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Bariatric Surgery in Germany

As the number of individuals with severe obesity continues to increase around the world, various countries are beginning to seriously look at the challenges of providing bariatric sugery to an increasing number of patients who desperately need treatment.

A paper just out in Obesity Surgery by a German Bariatric Surgery Working Group, looks at the trend in Germany between 2005 and 2007. The study was conducted by the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany).

In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were collected using an Internet online data registry. Data included perioperative characteristics, type of surgical procedures, and short- and long-term outcomes.

During the study period, 629 surgical procedures were performed at 21 hospitals in 2005, 828 procedures at 32 hospitals in 2006, and 1,666 procedures at 35 hospitals in 2007.

In 2005 and 2006, gastric banding was the most frequently performed operation, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was performed in 42.1% of all bariatric procedures.

Around 75% of patients were female; the mean body mass index (BMI) was consistently around 48.

Follow-up data after 12 months were available for 63.8% of the patients in 2005 and 2006 and showed greater reduction of BMI after malabsorptive than after restrictive procedures. Mortality was 0.1% (30 days) and 0.16% (overall).

The authors note that, in Germany, as elsewhere, there is an ongoing movement towards malabsorptive procedures and sleeve gastrectomies. Although the BMIs of German patients undergoing bariatric surgery appear to be substantially higher than those of patients from most other countries, there were no differences in intraoperative and short-term complications or in overall outcomes during follow-up compared with published studies.

Obviously, the total number of less than 2000 annual surgeries for a population of 80 Million with an obesity prevalence of around 20% is ludicrously small – I guess Germany is no better in providing adequate bariatric care to its citizens than most countries in the world – in fact, it even seems to fall significantly behind Canada, where access to bariatric surgery in most provinces is virtually non-existent.

Edmonton, Alberta


  1. As usual, a very informative post. One question – what range of BMI’s can be served by this type of treatment? Is it an option for people with a BMI of 30-35, or is it mainly for patients with a BMI > 40? I’m just wondering what proportion of the ~16 million Germans with obesity would be eligible for this type of treatment if capacity were unlimited.



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  2. Current indications for bariatric surgery generally assume a BMI > 40 or a BMI of 35-40 with significant obesity-related comorbidities. It is difficult to fully calculate the demand, but my guess is that there would probably be well over a million Germans out there who would benefit from surgery. This means that currently only around .2% of the potential demand is being met.

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  3. Living in Germany, I can suggest there are probably cultural reasons why weight loss surgery is so much lower than in other countries. There is a fetish around ‘natural’ here, to the point that even medical specialists don’t hesitate to hand out herbal treatments rather than medication. I can imagine that there would be strong social disapproval around the idea of treating obesity with medical intervention, which is perhaps why you’re seeing higher BMIs when surgery does happen. Also – and this is anecdotal evidence, I realise – I see surprisingly more men than women with weight problems, which is probably tied in to beer drinking. Perhaps men are not seeking help in the same way women do.

    Overall, though, I’m surprised to hear that 20% of the population has a weight problem, because I don’t see it. I realise what I see doesn’t mean anything statistically, but although I see a lot of middle aged upholstery, I don’t see the very high BMIs that are easily spotted in the UK or North America. Also, junk food is much less part of the food culture here. Snacking or eating in public is very frowned on and meal times are generally rigidly adhered to. In towns both big and small, cycling is still the preferred method of transport over medium distances.

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