Obese Gastroenterology often last chance

Overweight children: stomach surgery often the only way out

14/10/2013

In view of the increasing number of obese children and adolescents in Germany, many surgeons in a gastric reduction see the only chance for a better quality of life. "We're talking about 15-year-olds weighing well over 100 kilograms," said Philipp Szavay, chief physician at the Lucerne Cantonal Hospital (Switzerland) and spokesman for the German Society for Pediatric Surgery on Monday at the World Congress of Pediatric Surgeons in Berlin. "When diet and exercise are not successful, they weigh 200 kilos at the age of 20," he added.

Many children are too fat
In Germany, around 800,000 children and adolescents are severely overweight. Even under the strictest criteria for surgery, hundreds or even thousands of them would still be eligible for gastric reduction or gastric bypass, Szavay said. "But not only the weight gives the children a hard time, many have to endure teasing at school, social exclusion is not an isolated case, there are hardly any friends, a partner, or an apprenticeship or job in the distant future Szavay sees a significantly greater number of adolescent adiposity centers as necessary for the treatment in the future, but the operation should always be embedded in a preventive and postoperative program Adolescent clinics have already been established in Leipzig, Berlin, Essen and Ulm In the past, obesity surgeries were mainly carried out in obese adults, and around 22,000 people underwent a knife strike in Germany between 2005 and 2012. Since 2008, DAK has been providing insured persons with health insurance Increase in interventions by 60 percent The total cost of obesity As operations at the AOK 2012 amounted to 30 million euros.

Operations show effect quickly
Not all experts are positive about a gastric reduction, but the greatly reduced food intake shows significant success after only one year. Concomitant diseases such as joint and back pain or heavy sweating, typical obesity symptoms, disappear in many. This is proven by a Norwegian study.

What should not be underestimated is the psychological effect. Most patients felt not only physically, but also mentally and emotionally better. However, surgery can not help with previously acquired sequelae such as cardiovascular disorders and diabetes. Also, a visual blemish, when the weight reduction is so strong that skin and connective tissue hanging in rags, can not always be avoided.

There are hardly any valid data on obesity surgery in adolescents in Europe. That's why doctors are resorting to studies from the USA. Here it turns out that from a body mass index of 35 or 40 no other therapy is more promising and surgery is the last resort. In a meta-study with 637 young patients after a stomach operation after one year, a significant weight loss has been shown. But that's not a guarantee, says Szavay. If affected people do not change their diet at the same time, the stomach can grow again in adolescents. Long-term results are not yet available, because adiposity surgery in adolescents has only been around for about ten years.

Lifestyle has changed
20 years ago, child obesity surgery in Germany had not been discussed. Obesity in large numbers did not exist then. With a changed lifestyle, the oversized beverage cups, high-fat and high-fat fast food and an ever increasing lack of exercise, the picture has changed a lot. "These are not isolated cases, they are noticeable in every consultation," says Szavay. "16-year-olds come to me and say that they can not do it on their own anymore." Thereupon pediatric surgeons would have to adjust more and more. (Fr)

Image: Dieter Schütz