Widespread obesity: Patient and expert discussion
As a young mother, she was too heavy for the swings at the playground; today she is an avid triathlete: Thanks to her gastric sleeve, Nina Rohr has permanently lost 50 kilograms. Her operation was performed by Dr Beate Herbig at the Bariatric Hospital at Schoen Clinic Hamburg Eilbek. The head physician says that many patients who would seek operations due to excess weight would regularly be brushed off by their insurance companies.
Our patient tells her story
From 123 to 70 kilos: Nina Rohr’s success story
‘I have always been a bit overweight,’ says Nina Rohr. It turns critical after her pregnancy. The extra kilos hang on stubbornly. Until the young mother reaches 123 kilos at a height of 1.70 metres. The turning point happens on a playground. ‘My daughter wanted to play on the swings and slide with me. I did not fit in the playground equipment. I was too fat.’ Then Nina Rohr recalls how much her godfather’s wife had lost through gastric band surgery. And she reads up about it on Schoen Clinic’s website. ‘My main concern was a good doctor,’ says the 34-year-old. She comes across Dr Beate Herbig, a surgeon, arranges a consultation and decides on a sleeve gastrectomy.
Yo-yo dieting was her constant companion for years. The nurse works the night shift. ‘I am such a typical stress eater.’ The more weight she gains, the less often Nina Rohr dares leave the house. She copes with her frustration by eating. And gains more weight.
The sleeve gastrectomy lets the pounds fall off
The operation carries the promise of hope. But the procedure was not enough by itself. Nina Rohr has participated in a weight loss programme for several months, with nutrition counselling and exercise. She has finally met all the insurance company’s requirements and has gotten the OK for her operation. The procedure entails removing a large part of the stomach. The tubular remainder of the stomach can only accommodate small portions. Nina Rohr is thrilled. The pounds fall off. The procedure was a success.
To date she has lost about 50 kilos - more than a third of her old weight. ‘An awesome feeling. Now I am at a completely normal weight. I am fit and active.’ Very fit: Triathlons and half marathons make up her new sports programme. There is even a bit of chocolate in there from time to time. ‘Sometimes my mind still plays tricks on me. My stomach had the operation, not my head. The fear of gaining weight is frequently there. Surgery is not a guarantee of being permanently slim. There are goods days and less good days - but mostly good.’
In discussion with obesity surgeon
Dr Beate Herbig
You say that insurance companies regularly turn away patients seeking operations. Why is that?
The insurers decide whether we can operate on our patients. We run into a certain reflexive refusal there. I believe this stems from continued discrimination against fatness in our society. Many people associate excess weight with a weakness of character, a lack of discipline. They see an operation as the easy way out. Both of those are untrue. Obesity has been scientifically proven to have many causes. And the path to an operation and beyond requires a good deal of discipline. But the operation gives patients the chance for this discipline to lead to success that lasts for years.
Can you understand the doubt towards taking advantage of the operation?
I think it is appropriate to take a critical stance towards obesity operations, as a matter of principle. But the argument that is always put forth, that we are operating on a ‘healthy’ organ, comes from a traditional understanding of disease. You cannot tell by looking at a stomach whether the hormonal cycles it triggers are intact - but an operation changes these.
In addition, the indication for surgery is not based solely on whether someone is overweight. The determining factor is whether the person concerned has health problems due to their weight. We work according to medical guidelines and scientific findings. A bariatric operation can be considered for patients with long-term severe obesity and a BMI of 40. This was the case with Nina Rohr.
What do you recommend to patients whose insurance companies do not want to pay for a bariatric procedure?
First, enter a formal objection. And then try again, working with us doctors. At the obesity hospital of Schoen Clinic Hamburg Eilbek, we look after our patients from the first introduction to the years of follow-up care after the surgery. We set our patients on the right path, so to speak, that can lead to a successful operation. This generally includes a preparation phase lasting several months, with dietary and exercise therapy. We likewise examine whether there are any psychological problems that need to be dealt with.
Does an operation only help with losing weight, or can it also alleviate secondary diseases of obesity?
A typical secondary disease of obesity is diabetes mellitus. It has been scientifically proven today that a bariatric operation is a highly effective therapy for this. As excess weight increases, however, so does the risk of stroke or heart attack. The liver becomes diseased due to excess fat deposits, joints suffer under the long-term heavy load, and the risk of various cancers increases. Sleep is often disrupted due to breathing interruptions (sleep apnea) and well-being is impacted by severe heartburn. Many overweight individuals pull back socially and develop mental illnesses, such as depression.
Most of these secondary diseases improve with the surgery. Today there are no long-term effective therapies for severe obesity other than bariatric surgery. We cannot stop the obesity epidemic with a scalpel, but we can give affected individuals a new feeling of life.