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With a stomach reduction, part of the stomach is removed in one operation. This is said to help overweight people to reduce their weight. The intervention is the last option because it cannot be undone and also carries risks. The costs of a stomach reduction are only covered by the health insurance if the medical necessity is clearly proven and there are no alternative treatment options.
The last option
This intervention is the last option. If you suffer from "normal" overweight, do not change your diet, do no sports, eat too much sugar, indulge in alcohol and generally love hearty food, no responsible doctor or serious medical doctor advises you to reduce your stomach size.
After all, it is an intervention that cannot be undone. Rather, the target group is morbidly overweight people - this does not refer to morbid eating disorders that have a psychological cause.
Only with extreme overweight
Some people suffer from a body mass index over 40, which has mainly biological origins: they store a disproportionate amount of fat in the body and also suffer from severe obesity if they eat a balanced diet.
Not a substitute for a diet
Without concomitant illnesses, even if you are overweight, a doctor only recommends a stomach reduction if all conservative therapies have been exhausted. This means that the patient has changed their diet over the long term, they are physically active within the limits that their overweight allows. Nevertheless, her weight has remained at a height that severely limits normal life for at least three years.
Diseases are an indicator
Concomitant diseases such as high blood pressure, breathing interruptions during sleep and diabetes as a result of being overweight are hard medical indicators in which doctors also recommend surgery for a BMI over 35.
Mental stability required
In addition, those affected must first be of legal age, secondly they must be relatively stable emotionally, and thirdly they must have neither mental disorders nor substance abuse. This is particularly important since the cooperation between doctor and patient plays a major role after the operation.
Controlled lifestyle is necessary
The operation is not enough. Those who continue to pour alcohol into themselves or take drugs that damage their metabolism, who consume sugar in high doses, etc., no longer suffer from obesity as before, but they put a strain on the remaining stomach burdened by the procedure in such a way that serious illnesses can result.
Reduction or bypass?
In principle, surgery has two options for reducing extreme excess weight. First, shrink the stomach. A smaller stomach can absorb less food, and people are more quickly saturated.
This stops the urge to eat without limits in many people with pathological obesity. Possible operations are the stomach of the tube and the gastric band.
A bypass bypasses part of the digestive tract and limits the absorption of nutrients.
The stomach of the tube
This stomach reduction is named because the result is in the form of a tube. The remaining stomach consumes less than a tenth of the amount of a normal stomach, i.e. about 150 ml instead of two to three liters.
Not only can those affected absorb less, they also no longer produce the hunger hormone ghrelin, because the part of the stomach in which it is created is removed. So you feel full in every way faster.
This is not possible without complications: It is not possible without complications: the stomach of the tube no longer forms enough so-called intrinsic factor, which promotes the absorption of vitamin B12 in the small intestine, and patients have to take vitamin B 12 supplements permanently.
The operation is difficult because the gastric sutures must be absolutely tight, as gastric contents could enter the abdominal cavity through a hole and this would lead to the feared inflammation of the peritoneum.
The gastric bypass
A gastric bypass is much more complex than a stomach. The big advantage is that it not only reduces the absorption of food, but also the absorption of nutrients.
Patients with pathological overweight often suffer from the fact that their bodies do not use nutrients adequately.
The disadvantage is that patients usually have a lack of nutrients after the operation. They have to consume vitamins, protein and trace elements until their death.
The operation is performed under general anesthesia and is a difficult operation. The doctor or surgeon first shrinks the stomach and then sutures it with a small intestine loop to exclude the duodenum from digestion. As a result, however, the patient gets too little calcium, iron and vitamin B 12 in the long run. These must therefore be added artificially.
Biliopancreatic Diversion (BPD)
The BPD maintains a higher capacity than the classic stomach reduction, namely up to 300 ml. The surgeon links the gastric remnant with a small intestine loop as in gastric bypass and bypasses the upper small and duodenum.
But the BPD also redirects the digestive juices, which ensure the absorption of nutrients - the surgeon moves the small intestine for this. In this way, the juices from bile, liver and pancreas can continue to do their work, but the distance is reduced considerably.
A maximum of one meter of the small intestine still absorbs fats, carbohydrates, vitamins and minerals. The goal is for the patient to lose weight without suffering from a lack of nutrients.
Does the health insurance company pay for the stomach reduction?
Health insurance companies only cover the costs of such gastric reductions in individual cases and if there is a clear medical indication. In order to be reimbursed for surgery, it is necessary to undergo multi-layered therapy.
The team includes not only surgeons, but also internists and psychologists, movement therapists and nutritionists.
Put simply, if the health insurance company suspects that you are performing an operation in order not to undertake conservative therapies, it does not pay. She also does not pay if her overweight is in the first place and secondly has no biological causes.
However, this coincides with the indication of the responsible doctors, and this means that if you have serious reasons to undertake such an operation, there is a high probability that it will be paid for.
How big is the success?
The success of this operation is so great that most patients are happy to accept lifelong support with vitamins and minerals.
However, you must "play along" permanently. If you change your diet and develop an appropriate exercise program with advice from exercise therapists, you will lose up to two thirds of your excess weight in just two years.
But be careful: the psychological and therapeutic support is not just an organizational framework. If you are used to consuming calories to a high degree, you can continue this (often addictive) behavior by adding small amounts to the stomach, but extremely high-calorie food.
In addition, the stomach of the tube can be stretched again if you consume large portions in the long term. Here there is a risk that you "normalize" your eating behavior - in other words, you will lose a lot of weight at first and then get used to "eating like everyone else".
Post-treatment primarily includes psychological counseling. Those affected had previously set themselves up in their extreme overweight. The psychological indication of “eating addiction” is not decisive for an operation, but a certain lifestyle that goes hand in hand with obesity (obesity) must and should no longer exist after the procedure.
For example, people who were heavily overweight hardly ever moved before. They were unable to do a lot of physical work, for example handicrafts, and in the process depended on the help of other people.
Most of the time, those affected have to learn the physical participation of a normal-weight person in social life again after the operation. This new independence is not only unknown to them themselves, it also changes the relationship structure right through to the partnership.
Everyday life changes in marriage and the family. Partners, whose role was also to support the obese, no longer have to and cannot use this crutch and they often have problems with it.
Another danger is that those affected undertake too much. From long mountain hikes to nights full of dancing, they then try out everything that they were previously unable to do physically without having developed the necessary fitness.
Also, don't be fooled by "fake friends". Anyone who previously made fun of you for their fullness and is now looking for their closeness is not worth friendship.
Even among friends and acquaintances, you should be skeptical about compliments that only refer to their appearance. Serious discussions about the operation, the changes in life, and subsequent comments about your changed body have a completely different quality.
This also applies to sexual contacts to a limited extent. You may look different when you reduce your weight, but you are still the same person. Those who are looking for a (sexual) relationship with them will have the same similarities, problems and conflicts with you as before.
Be sure to share with other people who are affected because the problems you have after an operation are shared by other patients and they can give you good advice.
Last but not least: If you had problems before the operation, whether in your psyche, in your job or in your finances, these will not dissolve in the air due to their lower weight. Even in the life after the operation there are still conflicts, you will still have to master difficulties.
The skin apron
Serious doctors warn against equating the operation with an ideal body. On the other hand, a skin apron is usually left. The skin that was previously stretched due to being overweight now hangs like an empty sack on the body, and patients suffer from the fact that they do not look as aesthetic as they would like.
The bigger the overweight was before, and the more the patients lost weight, the bigger this skin apron is - there is no way around it.
Follow-up operations are necessary, and the health insurance companies only pay for clear reports - above all, the psychological assessment now plays a role, because in contrast to stomach reduction, tightening the fat apron is an aesthetic question, not a medical one.
A stomach reduction or gastric bypass should be considered very carefully - by everyone involved. Consult a wide range of experts, surgeons, psychologists and nutritionists about a possible operation.
Check whether you have really exhausted alternatives. Many obese people know the “miracle” when they regularly do weight training and actually eat vegetables, fruit, whole grain bread, low-fat fish, etc. in the long run.
In the first few months, you only lose a few kilograms, then in a "second phase" the pounds tumble without you suspecting it. The better-trained body now burns a lot more calories even when it is at rest and you also move a lot more than before, often without realizing it.
On the other hand, if you have become accustomed to a lifestyle that promotes obesity, it is very difficult to imagine another. You may now think sincerely that you have done everything, but you never learned how to reduce sugar in everyday life or how to integrate gymnastic exercises into your daily routine.
However, if surgery is really appropriate, it is an intervention that is not easy - but with appropriate behavior, it leads to massive weight loss. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
- Helmholtz Zentrum München: Operations for gastric reduction in obesity (accessed: August 12, 2019), diabetesinformationsdienst-muenchen.de
- Institute for Quality and Efficiency in Health Care (IQWiG): Operations for the treatment of obesity (accessed: August 12, 2019), gesundheitsinformation.de
- German Society for General and Visceral Surgery (DGAV): S3 guideline on surgery for obesity and metabolic diseases, as of February 2018, detailed view of guidelines
- Universitätsmedizin Leipzig, IFB Obesity Diseases: Surgical Treatment (accessed: August 12, 2019), ifb-adipositas.de
- Mayo Clinic: Guide to types of weight-loss surgery (accessed: August 12, 2019), mayoclinic.org
- Mayo Clinic: Bariatric surgery (accessed: August 12, 2019), mayoclinic.org
- National Institute on Diabetes and Digestive and Kidney Diseases: Bariatric Surgery (accessed: August 12, 2019), niddk.nih.gov
ICD codes for this disease: E66ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.