Fat people are often labelled as lazy and undisciplined. What have been your experiences with your patients?
This prejudice is completely untrue. The most extreme cases of obesity nearly always have a genetic cause. This stops the hormones in the bowel that signal when you are hungry or full from working properly (see box for more information). Patients feel an enormous sense of relief when they come to me and hear this for the first time: the burden of self-recrimination
is lifted from them. With us, treatment always begins with a crucial first step, which is to explain the medically proven causes of obesity. That is the first step on the road to weight reduction.
People can of course also lose weight under their own steam. Under what circumstances do you recommend consulting a specialist bariatrician?
If you’ve simply put on a couple of kilos over Christmas, you can shed them again through willpower, a few dietary changes and exercise. People can shift up to 7kg by themselves. But it is nigh-on impossible to lose 30kg without help. As I said, the reasons behind serious cases of obesity lie in a person’s genes rather than in their behaviour. If I send a patient like that off for some dietary advice, their weight may go down a bit at first, but a couple of years later they will generally weigh more than they did to start with. Studies have shown that only 4% of patients achieve and maintain their desired weight loss by following this approach. A bariatric specialist can help patients over the long term.
“Anyone looking to lose more than 7kg needs medical support.”
How do you advise your patients? Is your approach always the same?
We take the person as a whole, which includes their state of mind and personal life. It is important to set ambitious targets from the outset. If someone simply wants to feel physically fitter, and weight loss is not the priority, then dietary advice and exercise is the best route. If the patient wants something more, there are drugs that suppress appetite. However, these must be taken long-term, or the weight creeps back on again. Nevertheless, we try this step with everyone, as in some cases it is enough by itself. If it does not succeed, however, or if other diseases such as diabetes emerge in addition to obesity, then bariatric surgery becomes necessary.
Let’s say a guest comes to the Waldhotel wanting to lose weight. What can they expect?
At the Waldhotel Health & Medical Excellence, patients stay in an exclusive 5-star hotel with outstanding medical care. The Weight Management & Metabolism programme is tailored to guests who want to lose weight. If bariatric surgery is required, the Waldhotel works with the Adipositaszentrum Zentralschweiz, which encompasses the Kantonsspital Nidwalden and the Zentrumsspital Luzern. This strong partnership is one of the things that sets the Waldhotel apart. It means that every medical problem can be dealt with by specialists in the field. Personal attention is facilitated by the proximity to the centres, which greatly increases the quality of care.
If a patient travels to Switzerland for bariatric surgery, how much time do they need to allow?
You’re looking at about four weeks altogether. The patient stays in the Waldhotel during the preparatory and investigative stage, which takes about ten days. They then spend four days in hospital at the Kantonsspital Nidwalden for the surgery, before returning to the Waldhotel to continue their medical care and recovery in a comfortable hotel environment. After around 10 to 14 days, the healing process and dietary changes are far enough advanced that the patient can safely travel back home.
Do you continue to care for patients long-term, even after they have returned to their own country?
Yes, of course. It is very important to me that we support our patients over the long run, in some cases for up to five years after their operation. We keep in regular touch via video calls, and our dietary advice is also provided over the internet. The first follow-up session one year on should ideally take place here at the Waldhotel. If that is not possible, however, then we work with colleagues in other countries. This long-term care for international guests is unusual among surgical centres and has enabled us to accumulate a lot of experience and expertise.
Switzerland is one of the leaders in the treatment of obesity. How has the country achieved this position?
Switzerland was a major international pioneer in obesity treatment and one of the first countries to introduce laws permitting bariatric surgery. Switzerland also has a lot to offer at specialist medical conferences. The entire treatment philosophy – from recognition of the clinical picture through to medical and surgical treatment – is taken as a whole and is firmly established. Switzerland also boasts an outstanding healthcare system, with vast experience in obesity management and excellent collaboration between therapists and specialists.
The influence of bowel hormones on obesity
The mechanisms that regulate sensations of hunger and fullness are often disordered in very obese patients. Appetite- stimulating hormones are secreted in greater numbers, while others such as those that signal fullness and trigger insulin release are reduced. Bariatric surgery corrects these regulatory mechanisms. Immediately after the operation we see less hunger and better production of the body’s own insulin, and the effect is long-lasting. This reduces obesity and alleviates or completely cures diabetes.
Dr Martin Sykora is Chief Surgeon at the Kantonsspital Nidwalden, one of the largest centres in Switzerland for obesity treatment, also incorporating the Zentrumsspital in Lucerne. As bariatric consultant at the Waldhotel Health & Medical Excellence, he leads the hotel’s obesity management programmes.