Skip to main content
SpringerLink
Log in

Bariatrische Chirurgie: Erwartungshaltung und Therapieziele – ein Gegensatz?

Bariatric surgery: Expectations and therapeutic goals—a contradiction?

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Die metabolische/bariatrische Chirurgie führt bei dem Großteil der Patienten mit morbider Adipositas zu einem nachhaltigen und klinisch relevanten Gewichtsverlust, zu einer Verbesserung der adipositasassoziierten Morbidität, der Lebensqualität und der Funktionalität. Mit der Reduktion von Risikofaktoren für kardiovaskuläre Ereignisse und Krebserkrankungen wird die Lebenserwartung verlängert. Aufgrund der sehr guten antidiabetischen Wirkung wird in der aktuell gültigen S3-Leitlinie eine metabolisch/bariatrische Operation bei schlecht einstellbarem Diabetes bereits ab einem Body-Mass-Index (BMI) von 30 kg/m2 empfohlen. Mit dem Edmonton-Staging-System kann eine vom BMI unabhängige mehrdimensionale Betrachtung des Schweregrades der Adipositas für den individuellen Patienten vorgenommen werden. Patienten mit relevanten adipositasassoziierten Begleiterkrankungen sollten priorisiert therapiert werden und das möglichst bevor Endorganschäden vorliegen, die zum einen das perioperative Risiko erhöhen und zum anderen – zumindest teilweise – nicht mehr reversibel sind. Der Definition individueller Therapieziele und der Vermittlung einer realistischen Erwartungshaltung sollten bereits präoperativ – aber auch im Verlauf – viel Aufmerksamkeit gewidmet werden. Eine unrealistische Erwartungshaltung – „Operation löst meine Probleme“, „Operation macht mich schöner“, „Operation beseitigt Stigma“, „Operation garantiert Therapieerfolg“ – ist nicht selten. Sie kann zu Frustrationen und psychischen Dekompensationen führen und muss möglichst früh durch das interdisziplinäre Team adressiert werden. Redundanzen und eine stringente im Team gleichgerichtete empathische Kommunikation verbessern die Therapieadhärenz, die Erwartungshaltung und so das Outcome.

Abstract

In the majority of patients with morbid obesity, metabolic/bariatric surgery leads to relevant and sustained weight loss and improves obesity-related comorbidities, quality of life and functionality. Moreover, the associated reduction of risk factors for cardiovascular events and cancerous diseases has been shown to improve life expectations. Due to its excellent antidiabetic effect, the currently valid national S3 guidelines now recommend metabolic/bariatric surgery in patients who have a body mass index (BMI) ≥30 kg/m2 with poorly controlled diabetes. The Edmonton staging system enables a multidimensional consideration of the severity grade of obesity for each individual patient independent of the BMI. Patients with relevant obesity-related metabolic comorbidities should be prioritized for treatment and if possible before the occurrence of end-organ damage that is at least in some cases irreversible and which also increases the perioperative risk. Therapeutic goals for each individual patient should be carefully defined preoperatively in order to mediate realistic expectations. Unrealistic expectations, such as “surgery solves my problems”, “surgery makes me more beautiful”, “surgery eliminates stigma”, and “surgery guarantees success”, are common in bariatric surgery patients. These unrealistic expectations can lead to frustration and to severe psychological decompensation and need to be addressed as early as possible by an interdisciplinary team. Redundancies, conclusive and empathic communication in the team improve therapy adherence, the expectations and therefore the overall outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Adams TD, Davidson LE, Litwin SE et al (2017) Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med 377:1143–1155

    Article  PubMed  PubMed Central  Google Scholar 

  2. Adams TD, Davidson LE, Litwin SE et al (2012) Health benefits of gastric bypass surgery after 6 years. JAMA 308:1122–1131

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Aminian A, Brethauer SA, Andalib A et al (2017) Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg 266:650–657

    Article  PubMed  Google Scholar 

  4. Andalib A, Aminian A, Khorgami Z et al (2016) Early postoperative outcomes of primary bariatric surgery in patients on chronic steroid or immunosuppressive therapy. Obes Surg 26:1479–1486

    Article  PubMed  Google Scholar 

  5. Angrisani L, Santonicola A, Iovino P et al (2017) Erratum to: bariatric surgery and Endoluminal procedures: IFSO worldwide survey 2014. Obes Surg 27:2290–2292

    Article  PubMed  CAS  Google Scholar 

  6. Augurzky B, Wübker A et al (2016) Barmer GEK Report Krankenhaus 2016

  7. Arnold M, Pandeya N, Byrnes G et al (2015) Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol 16:36–46

    Article  PubMed  Google Scholar 

  8. Arterburn DE, Olsen MK, Smith VA et al (2015) Association between bariatric surgery and long-term survival. JAMA 313:62–70

    Article  PubMed  CAS  Google Scholar 

  9. Bankoglu EE, Seyfried F, Rotzinger L et al (2016) Impact of weight loss induced by gastric bypass or caloric restriction on oxidative stress and genomic damage in obese Zucker rats. Free Radic Biol Med 94:208–217

    Article  PubMed  CAS  Google Scholar 

  10. Batterham RL, Cowley MA, Small CJ et al (2002) Gut hormone PYY(3-36) physiologically inhibits food intake. Nature 418:650–654

    Article  PubMed  CAS  Google Scholar 

  11. Bennett PH (2014) The Look AHEAD study: a missed opportunity. Lancet Diabetes Endocrinol 2:775–776

    Article  PubMed  Google Scholar 

  12. Billeter AT, Kopf S, Zeier M et al (2016) Renal function in type 2 diabetes following gastric bypass. Dtsch Arztebl Int 113:827–833

    PubMed  Google Scholar 

  13. Bower G, Toma T, Harling L et al (2015) Bariatric surgery and non-alcoholic fatty liver disease: a systematic review of liver biochemistry and histology. Obes Surg 25:2280–2289

    Article  PubMed  Google Scholar 

  14. Brethauer SA, Aminian A, Romero-Talamas H et al (2013) Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg 258:628–636 (discussion 636–627)

    PubMed  PubMed Central  Google Scholar 

  15. Brody JE (2017) Why Weight Loss Surgery Works When Diets Don’t. The New York Times

  16. Bruze G, Holmin TE, Peltonen M et al (2018) Associations of bariatric surgery with changes in interpersonal relationship status: results from 2 Swedish cohort studies. Jama Surg. https://doi.org/10.1001/jamasurg.2018.0215

    Article  PubMed  Google Scholar 

  17. Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23:427–436

    Article  PubMed  Google Scholar 

  18. Canning KL, Brown RE, Wharton S et al (2015) Edmonton obesity staging system prevalence and association with weight loss in a publicly funded referral-based obesity clinic. J Obes 2015:619734

    Article  PubMed  PubMed Central  Google Scholar 

  19. Caravatto PP, Cohen R (2017) The role of metabolic surgery in non-alcoholic steatohepatitis improvement. Curr Atheroscler Rep 19:45

    Article  PubMed  Google Scholar 

  20. Carrasco F, Papapietro K, Csendes A et al (2007) Changes in resting energy expenditure and body composition after weight loss following Roux-en-Y gastric bypass. Obes Surg 17:608–616

    Article  PubMed  Google Scholar 

  21. Chambers AP, Jessen L, Ryan KK et al (2011) Weight-independent changes in blood glucose homeostasis after gastric bypass or vertical sleeve gastrectomy in rats. Gastroenterology 141:950–958

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Chavez-Tapia NC, Tellez-Avila FI, Barrientos-Gutierrez T et al (2010) Bariatric surgery for non-alcoholic steatohepatitis in obese patients. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007340.pub2

    Article  PubMed  Google Scholar 

  23. Chiappetta S, Stier C, Squillante S et al (2016) The importance of the edmonton obesity staging system in predicting postoperative outcome and 30-day mortality after metabolic surgery. Surg Obes Relat Dis 12:1847–1855

    Article  PubMed  Google Scholar 

  24. Christensen R, Bartels EM, Astrup A et al (2007) Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 66:433–439

    Article  PubMed  PubMed Central  Google Scholar 

  25. Coluzzi I, Raparelli L, Guarnacci L et al (2016) Food intake and changes in eating behavior after laparoscopic sleeve gastrectomy. Obes Surg 26:2059–2067

    Article  PubMed  Google Scholar 

  26. Cummings DE, Schwartz MW (2003) Genetics and pathophysiology of human obesity. Annu Rev Med 54:453–471

    Article  PubMed  CAS  Google Scholar 

  27. Dawes AJ, Maggard-Gibbons M, Maher AR et al (2016) Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA 315:150–163

    Article  PubMed  CAS  Google Scholar 

  28. Dietrich A (2018) AWMF S3-Leitlinie Chirurgie der Adipositas und metabolischer Erkrankungen

    Google Scholar 

  29. Driscoll S, Gregory DM, Fardy JM et al (2016) Long-term health-related quality of life in bariatric surgery patients: a systematic review and meta-analysis. Obesity (Silver Spring) 24:60–70

    Article  Google Scholar 

  30. Fischer L, Nickel F, Sander J et al (2014) Patient expectations of bariatric surgery are gender specific—a prospective, multicenter cohort study. Surg Obes Relat Dis 10:516–523

    Article  PubMed  Google Scholar 

  31. Garb J, Welch G, Zagarins S et al (2009) Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg 19:1447–1455

    Article  PubMed  Google Scholar 

  32. Gill RS, Karmali S, Sharma AM (2011) The potential role of the Edmonton obesity staging system in determining indications for bariatric surgery. Obes Surg 21:1947–1949

    Article  PubMed  Google Scholar 

  33. Giordano S, Victorzon M, Koskivuo I et al (2013) Physical discomfort due to redundant skin in post-bariatric surgery patients. J Plast Reconstr Aesthet Surg 66:950–955

    Article  PubMed  Google Scholar 

  34. Gregg EW, Lin J, Bardenheier B et al (2018) Impact of intensive lifestyle intervention on disability-free life expectancy: the look AHEAD study. Diabetes Care 41:1040–1048

    Article  PubMed  Google Scholar 

  35. Grill HJ, Skibicka KP, Hayes MR (2007) Imaging obesity: fMRI, food reward, and feeding. Cell Metab 6:423–425

    Article  PubMed  CAS  Google Scholar 

  36. Grothe KB, Dubbert PM, O’jile JR (2006) Psychological assessment and management of the weight loss surgery patient. Am J Med Sci 331:201–206

    Article  PubMed  Google Scholar 

  37. Harriger JA, Thompson JK (2012) Psychological consequences of obesity: weight bias and body image in overweight and obese youth. Int Rev Psychiatry 24:247–253

    Article  PubMed  Google Scholar 

  38. Hindle A, De La Piedad Garcia X, Brennan L (2017) Early post-operative psychosocial and weight predictors of later outcome in bariatric surgery: a systematic literature review. Obes Rev 18:317–334

    Article  PubMed  CAS  Google Scholar 

  39. Homer CV, Tod AM, Thompson AR et al (2016) Expectations and patients’ experiences of obesity prior to bariatric surgery: a qualitative study. BMJ Open 6:e9389

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hutopila I, Constantin A, Copaescu C (2018) Gastroesophageal reflux before metabolic surgery. Chirurgia (Bucur) 113:101–107

    Article  Google Scholar 

  41. Ivezaj V, Stoeckel LE, Avena NM et al (2017) Obesity and addiction: can a complication of surgery help us understand the connection? Obes Rev 18:765–775

    Article  PubMed  CAS  Google Scholar 

  42. Jakobsen GS, Smastuen MC, Sandbu R et al (2018) Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. JAMA 319:291–301

    Article  PubMed  PubMed Central  Google Scholar 

  43. Jung FU, Luck-Sikorski C, Konig HH et al (2016) Stigma and knowledge as determinants of recommendation and referral behavior of general practitioners and internists. Obes Surg 26:2393–2401

    Article  PubMed  Google Scholar 

  44. King WC, Chen JY, Mitchell JE et al (2012) Prevalence of alcohol use disorders before and after bariatric surgery. JAMA 307:2516–2525

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Laxy M, Stark R, Peters A et al (2017) The non-linear relationship between BMI and health care costs and the resulting cost fraction attributable to obesity. Int J Environ Res Public Health 14(9):984

    Article  PubMed Central  Google Scholar 

  46. Le Roux CW, Welbourn R, Werling M et al (2007) Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg 246:780–785

    Article  PubMed  Google Scholar 

  47. Maciejewski ML, Arterburn DE, Van Scoyoc L et al (2016) Bariatric surgery and long-term durability of weight loss. JAMA Surg 151:1046–1055

    Article  PubMed  PubMed Central  Google Scholar 

  48. Magouliotis DE, Tasiopoulou VS, Svokos AA et al (2017) Ursodeoxycholic acid in the prevention of gallstone formation after bariatric surgery: an updated systematic review and meta-analysis. Obes Surg 27:3021–3030

    Article  PubMed  Google Scholar 

  49. Mann JP, Jakes AD, Hayden JD et al (2015) Systematic review of definitions of failure in revisional bariatric surgery. Obes Surg 25:571–574

    Article  PubMed  Google Scholar 

  50. Mclawhorn AS, Levack AE, Lee YY et al (2017) Bariatric surgery improves outcomes after lower extremity arthroplasty in the morbidly obese: a propensity score-matched analysis of a New York statewide database. J Arthroplasty. https://doi.org/10.1016/j.arth.2017.11.056

    Article  PubMed  Google Scholar 

  51. Mingrone G, Panunzi S, De Gaetano A et al (2015) Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 386:964–973

    Article  PubMed  Google Scholar 

  52. Miras AD, Jackson RN, Jackson SN et al (2012) Gastric bypass surgery for obesity decreases the reward value of a sweet-fat stimulus as assessed in a progressive ratio task. Am J Clin Nutr 96:467–473

    Article  PubMed  CAS  Google Scholar 

  53. Miras AD, Le Roux CW (2017) Metabolic Surgery in a Pill. Cell Metab 25:985–987

    Article  PubMed  CAS  Google Scholar 

  54. Morton JM, Garg T, Nguyen N (2014) Does hospital accreditation impact bariatric surgery safety? Ann Surg 260:504–508 (discussion 508–509)

    Article  PubMed  Google Scholar 

  55. Neovius M, Bruze G, Jacobson P et al (2018) Risk of suicide and non-fatal self-harm after bariatric surgery: results from two matched cohort studies. Lancet Diabetes Endocrinol 6:197–207

    Article  PubMed  Google Scholar 

  56. Ng WL, Peeters A, Naslund I et al (2017) Change in use of sleep medications after gastric bypass surgery or intensive lifestyle treatment in adults with obesity. Obesity (Silver Spring) 25:1451–1459

    Article  Google Scholar 

  57. Olbers T, Bjorkman S, Lindroos A et al (2006) Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial. Ann Surg 244:715–722

    Article  PubMed  PubMed Central  Google Scholar 

  58. Ordemann J, Hüttl TP (2015) Metabolische Chirurgie. Diabetologe 11:471–478

    Article  Google Scholar 

  59. Peterhansel C, Petroff D, Klinitzke G et al (2013) Risk of completed suicide after bariatric surgery: a systematic review. Obes Rev 14:369–382

    Article  PubMed  CAS  Google Scholar 

  60. Peterli R, Wolnerhanssen BK, Peters T et al (2018) Effect of laparoscopic sleeve gastrectomy vs Laparoscopic roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA 319:255–265

    Article  PubMed  PubMed Central  Google Scholar 

  61. Petroff D, Hoffmeister A (2016) Excess weight loss should not be used to define success for bariatric endoscopy. Gastrointest Endosc 83:1306

    Article  PubMed  Google Scholar 

  62. Roux CWL, Aylwin SJB, Batterham RL et al (2006) Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg 243:108–114

    Article  PubMed  PubMed Central  Google Scholar 

  63. Schauer PR, Bhatt DL, Kirwan JP et al (2017) Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med 376:641–651

    Article  PubMed  PubMed Central  Google Scholar 

  64. Scholtz S, Goldstone AP, Le Roux CW (2015) Changes in reward after gastric bypass: the advantages and disadvantages. Curr Atheroscler Rep 17:61

    Article  PubMed  Google Scholar 

  65. Schulman AR, Thompson CC (2018) Abdominal pain in the roux-en-Y gastric bypass patient. Am J Gastroenterol 113:161–166

    Article  PubMed  Google Scholar 

  66. Seyfried F, Buhr HJ, Klinger C et al (2018) Quality indicators for metabolic and bariatric surgery in Germany : evidence-based development of an indicator panel for the quality of results, indications and structure. Chirurg 89:4–16

    Article  PubMed  CAS  Google Scholar 

  67. Sjostrom L (2013) Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med 273:219–234

    Article  PubMed  CAS  Google Scholar 

  68. Sjöström L, Gummesson A, Sjöström CD et al (2009) Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol 10:653–662

    Article  PubMed  Google Scholar 

  69. Sjöström L, Narbro K, Sjöström CD et al (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357:741–752

    Article  PubMed  Google Scholar 

  70. Sjostrom L, Peltonen M, Jacobson P et al (2014) Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 311:2297–2304

    Article  PubMed  CAS  Google Scholar 

  71. Sjöström L, Peltonen M, Jacobson P et al (2012) Bariatric surgery and long-term cardiovascular events. JAMA 307:56–65

    Article  PubMed  Google Scholar 

  72. Song P, Patel NB, Gunther S et al (2016) Body image & quality of life: changes with gastric bypass and body contouring. Ann Plast Surg 76(Suppl 3):S216–S221

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  73. Stroh C, Meyer F, Manger T (2016) Nutritional deficiencies and supplementation after metabolic surgery. Chirurg 87:762–767

    Article  PubMed  CAS  Google Scholar 

  74. Sundstrom J, Bruze G, Ottosson J et al (2017) Weight loss and heart failure: a nationwide study of gastric bypass surgery versus intensive lifestyle treatment. Circulation 135:1577–1585

    Article  PubMed  PubMed Central  Google Scholar 

  75. Svensson PA, Anveden A, Romeo S et al (2013) Alcohol consumption and alcohol problems after bariatric surgery in the Swedish obese subjects study. Obesity (Silver Spring) 21:2444–2451

    Article  Google Scholar 

  76. Tack J, Deloose E (2014) Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies. Best practice & research. Clin Gastroenterol 28:741–749

    CAS  Google Scholar 

  77. Tarride JE, Breau R, Sharma AM et al (2017) The effect of bariatric surgery on mobility, health-related quality of life, Healthcare resource utilization, and employment status. Obes Surg 27:349–356

    Article  PubMed  Google Scholar 

  78. Thomas JR, Marcus E (2008) High and low fat food selection with reported frequency intolerance following Roux-en-Y gastric bypass. Obes Surg 18:282–287

    Article  PubMed  Google Scholar 

  79. Trainer S, Benjamin T (2017) Elective surgery to save my life: rethinking the “choice” in bariatric surgery. J Adv Nurs 73:894–904

    Article  PubMed  Google Scholar 

  80. Vernon G, Baranova A, Younossi ZM (2011) Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 34:274–285

    Article  PubMed  CAS  Google Scholar 

  81. Wallwork A, Tremblay L, Chi M et al (2017) Exploring partners’ experiences in living with patients who undergo bariatric surgery. Obes Surg 27:1973–1981

    Article  PubMed  Google Scholar 

  82. Yu J, Fei K, Fox A et al (2016) Stress eating and sleep disturbance as mediators in the relationship between depression and obesity in low-income, minority women. Obes Res Clin Pract 10:283–290

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacherstr. 2, 97080, Würzburg, Deutschland

    I. Hering,  C. Stier &  F. Seyfried

  2. Medizinische Klinik und Poliklinik I, Universitätsklinik Würzburg, Würzburg, Deutschland

    C. Stier

Authors
  1. I. Hering
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Stier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Seyfried
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Seyfried.

Ethics declarations

Interessenkonflikt

I. Hering, C. Stier und F. Seyfried geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hering, I., Stier, C. & Seyfried, F. Bariatrische Chirurgie: Erwartungshaltung und Therapieziele – ein Gegensatz?. Chirurg 89, 597–604 (2018). https://doi.org/10.1007/s00104-018-0662-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-018-0662-x

Schlüsselwörter

Keywords

Search

Navigation