Obesity Surgery and the Treatment of Metabolic Diseases

3.9% of men and 5.2% of women in Germany suffer from second-degree obesity (body mass index [BMI] ≥ 35 to <40 kg/m2), and 6.5 million persons suffer from diabetes. Obesity surgery has become established as a further treatment option alongside lifestyle changes and pharmacotherapy.

The guideline was created by a multidisciplinary panel of experts on the basis of publications retrieved by a systematic literature search. It was subjected to a formal consensus process and tested in public consultation.

The therapeutic aims of surgery for obesity and/or metabolic disease are to improve the quality of life and to prolong life by countering the life-shortening effect of obesity and its comorbidities. These interventions are superior to conservative treatments and are indicated when optimal non-surgical multimodal treatment has been tried without benefit, in patients with BMI ≥ 40 kg/m², or else in patients with BMI ≥ 35 kg/m² who also have one or more of the accompanying illnesses that are associated with obesity. A primary indication without any prior trial of conservative treatment exists if the patient has a BMI ≥ 50 kg/m², if conservative treatment is considered unlikely to help, or if especially severe comorbidities and sequelae of obesity are present that make any delay of surgical treatment inadvisable. Metabolic surgery for type 2 diabetes is indicated (with varying recommendation grades) for patients with BMI ≥ 30 kg/m², and as a primary indication for patients with BMI ≥ 40 kg/m². The currently established standard operations are gastric banding, sleeve gastrectomy, proximal Roux-en-Y gastric bypass, omega-loop gastric bypass, and biliopancreatic diversion.

No single standard technique can be recommended in all cases. In the presence of an appropriate indication, the various surgical treatment options for obesity and/or metabolic disease should be discussed with the patient.