obesity clinic

Definition of obesity

Obesity is a condition characterised by having excessive body fat. It is a chronic disease that features significantly increased body weight. This is measured using the body mass index (BMI).

BMI is calculated as follows: body weight (in kg) divided by height (in m²).

The World Health Organization defines obesity as having a BMI of over 30. Extreme obesity is defined as having a BMI of 35 or more. This affects 1.5 million people in Germany alone – and the number is increasing.

Is obesity dangerous?

People who suffer from obesity over an extended period, but particularly after ten years or more, are likely to develop secondary conditions. For this reason alone, it is important to treat obesity before the patient’s health is affected, often with long-term consequences.

Secondary conditions may include:

• Type 2 diabetes
• High blood pressure
• Cardiovascular disease
• Lipid metabolism disorders
• Fatty liver disease
• Respiratory problems (shortness of breath on exertion, asthma)
• Sleep apnoea
• Joint problems (e.g. arthritis)
• Gallstones
• Heartburn (acid reflux)
• Gout (hyperuricaemia)
• Urinary incontinence
• Psychological problems, such as depression
• Infertility
• Increased risk of stroke and cancer
• Causes of obesity
• Obesity can have many causes. The most common causes are:
• Familial or genetic predisposition
• Unhealthy lifestyle (lack of exercise, poor diet)
• Insomnia
• Stress
• Depression
• Eating disorders (e.g. binge-eating disorder, night-eating disorder)
• Endocrine conditions (e.g. hypothyroidism, Cushing’s syndrome)
• Medicines (e.g. antidepressants, neuroleptics, mood stabilisers, anticonvulsants, antihyperglycaemic agents, glucocorticoids, some contraceptives, beta blockers)
• Other causes, such as pregnancy, immobility or giving up smoking

Conservative therapy as part of a multimodal therapy concept

All conservative measures are offered at the Asklepios Westklinikum obesity clinic as part of a multimodal therapy concept that aims to achieve individual and long-term lifestyle changes:

• Nutrition and behavioural therapy
• Physical therapy in special sports groups
• Training in patient seminars
• Contact with self-help groups
• Diagnosis of internal/endocrinological causes
• Diagnosis of psychological causes
• Diagnosis of sleep apnoea

Behaviour-based nutrition therapy

During the course of treatment, patients are advised and supported by certified nutrition therapists. Starting with an in-depth medical history, they can determine current eating habits using a nutrition log and work together with the patient to optimise eating behaviours. During the nutrition consultation, patients are provided with important information about a balanced, healthy diet. Behavioural therapy is also initiated here.

If bariatric surgery is indicated, the patient will be supported and informed about nutrition before and after the operation. They will receive suitable dietary recommendations based on the surgery option and information about dietary supplements in order to prevent certain deficiencies, such as vitamin deficiencies.

As part of the follow-up care, the nutrition therapists discuss the transition to a healthy post-operative diet and are on hand to help the patient achieve permanent weight reduction and stabilisation without relapses.

Physical therapy

Physical activity increases the number of calories burned and plays a major role in reducing and stabilising weight, as well as being proven to improve the patient’s well-being. As a result, it is an important component of the therapy concept.

Positive effects of physical therapy:

• Blood cholesterol levels are lowered and plaque in the blood vessels is broken down

• Additional oxygen supply to the brain has a positive effect on cognition

• Reduces stress hormones

• The cardiovascular system becomes healthier

• Fitness and lung capacity increase

• Improves shortness of breath upon exertion

• Muscles are built up; body fat is reduced

• Bone density is maintained and improved

• Increased flexibility of the musculoskeletal system

• Builds up cartilage in the joints, stabilises ligaments and reduces the risk of arthritis

• Natural endorphins are released, which has a positive impact on the mood

• Helps to prevent the symptoms of depression

The individual options for strength training and building stamina, as well as group fitness and seated workouts, are discussed with the patient.

Therapy options:

• Medical therapy using modern, computer-controlled equipment
• Strength training to strengthen the arms, legs and torso
• Endurance training: exercise bikes and recumbent ergometers, cross-trainers, treadmills and NuStep cross-trainers are all available
• Exercise pool and aqua aerobics: walking and aerobics in the water gently boost cardiovascular fitness and muscular strength while easing pressure on the joints

Psychological evaluation and behavioural therapy

Psychological factors and various psychosocial issues can often play a significant role when it comes to obesity. For this reason, conservative therapy is always accompanied by a psychological evaluation, which takes place as part of an extensive consultation with one of our psychologists. This helps to rule out any potential contraindications prior to surgery. In the event that the psychologist recommends further psychotherapy or psychiatric treatment, we will recommend further treatment with one of the obesity clinic’s cooperation partners.

Gastric balloon

A gastric balloon aims to help patients who are not able to undergo general anaesthetic due to obesity to reduce their weight. This is done in stages. The gastric balloon is not a stand-alone therapy but serves to enable an operation at a later date by reducing the weight.

Procedure:

The gastric balloon is positioned in the stomach using an endoscopic procedure and then filled with 500 ml water. In this way, it fills up most of the stomach and reduces the stomach’s volume.

Mode of action:

• Less food can be consumed
• The patient feels full more quickly and satiety lasts longer

Cons:

• The gastric balloon must be removed again after a maximum of seven months
• Only if the health and general condition of the patient allow them to undergo a general anaesthetic can subsequent surgery take place
• Subsequent surgery must take place quickly in order to avoid the patient relapsing to previous eating habits

In some cases, we offer the operation as a service for self-payers.  

Surgical methods

All surgeries are minimally invasive using keyhole surgery techniques. Our clinic features cutting-edge equipment, including 4K/HD technology. For patients, this means a significantly shorter hospital stay, better cosmetic results and lower pain levels after the operation.

1. Gastric sleeve

In this procedure, most of the stomach (around 80%) is removed. What is left is a sleeve-like section that is only able to absorb small amounts of food. The feeling of satiety is reached earlier. At the same time, the section of the stomach is removed where the hunger hormone ghrelin is formed. This means that patients have fewer hunger pangs, particularly in the time directly after the surgery, and fewer cravings.

 

 

 

Pros:

• The intestinal tract and normal digestive tract is retained
• Deficiencies tend to occur less frequently: however, it is still important to take vitamin and mineral supplements
• Gastroscopy is still possible

Cons:

• In order to maintain weight, the patient requires a high level of discipline: the gastric sleeve can expand if excessively large portions are eaten
• The benefits of the smaller stomach may be outweighed if soft, high-calorie foods or drinks are consumed
• Not suitable for patients with severe heartburn: it may increase or trigger symptoms

2. Omega-loop gastric bypass (mini gastric bypass)

A bypass procedure that forms a new digestive tract and is particularly well-suited to patients with type 2 diabetes and GERD.

The stomach is divided into a narrow, shorter sleeve and the residual portion, which remains in the body and continues to produce digestive juices. The side of the new, smaller stomach is then connected to a section of small intestine below that is around two metres long. The food now only passes through the new stomach and part of the small intestine. The other part of the intestines and remaining stomach portion are bypassed and no longer come into contact with the food.

Both the amount of food that can be eaten at each meal and the amount of energy absorbed from the food is reduced. An average weight loss of around 60–80% of the excess weight can be achieved.

Pros:

• Significant weight loss that remains stable for years
• Suitable for patients with heartburn
• Good long-term results and effect on improving or reversing type 2 diabetes

Cons:

• Vitamins and minerals can no longer be fully absorbed so patients will need to take a dietary supplement for the rest of their lives
• It is no longer possible to conduct a gastroscopy of the large part of the stomach that is no longer in use
• Resorption of certain medicines may be affected (antidepressants, contraceptives)

3. Roux-en-Y gastric bypass

This kind of gastric bypass divides the stomach into two parts: a small section that is directly sutured onto the small intestine, and the rest of the stomach. The new stomach section can only accommodate very little food until it is full, which restricts the resorption of certain medicines such as antidepressants and contraceptives. The small intestine is also diverted such that the digestive juices only come into contact with the food once it has already passed through a section of the small intestine. Some of the nutrients and calories are therefore not digested but are excreted in the faeces.

Pros:

• High weight loss that remains stable for years

• Usually relieves heartburn

• Good long-term results and effect on improving or reversing type 2 diabetes

Cons:

• Increased risk of deficiencies: it is essential that vitamin and mineral supplements are taken for the rest of the patient’s life

• It is no longer possible to conduct a gastroscopy of the large part of the stomach that is no longer in use

4. Gastric band removal

In recent years, it has become clear that the use of gastric bands is disproportionately associated with poor outcomes. The use of gastric bands has dropped around Europe and the Klinikum GmbH obesity clinic also completely avoids the use of gastric bands.

Patients who have been fitted with a gastric band can contact our clinic at any time if they experience any complications. We will inform you in detail about the alternatives available and can remove the gastric band if you wish. This is generally performed as keyhole surgery.

Possible complications:

• Increase in stomach pouch volume

• Extension into the oesophagus

• Weight gain despite gastric band. In this case, it may sometimes be possible to perform a gastric bypass or gastric sleeve surgery to replace the gastric band

The decision to undergo a specific surgery depends on many different factors and is discussed on a one-to-one basis with your doctor.

For all surgical techniques, the cooperation and level of information of the patient is crucial to success, as is the lifelong post-operative care.

Precise information and details of post-operative nutrition are absolutely essential. Regular medical follow-up care and nutrition therapy also help to identify and prevent any potential deficiencies in good time. Vitamin and mineral consumption as well as individual eating habits and behavioural patterns can then also be re-evaluated.

It also plays a significant role in stabilising weight after the surgery and in avoiding weight gain.

Follow-up care

A permanent change in lifestyle and eating habits determines the success of obesity therapy. This is where we come in: our concept comprises lifelong follow-up care that begins four weeks after your hospital stay. The first appointment is made with the patient while they are still in hospital.

Relevant aspects of follow-up care:

• Patient information and details on dietary changes after the surgery
• Creation of a personalised nutrition plan, taking into account the realities of the patient’s life
• Consultation and patient information on supplementary cosmetic operations, for example, to remove excess skin
• Diagnosing and treating any (vitamin and mineral) deficiencies

Furthermore, patients can contact the team at the obesity clinic at any time if they have any questions or experience any complications.

In many cases, patients who lose enormous amounts of weight suffer from excess skin folds. Plastic reconstructive surgery is offered by our cooperation partners. You can apply to your health insurer to have the costs covered.

Plastic surgery: partnership with Asklepios Klinik Altona

PARTNERSHIP WITH ASKLEPIOS KLINIK ALTONA

Following massive weight loss, it is often necessary to restore the body’s contours. Our specialised surgeons at the obesity clinic in Hamburg carry out these abdominoplasties (tummy tuck) and breast reduction surgeries.

Interdisciplinary partnership
We also work together with the department for plastic, aesthetic and reconstructive surgery in the Asklepios Klinik Altona. Under the expert care of Dr Weiß, lifting procedures are carried out to reshape the body following significant weight loss.

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Day clinic for eating disorders, young adults and obesity

Our day clinic for eating disorders, obesity and young adults combines various therapy elements, and structures the programme in such a way that you can receive treatment five days a week.

The following therapies are used:

• Medical diagnostics and treatment
• One-to-one psychotherapy and group therapy
• Nutrition counselling
• Instructions in cooking in our cooking workshop
• Feldenkrais therapy
• Physical therapy
• Information event on the topic of bariatric surgery (once a month)
• Consultation with psychosocial specialist

By alternating extensive therapy options during the day with testing things out in the evenings and weekends, it is possible to bring about long-term, effective changes in behaviour.

The treatment at the day clinic can also take place before bariatric surgery (such as a gastric band, gastric balloon, etc.) or as part of the follow-up care process.