More and more XXL operations

More and more XXL operations

More and more obese people see surgery as the last resort

Very overweight people are undergoing surgery more and more to get their weight problems under control. As the DAK-Gesundheit reports, "the procedures in so-called obesity surgery increased by 64 percent in the past five years and reached a new high in 2012." Many "XXL patients" see in a gastric band, gastric balloon or one Stomach reduction apparently is the only chance of a significant weight loss.

Since the number of morbidly overweight people in Germany has been rising significantly for decades, the increase in corresponding interventions for obesity treatment seems to be an understandable consequence. Because in the past, significantly fewer people simply fulfilled the requirements that apply to obesity surgery. According to DAK-Gesundheit, one of these medical prerequisites is, for example, "that the patients are overweight for more than five years and have a Body Mass Index (BMI) over 40", which would mean that for a 1.70 meter tall woman weighs 117 kilograms. For patients suffering from chronic concomitant diseases such as diabetes mellitus or severe spinal complaints, a BMI of more than 35 is the limit. Furthermore, it had to be demonstrated that "those affected did not have conservative treatment methods such as nutritional, exercise and behavioral therapies without the hoped-for success," reports DAK-Gesundheit.

Gastric band, gastric balloon or stomach reduction According to the DAK-Gesundheit, the increased operations on "XXL patients" also result in a massive increase in costs for the health insurance companies. For example, "expenditure on gastric surgery for severely overweight patients has more than doubled since 2008." According to the DAK-Gesundheit in 2008, 406 operations with gastric band, gastric balloon or gastric reduction cost a total of 2 million euros "Emerged. In 2012, "669 procedures were already invoiced for EUR 4.6 million" and "In the first half of 2013 there were 331 hospital treatments with expenditure of EUR 2.5 million", the DAK announced. The trend towards increasing costs thus continued in 2013. According to the health insurance company, this is not least due to the fact that "the average cost of an operation has increased rapidly."

Rising case costs in obesity surgery While the so-called case costs of gastric surgery were just under 5,000 euros per procedure in 2008, they reached just under 7,500 euros in the first half of 2013. "The clinics are accounting for more and more large operations with complex procedures", what leads to a corresponding increase in the case costs, explains hospital expert Peter Rowohlt in the press release by DAK-Gesundheit. In the period from 2010 to 2013 alone, the proportion of serious operations increased from 62 percent to 76 percent. Rowohlt emphasized that he was concerned about this development, because "it not only drives up costs, but also poses a health risk for many patients." Doctors, nutritionists and psychologists are required to prevent further interventions by early advice.

Berlin and Hamburg strongholds of gastric surgery According to the DAK-Gesundheit report, hospital statistics show that "especially in Berlin and Hamburg, the rates of those who are heavily overweight are treated well above the national average". In 2012, 41 out of 100,000 insured persons in Berlin underwent a corresponding intervention. 33 gastric operations were performed in Hamburg for every 100,000 insured. The nationwide average is only twelve interventions per 100,000 insured. A possible explanation for the significantly increased number of cases in Berlin and Hamburg is "that special centers are also used here by patients from the surrounding area," the DAK said.

Obese women are increasingly putting themselves under the knife The health insurance company also announced that a considerable majority of the operations in obesity surgery are carried out on women. As many as 81 percent of the procedures concerned XXL patients. A distribution that by no means corresponds to the population share of very overweight women and men. Apparently, women with massive overweight choose surgery more often than men.

Avoiding operations through prevention The development outlined by DAK-Gesundheit also reflects to some extent the attitude towards life and body awareness in the population. Far too often, years of misconduct are accepted and then an attempt is made to correct the problem with an operation. This applies not only to obesity, but also to numerous ailments, such as cardiovascular diseases and back problems. If those affected take early countermeasures at the first sign of back pain or heart problems and change their lifestyle accordingly, further measures would often not be necessary. But it is not uncommon for intervertebral disc surgery, cardiac surgery or - for those who are very overweight - obesity surgery to end up. The errors of the past are to be eliminated with a single intervention. The importance of prevention cannot therefore be emphasized enough. (fp)

Image: Martin B├╝denbender /

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