Bariatric interventions show what can be achieved when an efficient and timely medical therapy brings about a definitive turning-point, so costs are cut on a long-term basis. For severely overweight individuals, a gastric bypass can prevent secondary conditions in the long term – or can even eliminate them completely.
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eatrice finally reached breaking point during an outing with her family, when even a gentle uphill slope left her out of breath and she could no longer manage without help from others: "I knew that the time had come for something to happen," says Beatrice (who is now 72). Back then, she weighed in at 96 kilograms – distributed over a body height of 1.50 meters. The consequences of being overweight were making her life difficult: joint pains, shortness of breath and type 2 diabetes. Beatrice K. numbered among the eleven percent of obese individuals in Switzerland.
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"Obesity is a chronic condition," according to Professor Ralph Peterli. For many years, this surgeon has undertaken research on obesity and its consequences at the Obesity Center of Clarunis (the University Center for Gastrointestinal and Liver Diseases) on the Claraspital site in Basel. "The idea that obese individuals eat too much simply because they lack discipline and willpower is wrong," the specialist points out. In his day-to-day work, he sees that many factors are conducive to obesity: they include genetic and psychological factors as well as an unhealthy lifestyle or a metabolic disease. "Individuals with this condition can take as many slimming cures as they like – but through their own efforts, they rarely shed enough weight to restore them to normal levels."
According to the Swiss Federal Statistical Office (SFSO), 12% of men and 10% of women in Switzerland are obese. These figures have doubled over the last 25 years. And the Federal Office of Public Health (FOPH) also notes a breathtaking increase in the cost to the national economy over the same period: overweight individuals cost society CHF 8 billion in 2012. This makes it a matter of urgency to discover how obese individuals can be helped without a constant increase in costs.
Gastric Bypass
Gastric Bypass
A gastric bypass is a surgical intervention that involves amputation of the stomach just below its entrance.
The small residual stomach is connected to the small intestine. Digestion then begins directly in the small intestine. As well as reducing the intake capacity and lowering the absorption of food, the operation has a positive influence on the hormones produced in the small intestine that control satiety (the feeling of being replete). For the vast majority of patients, all of these effects result in a loss of weight.
A gastric bypass is regarded as the last resort if conservative methods of inducing long-term weight loss fail to produce results. It is only performed on patients with a BMI of 35 or more. The period of the patient's stay in hospital after the operation is between three and five days.
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alph Peterli sees surgical interventions such as the gastric bypass as a potential way of liberating obese individuals from their overweight on a long-term basis. He has already performed around 3,000 operations of this sort. The results are encouraging: in most cases, the bypass leads not only to a massive loss of weight but also to a reduction of the costs incurred due to obesity. "Even just a short time after the operation, diabetes is reduced and can even disappear in some cases; hypertension is brought under control, and there is less joint pain thanks to the loss of weight – the list of positive effects could go on."
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Beatrice K. had read about the possibilities offered by a gastric bypass, and she had also learned that it could cure diabetes. At age 70, Beatrice was admitted to the Claraspital in Basel where she was examined by a team of nutritionists, psychologists and physicians to determine whether she was suitable for an intervention. She has nothing but positive experiences to recount: "I felt that I was being taken care of and understood. At last, I could take a positive view of the future, and I knew that everything would be all right," she recalls. The minimally invasive intervention, which involves massively reducing the size of the stomach and connecting it directly to the small intestine, takes about one hour. Even so, she points out, it is a serious operation – but she was happy to accept the inconvenience it entailed: "Staying fat wasn't an option for me." Everything went according to plan, and she was discharged after five days.
She has since lost 30 kilos. She is healthy. Her diabetes has vanished. She no longer gulps down medicines. She feels as if she has given herself the gift of a new life: "I'm active again, I often go for a walk with my dog, and I meet up with friends." Surgeon Peterli views the entire process as an interaction between the interdisciplinary medical treatment team, the patient, and the operating method. "In the preparatory phase, we investigate in detail whether the patient is ready to adapt his or her eating behavior and exercise patterns after the operation so that we can all collaborate to achieve the best possible result." He believes it is essential for patients to receive ongoing support from his team – for their entire lifetimes.
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