A bariatric surgery is worth it
Severely overweight (obesity): how is it treated today?
The necessity and the type of treatment are determined by means of a careful clarification. Here it is worthwhile to go to a recognized obesity center.
A BMI below 35 is still treated without surgical intervention (conservative). The focus here is on a change in diet, regular physical training and, if necessary, psychological measures.
If conservative treatment (without surgery) is unsuccessful, surgical treatment methods can be considered. Today we know that obesity can shorten life by 10 years, which is why bariatric surgery has become increasingly important in recent years.
What to do if you are seriously overweight
From a BMI over 35 one speaks of severe obesity or obesity. In this case, we know that sheer willpower, a change in diet and exercise alone rarely lead to lasting success
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Treatment for obesity - what does it mean?
Surgery as a last resort - for whom?
The bariatric operations include the gastric balloon, gastric band, stomach reduction and gastric bypass.
A prerequisite for a surgical intervention is a BMI of over 35 and the patient must demonstrably have had at least two years of unsuccessful weight-reducing therapy. The suitable surgical treatment method is discussed in detail with the patient in advance - also with regard to his state of health - and selected accordingly.
Bariatric operations today are mostly performed laparoscopically, i.e. with a small incision in the abdominal wall and often with robot assistance. This makes the operations very safe for the patients.
Surgical treatment methods in detail
Inserting a gastric balloon is an aid that can lead to weight loss with a simultaneous change in diet, behavioral changes and regular physical training.
Method: A plastic or silicone balloon is inserted into the stomach via the esophagus and filled with air. The air filling prevents the balloon from migrating back into the esophagus or migrating through the intestine. The goal is an early feeling of satiety and reduced food intake.
If you are 15 kg overweight, a gastric balloon can help you lose weight quickly and feel better. A gastric balloon is often used before a stomach reduction in order to reduce the weight of very heavy patients by 15-20% and thus also the risk of surgery.
A stomach reduction (also known as sleeve gastrectomy) is achieved by removing part of the stomach. The remaining part is transformed into an elongated tube. Due to the reduction in stomach volume, not so much food can be consumed afterwards, which leads to an earlier feeling of satiety. The sleeve stomach also has the advantage that the "hunger hormone" gherlin produced in the gastric mucous membrane is markedly reduced and a correspondingly reduced feeling of hunger develops.
From a BMI over 40, stomach reduction can help eliminate or significantly reduce concomitant diseases and achieve a healthy weight. After the operation, life can go on normally. However, when eating food, you should chew it well and avoid high-calorie or carbonated drinks. The stomach reduction is irreversible, so this step needs to be considered carefully.
The gastric band is a mechanical lock. The stomach is not made smaller and the production of gherlin remains intact. Under anesthesia, a laparoscopic silicone band is attached to the upper part of the stomach around the stomach. The inside diameter of this band can be made narrower or wider, which requires a high level of experience from the surgeon. When the gastric band is put on, a small forestomach is created, which is responsible for absorbing food. The forestomach is much smaller than the stomach itself, which also results in much less food intake.
The gastric band is particularly recommended for patients with a BMI over 40 or with existing comorbidities (e.g. diabetes) with a BMI of 35 or more. After gastric band surgery, you should mostly avoid sweets. If you have trouble here, a gastric bypass is recommended.
Gastric bypass is a procedure in which the function of more than two-thirds of the stomach is stopped. At the same time, the rest of the stomach is connected to the first loop of the small intestine. Depending on the length of this loop of small intestine, food intake or food utilization is correspondingly greatly reduced, so that excess pounds drop off fairly quickly.
According to international standards, gastric bypass is recommended from a BMI of 40 or from 35 with existing concomitant diseases (e.g. high blood pressure, diabetes, etc.) to improve health. The prerequisite is the willingness to make a lifelong change in eating and nutritional behavior as well as taking up regular physical activity. The goal is a relatively rapid, high weight reduction. Disadvantage: This procedure cannot be reversed and the operation is more time-consuming than, for example, a stomach reduction.
Plastic surgery after the operation
Plastic surgery is necessary when excess tissue (so-called skin aprons) has to be removed. Due to the lack of elasticity of the skin, these problems cannot be eliminated with exercise, massage or liposuction alone. However, the skin folds can become a hygienic and physical problem for the patient, since skin rubs against skin. In most cases, a one-time procedure is not enough.
Follow-up care and control of the success of the operation
Modern treatment centers do not leave the patient alone even after the operation. After the operation, the course is examined and documented using x-rays. From the 6th week onwards, there is targeted training in eating habits and a special nutritional program. At the same time, exercise experts help to set up an exercise program. Because: The operation alone is not enough. The affected person must urgently and lifelong change his diet and from now on regularly exercise himself if the operation is to be successful. Nutritionists offer valuable help and support here.
With weight loss, the desire to move more often comes naturally. Sports activities in the group also help motivation. With simple tricks - sitting instead of standing, running instead of driving - it is relatively easy to get more exercise in everyday life and thus consume more calories.
But not only the body but also the soul, which also always suffers greatly in overweight people, needs help. With psychological support, those affected learn to determine the causes of the disrupted eating behavior and to strengthen self-confidence. In addition, they learn to deal better with stress and strain and not simply to compensate for feelings of frustration with food.
Bariatric Surgery - Who Pays?
From a BMI of 35, surgical treatment in Switzerland has been covered by basic insurance since the beginning of 2011. These include stomach reduction, gastric banding and gastric bypass. For severely overweight patients (from BMI 40) and especially for those patients who can no longer be operated on due to their high obesity, the costs of the gastric balloon are also covered by the health insurance companies. A price comparison is worthwhile.
Prerequisite: The patient has had two years of unsuccessful weight-reducing therapy and the indications, the implementation of the operation, the quality assurance and the follow-up controls of the treatment take place in a center that follows the guidelines of the "Swiss Study Group of Morbid Obesity" (SMOB) followed.
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