Conditions for surgery

At Obesity Clinic Dendermonde we have a multidisciplinary approach. This means that you are guided by various disciplines that work together as a team.

Your BMI value and any health problems determine the treatment of your excess weight. This can range from a conservative treatment, medication to a weight-loss operation (or a combination of both).

Before the operation, the patient goes through an intake process. First, there is a conversation with the obesity nurse, endocrinologist or the surgeon. During this conversation you receive information about morbid obesity, the health risks, necessary examinations and the various surgical and non-surgical treatments.

After the intake conversation, a number of examinations follow as well as a consultation with a dietitian, psychologist, endocrinologist (hormone specialist) and the surgeon. After that, all findings will be discussed in a group consultation, to which the general practitioner is also invited. Following this you receive a final recommendation. Throughout the entire process you can ask questions and take time to consider the proposed pathway and the final treatment.

Treatment of obesity

The treatment of obesity consists of various methods.

There is a conservative or non-surgical approach (non-surgical programme) that focuses on adjusting eating habits and physical activity, sometimes combined with drug treatment. The conservative programme is aimed at patients who do not want a weight-loss operation, who cannot undergo a procedure due to certain medical conditions, who have never followed a diet, or who do not qualify under the RIZIV (Belgian national health insurance) conditions (RIZIV conditions).

However, if after repeated dieting, combined with regular exercise or sporting activities, no weight reduction is achieved, a weight-loss operation is preferred (provided the RIZIV criteria are met).

Various studies have shown that a weight-loss operation offers the greatest chance of a successful and long-lasting approach to morbid obesity.

Surgical treatment (such as a gastric bypass, sleeve gastrectomy, mini gastric bypass, etc.) offers a proven:

• Significant and lasting weight loss
• Reduction or disappearance of associated diseases (comorbidity) or complaints
• Increase in quality of life
• Increase in life expectancy

Not every weight-loss operation is suitable for every patient with obesity.

Depending on the weight, eating habits and associated diseases (comorbidity) or complaints, it is determined which procedure is most effective.

Contraindications for a weight-loss operation are:

• Pregnancy
• Alcohol addiction or drug use
• Psychosis
• Excess weight as a result of a treatable disease

Pre-operative diet

To reduce the chance of complications during the operation, you are asked to follow a protein diet for 1 week before the procedure. This is to reduce the size of the liver and to remove fat from the tissues. This will be discussed with you by the surgeon well in advance of the weight-loss operation.

Reimbursement conditions

Belgian law stipulates that strict conditions must be met in order to qualify for reimbursement of obesity surgery.

BMI and comorbidity

• BMI > 40 kg/m²
• BMI > 35 + diabetes mellitus
• BMI > 35 + sleep apnoea
• BMI > 35 + hypertension (treated with 3 medications)
• BMI > 35 + previous obesity procedure with insufficient result (gastric band, Mason, sleeve, etc.)

General conditions

• Minimum age of 18 years.
• You must be able to demonstrate that you have made serious attempts to lose weight for at least 1 year. A certificate from your general practitioner or dietitian is sufficient for this.
• Approval after multidisciplinary consultation and with the written agreement of an endocrinologist/internist, psychologist/psychiatrist, dietitian and surgeon.
• Willingness to adjust your eating habits and lifestyle after the operation.
• Willingness to undergo lifelong follow-up.
• Prior to the obesity procedure, the treating physician must send a notification form to the medical adviser of your health insurance fund.