Obese: gastric surgery is often the last chance

Obese: gastric surgery is often the last chance

Obese children: gastric surgery is often the only way out

In view of the increasing number of obese children and adolescents in Germany, many surgeons see a stomach reduction as the only chance for a better quality of life. "We're talking about 15-year-olds who weigh well over 100 kilograms," said Philipp Szavay, chief physician at the Lucerne Cantonal Hospital (Switzerland) and spokesman for the German Society for Pediatric Surgery on Monday at the World Congress of Pediatric Surgeons in Berlin. "If the change in diet and exercise are not successful, they will weigh 200 kilos at the age of 20," he added.

Many children are too fat
In Germany, around 800,000 children and adolescents are extremely overweight. Even under the strictest criteria for surgery, hundreds or even thousands of them would still be eligible for gastric reduction or gastric bypass, Szavay said. "But it is not only the weight that is difficult for the children. Many also have to endure teasing at school. Social exclusion is not an isolated case. Later there are hardly any friends, a partner or a training and job far away. Up to now, it has been estimated in Germany 1,000 obese adolescents had gastric surgery, and in the future Szavay sees a significantly larger number of adolescent obesity centers than necessary for treatment, but the operation should always be part of a pre- and after-care program Hospitals for adolescents in Leipzig, Berlin, Essen and Ulm. In the past, obesity surgeries were mainly carried out on obese adults. Around 22,000 people were put under the knife in Germany between 2005 and 2012. The health insurance company DAK has seen one of its insured since 2008 Surgery increases by 60 percent The total cost of obesity surgery at the AOK 2012 amounted to 30 million euros.

Operations quickly take effect
Not all experts are positive about stomach reduction, but the greatly reduced food intake shows clear success after only one year. Concomitant diseases such as joint and back pain or profuse sweating, typical obesity symptoms, disappear in many. This is confirmed by a Norwegian study.

What should not be underestimated is the psychological effect. Most patients felt better not only physically, but also mentally and emotionally. However, surgery cannot help against complications that have already been acquired, such as cardiovascular disorders and diabetes. Even an optical flaw, when the weight reduction is so strong that skin and connective tissue hang in rags, cannot always be avoided.

In Europe, there is hardly any valid data on obesity surgery for adolescents. Therefore, the doctors resort to examinations from the USA. This shows that from a body mass index of 35 or 40 no other therapy is promising and surgery is the last option. In a meta-study with 637 young patients, significant weight loss was already evident after one year after gastric surgery. But that is not a guarantee, restricts Szavay. If those affected do not change their diet at the same time, the stomach in adolescents can also grow again. Long-term results are not yet available because obesity surgery in adolescents has only existed for around ten years.

Lifestyle has changed
20 years ago, surgery for overweight children in Germany was not yet under discussion. There was no obesity in mass at the time. With a changed lifestyle, the oversized drink cups, sugar and fat-rich fast food and an ever greater lack of exercise, the picture has changed a lot. "These are no longer isolated cases; they stand out in every consultation hour," reports Szavay. "16-year-olds come to me and say that they can't make it on their own." Pediatric surgeons would have to adapt to this more and more. (fr)

Image: Dieter Sch├╝tz /

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