Treatment methods

Obesity treatment: Healthier from losing weight

Obesity treatment not only has the goal alone of reducing your weight, but also keeping the reduced weight in the long term. This is the only way consequential diseases can be avoided or improved. A long-term change in your dietary and physical activity habits and behaviour is required regardless of whether an obesity surgery is included in your treatment.

Conservative treatment methods

Medicinal obesity treatment

Unfortunately, there are no permanently effective drugs for obesity to this day. At present, only orlistat, liraglutide and, since 2018, bupropion / naltrexone have been approved for temporary treatment in Germany. However, side effects reduce the benefits, the weight reduction is relatively low and none of the drugs are reimbursed by health insurance.

Surgical treatment methods

Surgical obesity treatment

If all conservative measures do not yield a satisfactory result for at least six months, and if the BMI continues to be above 40, obesity surgery may be considered. In the case of diabetes, surgical treatment may be considered as early as BMI 35 (metabolic surgery).

Unlike all dietary efforts, surgery can help to maintain a significant weight loss for a long period of time. After surgery, many patients still remain overweight, but at a much lower and healthier level than before. 
But the most important thing is that your health improves and your quality of life improves.
In addition to weight, obesity operations also affect numerous secondary diseases such as hypertension, sleep apnoea (breathing interruption while sleeping) and joint problems, especially in the knee joints. Infertility or back pain attributable to being overweight also improve in many cases. Surgeries play a special role in obese diabetics: Usually the diabetes illness can be improved or even temporarily stopped here. This means tremendous relief of everyday life, especially for diabetics who do not need to inject insulin after an operation. Because of the special effect on the diabetes illness, this is called metabolic surgery.

Most interventions can be carried out very gently with the "keyhole technique". The surgeons discuss with you in personal conversation which method is most effective for you.

Roux-en-Y gastric bypass

In this procedure, our surgeons divide your stomach into a small stomach pocket and a larger remaining stomach that still produces gastric juices. The stomach pocket is filled quickly, since it can absorb only a little food. This will make you feel full faster in the first few months and stay full for longer. 
What is decisive, however, is the deviation of the small intestine so that food and digestive juices first mix in the middle small intestine. As a result, some of the nutrients and calories are not digested, but rather leave the body again with the stool. In large part, the effect of the gastric bypass is due to the change of the regulatory cycles of the digestive hormones. The special effect on a diabetes disorder is also due to these hormonal changes.

Advantages: 
  • More pronounced weight loss that is stable for years is possible
  • Permanent removal of heartburn 
  • Long-term improvement or decrease of type 2 diabetes mellitus
  • Long-term improvement of numerous secondary diseases of obesity
Disadvantages: 
  • You need extra vitamins and minerals for life 
  • An endoscopy of the residual stomach, duodenum and / or bile ducts is no longer possible
  • Certain medications (such as contraceptives) may not work properly

Omega-loop gastric bypass

Here we sew an intestinal loop onto your slightly larger stomach pocket. This has a length of 180 to 250 cm from the stomach outlet to the suture on the stomach pocket. The digestive fluids of bile and pancreatic juice flow through them, which then mix with the food from the stomach pocket only after about two metres. The longer the intestinal loop, the more weight loss is possible - but this also increases the risk of deficiency symptoms and other side effects such as diarrhoea. 

Advantages: 
  • More pronounced weight loss that is stable for years is possible
  • Long-term improvement or decrease of type 2 diabetes mellitus
  • Generally feasible, even with a very high BMI
  • Long-term improvement of numerous secondary diseases of obesity
Disadvantages: 
  • You need extra vitamins and minerals for life 
  • An endoscopy of the residual stomach, duodenum and / or bile ducts is no longer possible
  • Certain medications (such as contraceptives) may not work properly

Sleeve gastrectomy

Here, our specialists remove most of your stomach, leaving only a tubular residual stomach. This allows you to absorb only small amounts of food and feel full faster. The normal digestion process remains untouched. 
In patients with a very high BMI, a gastric bypass is technically not feasible. For them, a tubular stomach may be the first of two operations. If desired, the tube can then later be converted into a Roux-en-Y gastric bypass or an omega-loop gastric bypass. 

Advantages: 
  • Despite the strong reduction of the stomach, the normal path of food remains the same
  • Deficiency symptoms (vitamins / minerals) are less common, but a lifelong dietary supplement is recommended
  • A gastroscopy is still possible without any problems
Disadvantages: 
  • The surgery cannot be reversed
  • Complications, such as suture leaks or fistulas, are more difficult to treat than with a gastric bypass
  • Pronounced heartburn can occur

Good to know

All three locations of Schoen Clinic, which offer surgical obesity treatment (Hamburg Eilbek, Düsseldorf, Nuremberg Fürth), are certified by the DGAV (German Society for General and GI Tract and Endocrine Surgery). The Obesity Clinic in Hamburg Eilbek is one of four institutions in Germany that have received the highest certification level and thus the highest quality certification as a "Centre of Excellence for Obesity and Metabolic Surgery “. 
At these centres you can rely on high quality standards in treatment, equipment and aftercare. 

Long-term aftercare

Surgical obesity treatment is the most important element in treating severe obesity and the associated health-threatening consequences. However, surgery alone is unable to resolve all physical and mental problems associated with being overweight. It is necessary to change your previous habits for life. 
Since obesity is a chronic disease, regular care over many years determines the success of your surgery. This follow-up also helps to detect possible deficiency symptoms or physical and mental problems in good time. 
The latter may, for example, be due to a recurrence or increase in eating disorder,  depression or other mental stress and often favour weight gain. In these cases, we discuss with you whether outpatient psychiatric / psychotherapeutic or inpatient psychosomatic treatment should be included in the overall treatment.