obesity clinic

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.

Bariatric surgery

Bariatric surgery is the most effective option and can reduce weight permanently. The surgery, which takes the form of either a gastric bypass or a gastric sleeve, enables the patient to lose around 70% of their excess weight. However, it is important to know that obesity is a chronic disease and that, despite the surgery, lifelong treatment is required. Therapy can only be effective if the patient’s habits are changed after the surgery. It is important that patients work on this their whole lives.

Patients should see the surgery as the start of a new chapter in their lives. The amount of weight a patient stands to lose following the surgery largely depends on the following factors:

• Age
• Starting weight
• General condition
• Ability to stick with new habits and diet plans
• Intrinsic motivation

Surgery is indicated when:

• Patients have suffered from obesity for many years
• All conservative therapy options, such as nutrition therapy and physical therapy, have been exhausted
• BMI of over 40 (or over 35 with relevant concomitant disease)
• Hormonal causes, psychological conditions and addiction have been excluded

In confidential and extensive consultations, the experts at the obesity clinic will initially assess the individual situation of each patient and will consult other experts for specific issues.

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

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.