If dietary changes and a more active lifestyle are not enough to reduce weight in obese patients, a stomach reduction surgery can help.
One speaks of adiposity (obesity) from a BMI (body mass index) over 30. This is associated with an increased risk of type 2 diabetes, cardiovascular diseases and even cancer. Weight loss programs alone are often not enough to reduce body weight to a healthy level.
In these cases, surgery to reduce the size of the stomach may be an option. It can help improve the health and quality of life of obese patients and prevent physical complaints.
Why is obesity so dangerous?
60 percent of adults in Germany are overweight (including obesity). Obesity is a chronic disease associated with serious health risks. Type 2 diabetes mellitus, cardiovascular diseases such as high blood pressure and heart attack, but also fatty liver, depression, sleep apnea and an increased risk of cancer are among the diseases associated with obesity. Obese people live several years less than people of normal weight.
“The negative effects of obesity can be very dramatic. In the long term, obesity can lead to pathological changes in almost all organs. Obesity even has a negative effect on our brain and our genes. More than 60 different secondary diseases are now known,” says Professor Jürgen Ordemann , Head of the Center for Obesity and Metabolic Surgery at the Vivantes Klinikum Spandau and expert of the German Obesity Society e. V
Why it is so difficult to lose weight when you are obese
Many people who are very overweight try to lose weight for many years – without success. This leads to frustration and helplessness. Despite strict diets, more sport and accompanying weight loss programs, body weight cannot be permanently reduced. Why is that?
Research increasingly indicates that, on the one hand, central weight regulation mechanisms are disturbed by the so-called “obese” environment (high-calorie diet, little exercise, mental stress, stress), and on the other hand, the entire fat mass acts as an independent organ. Fat cells not only store fat, but also produce messenger substances and hormones that, among other things, can trigger inflammatory processes in the body. Belly fat in particular is metabolically active. Above a certain level of overweight, the associated metabolic processes are difficult to control.
When is a stomach reduction in obesity in question
“A stomach reduction is never the first therapy option. First of all, dietary changes, increased exercise and also behavioral changes must be seen as therapy of the first choice. However, a stomach reduction or bariatric therapy makes a lot of sense if the affected patients cannot control their weight gain and the weight is within a certain ‘ threshold’ exceeded,” explains Ordemann.
According to the expert, gastric surgery also makes sense if secondary diseases such as type 2 diabetes mellitus cannot be adequately treated with diet, exercise and medication. According to the guidelines of the medical societies, an operation is indicated when the BMI is over 40 or above, or a BMI between 35 and 40 and other diseases, such as type 2 diabetes mellitus, also exist.
What happens during a stomach reduction?
The most common surgical procedures used for obesity are gastric bypass and gastric sleeve. Both procedures are performed minimally invasively (laparoscopically) via several small incisions above the navel. A large incision in the abdominal wall is not necessary.
“In laparoscopic operations, not only is the stomach reduced, but the way food passes through the stomach and intestines is also changed. Only in recent years have we learned that weight reduction after an operation is not only due to a reduction in the size of the stomach, but above all to a ‘neurophysiological readjustment’ of the brain takes place,” explains Ordemann.
“This means that the feeling of hunger and satiety, but also the metabolism, are changed to such an extent that a diet is no longer perceived as a struggle, but as a normal state.” And that, according to the expert, is exactly what makes such an operation so successful. In addition, secondary diseases are reduced by altered messenger substances. For example, high blood sugar is lowered. The diabetes improves.
Obesity surgery: what gastric bypass and gastric sleeve mean
In gastric bypass and sleeve gastrectomy, the stomach is surgically modified: “In gastric bypass, the most common surgical procedure performed worldwide, a large part of the stomach is excluded from the food passage. The food is passed directly into the small intestine via a small stomach pouch, bypassing the rest of the stomach. With a gastric sleeve, on the other hand, about three quarters of the stomach is removed and only a small residual stomach remains in the form of a tube,” explains Ordemann.
