a) Statement regarding morbid obesity and its treatment Morbid obesity is a chronic, lifelong, multi-factorial, hereditary disease presenting excessive storage of fat and highly significant medical, mental, social, physical and economical consequences. Inherited, biochemical, hormonal, environmental, behavioural, health-related, and cultural elements are also involved. Morbid obesity represents an extreme health risk but is rarely a result of immoral or addictive behaviour. In the long-term morbidly obese patients show an extremely high rate of failure to achieve and maintain only a 10 percent weight reduction by means of non-surgical treatment. In contrast, obesity surgery proved to be the most effective therapy in the treatment and prevention of life-threatening complications and severe degenerative problems of morbid obesity. It is indicated due to failure of non-surgical therapies, the high risk of untreated morbid obesity, and because of the safety and efficiency of surgical treatment. Safe and efficient surgical procedures increase life expectancy and quality of life for morbidly obese patients. Such surgery is performed in order to treat secondary diseases of morbid obesity. Although weight loss is an important aspect of the treatment, it is only a secondary goal, as is the cosmetic result. Patients with respiratory pauses during sleep (sleep apnoea), hypoventilation caused by overweight, heart failure or other life threatening complications may require emergency admission and treatment. In these cases surgery may be scheduled after stabilisation of the condition with appropriate heart and lung function. An excessive body mass discriminates massive overweight persons and prevents them from getting necessary medical therapy. Such discrimination and continued isolation are unacceptable. However, it is not justified either to ask morbid obese patients to participate in long term programs for weight reduction as a prerequisite for bariatric surgery, unless the surgeon insists on it.
b) “Statement” regarding patient selection for bariatric surgery A Body Mass Index (BMI) of 40 kg/m2 or more represents a severe clinical obesity that requires medical treatment and justifies surgery, as long as patient and surgeon agree on it. Patients with a BMI of 35 to 40 should be considered for surgical treatment, especially if they suffer from secondary diseases that can be sufficiently improved with loss of weight. Diabetes and hypertension are two such diseases which are difficult to control in patients with untreated excessive weight. As the use and evaluation of the BMI is generally hard to understand for the general population, national insurance companies have issued comprehensible guidelines with almost identical data of height and weight. E.g. one of these guidelines reads as follows: - According to a weight table (e.g. 1983 Metropolitan Height-Weight Tables) the patient should have a BMI of 40 kg/m2 or more and 45 kg or more over the ideal weight, respectively. - If the patient has a BMI between 35 and 40 (i.e. less than 45 kg above the ideal weight), severe health problems may require loss of weight and justify the risks of proposed surgical treatment. The patient must be capable of providing for himself or have adequate care available to secure the necessary follow-ups. The prognosis of the patient at a given weight-loss should justify the risks of surgical treatment. |
