Metabolic and Endocrine Disorders

Current Indications and Standards for Metabolic Surgery

Obesity is one of the most prevalent problems in the developed world, causing numerous common and lethal diseases. The health consequences of obesity include heart disease, diabetes, hypertension, hyperlipidemia, osteoarthritis, and sleep apnea. Non-surgical treatment efforts, unfortunately, have failed to provide an effective and sustainable solution (1). Surgical treatment has shown greater efficacy, both for effective weight loss and long-term maintenance (1,2,3) 

Metabolic surgery includes the procedures of gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic bypass. With respect to the selection of procedures sleeve gastrectomy (SG) and the traditional Roux-en-Y gastric bypass (RYGB) can be used as safe and evidence-based operative procedures (4). These procedures have been shown to produce substantial and durable weight loss (1,2,3). Weight loss of 5% to 10% has been associated with marked reductions in the risk for these chronic diseases and reducing the incidence of diabetes (2). Most patients will lose about 50 to 70 % of their excess body weight after surgery, with substantial weight loss occurring 12 to 24 months after surgery (3).

But, bear in mind that bariatric surgery isn't for everyone who is severely overweight.The surgical treatment for obesity should be considered as a treatment of last resort after dieting, exercise, psychotherapy, and drug treatments have failed. It is needless to say, that the indication for surgical treatment should be carefully determined with consideration of risks and benefits of surgery. In this manner, German Health Advisors will help you to get Second Opinion for your individual case, which would guide you to make a right decision. Below, we list the main indications for bariatric surgery and required information on your health situation, in case you wish a Second Opinion for a surgical treatment.  

Indications for Metabolic Surgery

According to guidelines of professional associations, weight-loss surgeries could be a treatment option in following cases: 

  • Patients with a BMI≥40 kg/m2 without coexisting medical problems and for whom bariatric surgery would not be associated with excessive risk (1).
  • Patients with a BMI≥35 kg/m 2 and 1 or more severe obesity-related co-morbidities, including diabetes mellitus, hypertension, hyperlipidemia, obstructive sleep apnea (OSA), obesity-hypoventilation syndrome (OHS), Pickwickian syndrome (a combination of OSA and OHS), nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH), Idiopathic intracranial hypertension (IIH), gastroesophageal reflux disease (GERD), asthma, venous stasis disease, severe urinary incontinence, debilitating arthritis, or considerably impaired quality of life (1).
  • Patients with BMI of 30–34.9 kg/m 2 with diabetes or metabolic syndrome may also be offered a bariatric procedure although current evidence is limited by the number of subjects studied and lack of long-term data demonstrating net benefit (1).

Medical History

In order to produce a second opinion for you, we need to have a detailed information on your individual medical history. Please, provide us with following details: 

  • Your Body Mass Index and why you want to get surgical treatment?
  • Did you try any other ways to lose excess weight?
  • Do you have one or several of above mentioned (See Indications for Metabolic Surgery) health problems?
  • Laboratory tests for assessing metabolic balance. This can be done at of our local partner laboratories.
  • Do you have any other further illnesses and chronic comorbidities?

Please, fill out the request form of German Health Advisors to provide us with more information. If it is necessary, you can visit our local colleagues or contact them via our secure videoconference system to prepare a detailed report on your health concern.  

Your German doctor will study your case carefully. If necessary, we will organize a meeting with your doctor in Germany via videoconference to provide you with a second opinion

Follow-Up After Treatment

After weight loss surgery, the health benefits often happen right away. For instance, your diabetes, high blood pressure, sleep apnea, high cholesterol, arthritis, and other conditions might improve dramatically. You will need regular follow-up controls, that your doctor can monitor the improvements and make necessary adjustments.

Patients, who received their treatments in Germany, usually do not need to return to Germany for the follow-up visits. German Health Advisors will provide you with follow-up care through its Telemedicine platform.

Keywords: obesity, bariatric surgery, diabetes mellitus, obstructive sleep apnea


1.Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery." Obesity 21.S1 (2013): S1-S27.

2.Meta-analysis: surgical treatment of obesity.  Maggard, Melinda A., et al. Annals of internal medicine 142.7 (2005): 547-559. APA

 3. Long-term drug treatment for obesity: a systematic and clinical review. Yanovski, Susan Z., and Jack A. Yanovski., Jama311.1 (2014): 74-86

4. Metabolische Chirurgie. Billeter, A. T., and B. P. Müller-Stich.  Der Chirurg 90.2 (2019): 157-170.