Obesity treatment in Germany / Top clinic in Germany, Friedrichshafen

Obesity treatment

Understanding obesity is the basis of successful treatment. Often, for those who suffer from this disease, surgery is not an alternative to conservative treatment, but the only possibility to recover and feel healthy for a long time.

Obesity

Obesity is said to be a strong overweight that can harm your health. Obesity is a chronic disease associated with impaired quality of life and high risk of complications. However, affected people not only suffer physical consequences, but also stigmatization by the environment. Read here exactly what obesity is, how it expresses itself and what you can do about it.

Obesity: short overview

Description: morbid obesity, chronic disease, BMI of 30 and more,

Symptoms: abnormally high levels of fat accumulation in the body, decreased performance, shortness of breath, excessive sweating.

Consequential damages: diabetes, cardiovascular diseases, fatty liver, joint problems, back problems, gout, kidney stones, various types of cancer, psychological problems.

Causes: genetic predisposition, unhealthy eating habits, lack of exercise, slow metabolism, various diseases

Treatment: Nutrition, exercise, behavioral therapy, medication, stomach reduction

Prognosis: difficult to treat, high risk of secondary diseases, shortened life expectancy

What is obesity?

Obesity or obesity is not a figure problem of low-character people, but a recognized, chronic disease. It belongs to the group of hormonal, nutritional and metabolic diseases. The German Obesity Society defines obesity as an excess of normal fat accumulation in the body.

Standard Body Mass Index (BMI)

From a body mass index of 25 a person applies the guidelines of the World Health Organization as obese, with a BMI of 30 as obese. The BMI is calculated from the weight (in kg) divided by the height squared (m2). Thus, for example, would a person with a body size of 180 cm with a weight of 81 kilograms overweight and obese 98 kilograms.

Being overweight or obese a person is when he feeds his body in the long term more energy than it consumes (positive energy balance). Nutritional intake and exercise are thus two adjusting screws, over which the weight can be influenced.

Individual factors influence the weight

However, there are numerous factors that significantly affect the metabolism and thus the individual energy balance. These include the genetic make-up, the diet of the mother in pregnancy or the hormones. Therefore, someone who is overweight does not necessarily have to eat more or move less than a slim person.

Obesity permagna

From a BMI of 40, physicians also speak of a obesity permagna or obesity grade 3. The affected persons are very obese and therefore mostly severely limited in their quality of life. Even slow walking or sitting is difficult for them. The likelihood that they have complications such as diabetes and high blood pressure is particularly high, their life expectancy is reduced. Self-esteem usually suffers from heavy obesity and people are stigmatized by their environment. Significant weight loss is crucial for very strong obese to become healthier again. You can read more about grade III obesity in the article Adipositas permagna.

Obesity: symptoms

The more pronounced the overweight is and the longer it is, the greater the physical discomfort. The risk of secondary diseases is also increasing. The messenger substances that are formed in the fatty tissue also contribute to this. These include angiotensinogen, interleukins and cytokines. While there are quite a few in the overweight segment who are physically fit and healthy, this is unlikely in obese people.

Main symptom of morbid fat accumulation

The main symptom of obesity is the excessive accumulation of fat deposits in the body. They burden the body already by the sheer load, which it has to carry and which must be supplied with oxygen and nutrients.

The fat deposits are also no mere fat storage. They produce messenger substances that adversely affect the metabolism and many other bodily functions.

Fat distribution: apple type and pear type

How dangerous the fat is depends not only on the amount, but also on where it accumulates. As a particularly unfavorable health fat storage in the abdominal region. The so-called visceral fat accumulates not only under the skin, but also around the organs. The body silhouette in this fat distribution is also referred to as "apple type". It is especially typical for men.

In women, however, fat accumulates mainly on the hips and thighs. Therefore, this form is called "pear type". These depots are less harmful to health than those of the apple type.

Spreading more and more around the world, obesity results from a long-time positive energy balance, which means that every day you get more energy with food than your body can use. In more than 90%, this causes fat deposits and obesity.

Together with bad eating habits, such as consuming fatty foods, or irregular food intake, a sedentary lifestyle is crucial in weight gain. Numerous social and cultural factors also contribute to the rapid, epidemic – according to the WHO – growth of morbid obesity among the population. These include the prevalence of passive leisure. Advertising on TV and online promotes high-calorie foods, sweets and fast food. In some cases, metabolic diseases or intake of some medications can lead to obesity or contribute to its development.

The role of genetic factors has been studied for many years and, till now, it is not single-valued.

There is a variety of surgical treatments for obesity.

The causes of overweight are complex; the disease can only be cured only by joint efforts of an interdisciplinary team. If conservative treatment is not successful, surgery is the only method that ensures weight loss for long time, improves metabolism, and results in a number of other positive effects.

Surgical treatment of obesity is one of specializations of the Surgery Department of Clinical Center of Friedrichshafen. The years of experience, high quality standards and cooperation with other specialists are the basis of our success in treatment of excess weight.

Obesity: causes and risk factors

Obesity causes far more than too much food and too little exercise. A whole range of factors seem to influence and reinforce each other. The exact mechanisms are not yet fully understood. However, it is becoming clear that the disease tends to become independent: the more pronounced the obesity is, the more stubbornly the body defends the superfluous pounds.

Diseases as an obesity cause

Some diseases and medications can also increase weight and thus obesity. Then experts speak of a secondary obesity.

Polycystic Ovary Syndrome (PCOS): About four to twelve percent of women of childbearing age suffer from ovarian cystic disease. Characteristic of the disease are cycle disorders and obesity.

Cushing's disease (hypercortisolism): In this disease, the adrenals release unnaturally much cortisone into the blood. The hormone cortisone causes a permanently increased blood level, a strong weight gain, especially on the body trunk ("Stammfettsucht").

Thyroid hypofunction (hypothyroidism): In hypothyroidism, the thyroid hormones T3 and T4 are not produced in sufficient quantities. The energy turnover is then lower than normal.

Testosterone deficiency in men (hypogonadotrophic hypogonadism): Due to inadequate hormone production in the pituitary gland or hypothalamus, men produce less testosterone in this condition. This also favors fat deposits.

Genetic syndromes: People with Prader-Willi syndrome (PWS) or Laurence-Moon-Biedl-Bardet syndrome (LMBBS) are often extremely obese.

Mental illnesses: People with depression or anxiety disorders often also suffer from obesity. Eating serves as a short-term relief for the psyche. In turn, mental stress can increase as body weight increases, causing people to eat even more to feel better again.

Binge eating disorder: Even binge eating, in which the affected people repeatedly binge eating, can cause a strong weight gain.

Obesity: examinations and diagnosis

If you have discomfort because of your increased body weight or if you are gaining weight for no apparent reason, you should first visit the family doctor. This will ask you in the so-called Anamnesegespräch first some questions to narrow down the possible causes:

  • How long has the excess weight already existed?
  • Have you ever had problems with your weight?
  • Are you still gaining weight?
  • Do you have any physical symptoms such as back pain, knee problems or shortness of breath?
  • What is your daily diet?
  • Do you move regularly?
  • Do family members (parents, siblings) have problems with being overweight?
  • Do you regularly take medication?

Determination of body mass index BMI

The doctor will now determine the extent of obesity by calculating the body mass index. The body weight is set in relation to body size. The body mass index is calculated from the weight, divided by the height in meters squared, or as a formula: BMI = weight [kg] / (height [m]) 2.

Example calculation for a person with a height of 1.75 m and a weight of 70 kg: BMI = 70 / 1,752 = 22.86 kg/m²

BMI table

UnderweightUnder 18.5
Normal weightBMI 18.5 to 24.9
OverweightBMI 25 to 29.9 kg/m²
Grade 1 obesityBMI 30 to 34.9 kg/m²
Grade 2 obesityBMI 35.0 to 39.9 kg/m²
Grade 3 obesityBMI from 40.0 kg/m²

Obesity: treatment options

To treat obesity, it is not enough to reduce weight in the short term. To avert serious sequelae, people with obesity must permanently lower their weight and normalize their energy metabolism.

In order for obesity therapy to be successful in the long term, profound changes in lifestyle habits are necessary. Obesity therapy is always based on the combination of nutritional, exercise and behavioral therapy.

Nutritional therapy

Changing his diet is not easy. What has long crept in as love habits, you will not go away so fast. People with obesity should therefore receive nutritional advice tailored to their needs. The personal and professional environment should be taken into account.

It is important that concrete goals are formulated. For example, to save 500 calories every day. In addition, the practical aspects of diet change should be taken into account. For example, patients learn what they need to look out for when shopping, how to cook a varied diet with little effort.

Movement therapy

Exercise is a central component of obesity therapy. To effectively lose weight, patients should exercise at least 150 minutes a week, consuming 1200 to 1500 kilocalories. In case of heavy obesity, the sports should be, which do not burden the joints and skeleton additionally.

Behavior therapy

The first step to fundamentally changing one's lifestyle is to develop an appropriate awareness of the problem. Specially trained therapists can help uncover the mental causes of obesity and obesity-promoting behaviors and patterns. For example, many overweight people compensate for negative emotions such as grief, frustration and stress with food. It is not easy to discard such patterns of behavior that have worn themselves over years or even decades. With the help of psychosomatic medicine and behavioral therapy, however, new ways open for the patient to replace health-damaging behavior with healthier behaviors. This theoretical knowledge is solidified and practiced in practical exercises. If this basic therapy of nutritional, exercise and behavioral therapy does not achieve the goal or if it does not promise sufficient success due to the strength of the overweight, medical or surgical measures such as gastric reduction may also be considered.

Medication

There are countless pills and pills to help you lose weight. For example, by curbing your appetite, boosting your metabolism or feeding certain food components such as fats undigested through the intestine. These are called anorectics.

Stomach reduction

For reduction of stomach volume there are various methods. A gastric band or gastric balloon prevents you from eating larger quantities. They are reversible - but have less of an effect than surgical gastric reduction.

Operatively, a simple tube can be made in the stomach or a gastric bypass, which also bridges a portion of the small intestine so that less of what is consumed can be absorbed by the body.

Interestingly, gastric surgery is often accompanied by astonishing changes in metabolism. For example, diabetes can improve rapidly and drastically. Stomach reductions are often very effective weight loss measures. But they represent a major intervention in the body anatomy and are irreversible.

Obesity: disease course and prognosis

Obesity is rapidly becoming a worldwide problem. The German Obesity Society estimates that around 16 million people in Germany are currently obese. Being overweight not only reduces quality of life, it increases the risk of various serious illnesses. The reasons for this include messenger substances that are produced in adipose tissue: interleukins and cytokines. Among other things, they trigger chronic inflammatory reactions in the body.

Consequences

One possible consequence of these chronic, silent inflammations is type 2 diabetes, which mainly occurs in overweight people. Arteriosclerosis is also common in people with obesity. The arteriosclerosis in turn is the cause of the two most common causes of death worldwide: heart attack and stroke.

In addition, various cancers occur more frequently in obese people. There is a particularly strong link between obesity and breast cancer, but also other types of cancer such as colon cancer, esophageal cancer, renal cell cancer, uterine cancer and pancreatic cancer.

Expertise

Weight-loss surgery for obesity in our clinic includes:

  • Sleeve gastrectomy
  • Gastric band removal and gastric bypass in one surgery
  • Revision operations on the gastric pouch
  • Gallbladder removal after surgery for obesity
  • Postoperative care of abdominal wall hernias after obesity surgery
  • Surgical techniques for obesity

Am I a Candidate for Surgical Treatment of Obesity?

Surgery for excess weight can be considered after a number of steps and considerations, which includes:

  • consultations with GP;
  • BMI at least 35 kg/m²;
  • age of a patient not more than 60 years;
  • at least two years of unsuccessful conservative treatment of obesity;
  • at least one concomitant disease (such as hypertension, diabetes, hypercholesterolemia, sleep apnea syndrome, heart disease, etc.);
  • health examination before, during and after surgery by a multidisciplinary team of doctors.

In some cases, surgical treatment can be indicated with BMI > 32 kg/m².

Depending on the type of the operation, you can lose up to 40-70% of the excess weight, after which you can start gaining weight again. The greatest weight loss occurs in the first two years after the surgery and, then, it slows down.

There are many surgical procedures for obesity. All the methods are based on restriction (reduced food intake due to the reduction of the stomach), malabsorption (limited absorption of nutrients due to a lesser contact of food with digestive juices), or combination of the both techniques. In addition, the hormonal effect of surgery also plays an important role, decreasing the feeling of hunger.

Gastric Bypass

This surgery is the most common and progressive method widely applied for treatment of obesity. It combines both reduction and malabsorption.

A smaller part (called the pouch) is separated from the stomach and, then, connected directly to the small intestine. Apart from reducing the stomach size, this procedure enables delayed exposure of food or drinks to the bile and pancreatic juice necessary for digestion. The creation of a new passage has an effect on insulin production and, in about 3 months, 80% of patients with type 2 diabetes can stop the medication or insulin therapy. As a rule, excess weight is reduced by 70% in the first year after the surgery.

The two principles of weight reduction are used in this surgery:

  1. Bypassing: excluding from digestion a significant portion of the small intestine, which makes possible effective weight reducing and keeping it at the same level for a long time.
  2. Restriction: decreasing a working part of the stomach in size, and, hence, the amount of food consumed.

When gastric bypass is performed with staples, the stomach is sewn with overlapping seam in the horizontal or vertical direction (depending on the technique) and subsequently dissected along the seam, forming, thus, a small pouch with a volume of about 30-50 ml.

At the second step, the small intestine is bypassed at 50 to 100 cm from its beginning. After this, the distal (further) part is connected to the pouch, and the proximal (closer) part of the small intestine is connected to the distal part in, at least, 1.0 m from the pouch.

Thus, bile and pancreatic juice, containing enzymes necessary for digestion and absorption of food, meet with the food much later than it was before the surgery, thereby excluding at least 1.5 m of the small intestine from digestion.

Variations of the operation may involve increasing or decreasing of the pouch size and vertical or horizontal stomach bypass, as well as a significant increasing of the disconnected portion of the small intestine, so that the length of the small intestine where nutrient absorption takes place can be reduced to only 2,0-2,5 m.

In the first 2-3 years, there may be a deficiency of vitamins, iron, microelements and proteins in the body. To compensate this, it is enough to take regular courses of complex medications containing the above components. No in-patient treatment is required.

Adjustable Gastric Band

After gastric bypass surgery became the common standard, a couple of years ago, Friedrichshafen Clinic had stopped surgeries for gastric band placing. We perform many revision surgeries to the patients who had a gastric bandage installed and experience problems due to its improper work. In most cases, we remove the bandage and do gastric bypass. This technically complex operation is carried out in our center in Germany on the permanent base and with a tendency to increase in number.

A gastric band decreases the stomach volume. As a rule, the surgery is minimally invasive. The band is installed around the upper part of the stomach, which divides the stomach into two unequal parts. The width of the band can be changed through a port system installed subcutaneously. Due to the gastric band, the food intake decreases sharply by mechanical means and you feel full faster. Provided a patient has good cooperation with a doctor, the average weight loss can reach 50%.

Sleeve Gastrectomy

This is another type of surgery to reduce the stomach volume. In addition to the restriction of food intake, this operation leads to limited production of gastric acid, whilst hormonal effects reduce the feeling of hunger.

The surgery involves almost complete removal of the stomach, except its small part. This procedure is performed with laparoscopic method. As a result, in two years, the patient loses 50-70% of the excess weight.

The long-term effects are still being studied. In some cases, it is necessary to remove the gastric band placed in the past (especially if there is no weight loss or, even, some gain take place), and perform gastric bypass instead, in one surgery.

Obesity treatment in Germany

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Medical Staff

Prof MD Christian Arnold

Prof MD Christian Arnold
Head of the Gastrological Department

MD Karl Winkler

MD Karl Winkler
Head physician assistant

MD Thomas Günther

MD Thomas Günther
Senior physician

MD Inga Münkle

MD Inga Münkle
Senior physician

MD Gunda Millonig

MD Gunda Millonig
Senior physician

Ursula Fecht

Ursula Fecht
Medical secretary

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