the initial weight. After a certain period of time, a kind of stable phase of weight development occurs, which prevents obese people from suddenly having too little weight. The aim of the operation is for the patient to become of normal weight or at best slightly overweight – and above all to remain permanently. We have to be careful that there are no deficiencies in the supply of vitamins, minerals and trace elements. Ensuring this is one of the tasks of long-term follow-up care, which is an essential part of the operation.
What effects does the operation have on diseases that often accompany obesity?
Dr. Sprenger: These are very important effects. Weight loss is actually just one aspect of such an operation. The aim is to ideally completely eliminate the mentioned secondary diseases or at least significantly improve them. Most of our patients can significantly reduce the number and dose of their blood pressure medication or even stop taking them a few months after the operation. In type 2 diabetics, a lot depends on how long the disease has been around. In the best case scenario, the diabetes can go away in the long term, even if the patient had to inject insulin beforehand. Obstructive sleep apnea is also eliminated and osteoarthritis of the joints improves noticeably in many cases.
And what behavior do you expect from the patient?
Dr. Sprenger: It is important that the patients are well informed and motivated to go to the operation with us. One must not persuade anyone to undertake such an operation, even if we objectively see a high medical urgency. The patient can of course contribute a great deal to the overall success, for example by consciously changing their diet and modifying their behavior with regard to their diet and eating habits. For example, to avoid the usual, possibly high-sugar or fatty foods and prefer to consume water or tea instead of sweet drinks.
It is fundamentally important that the patient is well prepared and therefore able to help achieve a result that is satisfactory for himself.
It all sounds like a psychological challenge.
Dr. Hauenschild: Before the patients are operated on, we make an appointment in our psychosomatic clinic in addition to the physical examinations. We want to know from the experts there whether the patient can cope with his new situation after the operation. In fact, there are some patients who develop psychological problems with their new, significantly lower body weight. Patients who are in follow-up care with us are, however, in the vast majority of cases satisfied with the decision they have made – and often describe it as the best of their lives.
Your experts in obesity treatment:
PD Dr. Thilo Sprenger
Senior physician, head of the bariatric surgery section
Dr. oec. troph. Annette Hauenschild
UKGM Nutrition Commission, Obesity Center