Life to eat
“I could still cancel,” whispers Katrin Böttcher *. “We’re going through this now,” says Andi, her husband, and makes a joke. Katrin grimaces. Laughter does not work, not anymore.
Room 18, ward A / B in house 2 of the “Schön Klinik Nürnberg Fürth”, one of around 70 obesity centers in Germany: Katrin Böttcher, 40 years, 165 centimeters, 118 kilos, sits silently on her bed and taps his feet , She is nervous, what else. Only a few minutes, then a caretaker will come. He will push Katrin on her trundle bed into the elevator and then into the operating room. There Katrin will remove much of her stomach. The remainder will be as thin as her index finger and as thin as a tube. Hence the name: tubular stomach.
Katrin finally wants to lose what she calls “my shell” with the operation. Softly she murmurs: “Andi, say that everything is going well …” One day before the operation, Katrin and Andi are sitting on the terrace of their terraced house, in a pond swim goldfish. The two joke a lot, often the sound is harsh, but there is also a tender intimacy. Katrin, shoulder-length brown hair, black pants, black T-shirt – another color does not attract her – radiates. She says she is happy. For more than a year she has been waiting for the surgery, well , “finally!”, The countdown is running. Andi is a bear of a man, muscular and almost two feet tall. He drinks lemon juice, repeatedly adjusting the parasol so that Katrin always sits in the shade.
What do I do if it does not work?
A blue towel hangs over Katrin’s chair back. “I can not do anything without sweating, and if I do not do anything, I’m sweating too, I hate being so thick, but what do I do if the operation does not change anything?” Katrin’s hand moves to her stomach, which could also be the belly of a pregnant woman. She often experiences that strangers ask her kindly, when is it so far, when shopping, in the supermarket, in the bus. That it does not work is her biggest concern. But she is also afraid of general anesthesia and pain. 40 kilos should go down, minimum. “I am a thinness in the body of a fat man – yes, really, that’s how I feel!”
In a room of the “Schön Klinik”, Katrin’s feelings are carved in wood. Next to the desk of Professor Thomas Horbach stands a sculpture: a thin one in the body of a thickness. The figure looks trapped and, though she is tightly wrapped, almost defenseless. “Obesity is a chronic disease,” says the surgeon and nutritionist. “Non-will weakness prevents weight loss, but processes in the body.” Horbach knows the prejudices: Should the fat eat differently, do sports, then they need no surgery. ” Thick people are marginalized in Germany, laughed at, insulted on the open road, the suffering is often very extreme.”
The Head of General and Visceral Surgery and his team operate around 200 Adipese, ie morbidly obese, every year. Katrin Böttcher is also his patient. There are various methods – in addition to the shaping of a tubular stomach, for example, the laying of a gastric band or bypass; is decided individually, because the one, best method does not exist. It also depends on existing comorbidities.
The prejudices that Dicken encounters make Horbach furious, because they contradict not only his experience as a surgeon, but also the current knowledge of medicine. In people who are starving, the saturation decreases. When they return to normal diet, they need more calories to feel full. A vicious circle. In order not to increase, they would have to stay on a diet all their lives. The energy metabolism burns after starvation on the back burner. “Our body always tries to maintain the level it has once reached,” explains Horbach. “He’s programmed for that.”
It’s just too much unhealthy food
Of course it would be good, people would not even fat. But it would also be good if people did not smoke or do not do extreme sports. In Germany, a quarter of adults are considered obese. Food is available around the clock today, and calorie density has also increased dramatically. The food industry mixes sugar with three out of four products. Everybody who lives in Germany eats about 70 grams of added sugar on average every day – with decreasing energy consumption. Physical work is the exception and no longer the rule. Sometimes it is frustration, anger, grief, loneliness that makes people eat too much. Others are due to a kilos disease.
Katrin is leafing through a photo album. In one picture she poses in a mini skirt, on another she grins in a swimsuit into the camera; The photos are 15 years old, and Katrin is so slim on it, that one stops involuntarily when looking at it. She realizes that, of course. Her first diet made her 16 because her mother found her too fat. Then another and another, FDH and Shakes, Radikalverzicht and Atkins. That her mother probably had an eating disorder herself, she understands only for several years. In the middle of the twentieth week Kilos suddenly hailed, Katrin increased, three, six, eight, ten kilos. The doctors diagnosed a thyroid disorder, but when the drugs were discontinued, the scales showed already 30 pounds more. Later, she eats out of frustration: when nothing goes down, not even with a personal trainer she pays for half a year once a week,
Katrin goes up the stairs to the first floor, another towel hangs on the railing, they are distributed in the house and garden. Countless shoe boxes line the walls in a narrow room. Katrin pulls a red box from the shelf, white high heels, ten inches of heel. “My wedding shoes,” she says. The other pairs are high-heeled, they are in red and blue, black, brown, white and color, with five, eight, ten and twelve inches of heels, more than 200 in total. “That’s my hobby,” says Katrin, improving immediately and muttering, “That was my hobby.” For three years now she no longer wears heels, “they simply can not make 118 kilograms”.
Health insurance companies are too often cross
Being fatigued restricts Katrin. And being fat injures and borders. Sellers send them to the maternity wear, others hardly say that they are in the store: in size we have nothing. Katrin tells of a bike ride with Andi, after a short climb she was so ready that Andi wanted to call the ambulance. Not in the fun, “hey, you’re puffing, like you need a doctor!”, But seriously. Katrin does not ride a bike anymore. She does not ride a motorcycle any more. She barely goes out. Less because of the looks that say, what’s the fat eating an ice cream now? She is seldom talked to, but also because of Andi, the bear of a man at her side. “But I feel unwell.”
Thomas Horbach, Katrin’s doctor, scrolls through charts and graphs. “When it comes to reimbursement for an obesity surgery, the health insurance companies often cross, we are in last place in Europe,” says the physician. International guidelines state that every person with a BMI of over 40 is entitled to such an OP.And a German guideline states that in a BMI over 35 should be checked whether an OP makes sense. Katrin has a BMI of 44, and she was lucky. But for the non-objection of the health insurance it needed a medical marathon. A general practitioner certified her hypertension, an orthopedist the herniated disc, she had to write nutritional records, talk to a psychologist and prove that she had tried unsuccessfully to lose weight with conservative methods.
But is not that good? Should not surgery be the last resort? Horbach waves off. “That’s it, but with 30, 40 kilos overweight even losing weight hardly works with lasting success.”
Obviously, an obesity surgeon talks like that. But what Horbach says reflects the current state of research. A study from the USA shows very emphatically that the participants were highly obese, weighing an average of 130 kilos. Within two years, those who did not undergo surgery lost one to two kilos. The operators made 45.
What will be the last meal?
That alone is a success, but it is not all. Horbach shows more diagrams. The vast majority of obese people are struggling with the diseases that are typical for the severely overweight: diabetes, liver and kidney disease, high blood pressure. Now long-term studies show that many diseases improve after an operation, some even disappear. In one study, for example, three-quarters of the patients underwent overweight diabetes.
It’s the last night before the operation , and Katrin can not decide. Meat? Fish? But vegetables? The Böttchers sit with their ancestral Greeks, as well as every one or two weeks. But today it is different. It’s Katrin’s last meal with a whole stomach. Katrin talks like a waterfall, her thoughts jump. Andi should bring her pillows to the clinic after the surgery, do not forget, do you hear, maybe a starter plate, when do we have to go again? “That’s Katrin when she’s excited,” laughs Andi.
Katrin finally orders fried aubergine and a small appetizer dish, which she only eats half. As if to prove that she is not excessive. That’s what she keeps saying: that the days when she devoured two pizzas in the evening are long gone. “I know what’s in there: The fat woman is too lazy to lose weight, so she puts herself under the knife, but that’s not how it is.” Lots of vegetables, lots of fruit, a smoothie in the morning. That’s her diet now. Still do not go down.
A sterile operating room. Katrin in anesthesia, half lying, half sitting. “Beach Chair Storage” is the name of the position, her upper body is elevated as if she were in a deck chair. Of course, the scenario has nothing to do with a relaxing day on the beach. Sisters scurry around, an anesthetist controls the monitor. Five liters of CO2 gas flow into Katrin’s stomach. Thomas Horbach needs space in it. Tubular stomach surgeries are minimally invasive procedures, for a long time surgery is no longer performed on the open abdomen. Horbach makes four tiny cuts. One for the camera, one for the arm, two for his instruments.
Horbach’s eyes rest on the monitor, the inside of the abdomen is threefold enlarged. The support arm raises Katrin’s liver, an important moment, because the blood levels do not measure exactly how thick the organ is already fatigued. Katrin is lucky. Your liver shows little fat. “That looks quite different with many other obese,” says the surgeon. A fatty liver can have dangerous consequences such as liver inflammation to cirrhosis. One sister hands Horbach the ultrasound scalpel. 76 minutes later, 90 percent of Katrin’s stomach is missing.
So it goes on after the operation
The narrow clamped tube, Katrin’s new stomach, holds about 150 milliliters. In a normal fit 1500 to 2500 milliliters. Katrin is allowed to eat about 50 grams per meal in the first few months after surgery, which is equivalent to half a roll or one egg, five to six servings in one day. In the long term, it should come to no more than 150 grams per meal. Tubular stomach operations are thus restrictive. But that’s not all: the little thing that still has room in Katrin’s stomach stretches her stomach wall earlier. This stretch signals: I am full, I do not like to eat anymore.
So you can say: Horbach has reprogrammed Katrin’s body. And something else he has done: In the piece of the stomach, the physician now draws a vacuum balloon through one of the cuts from the abdomen, the hormone Grhelin is formed, which is responsible for the feeling of hunger. Surgeon Horbach leaves the field to the anesthesiologist: “Wake up, Frau Böttcher, you’ve made it!”
Katrin had to stay in the “Schön Klinik” for five days and was on sick leave for six weeks. Now she opens the door of the row house and says, “Ten kilos!” On the face you can already see the weight loss, but she looks unhappy. What’s happening? It was a stupid day, there was nothing left in the office after lunch, a tingling in the stomach and problems with the circulation. She sat on the sofa in the conference room for half an hour, her feet up, breathing, breathing, breathing. Katrin tells her that she is rattling, day after day, still. What kind of food does it tolerate, which does not? Mashed potatoes (one tablespoon) and Ikea Köttbullar (three pieces): great. Toast bread: does not work.
“Katrin is impatient,” says Andi. “My thoughts are always racing,” says Katrin. Today she is down. It bothers her that food has this status again, she reckons, again she weighs, measures gram by gram and thinks in calories. “I thought that was behind me,” she points out to her diet.
Andi it is then, who turns the mood, again. But this time he does not make a joke. When he says that Katrin has not had to take blood pressure medication for two weeks and how glad that makes him, she still smiles. And now calculate. Nine kilos still, then she has the 99. Currently disappear one to two kilos per week, in six months she has her birthday. “I want to go to the high ropes course, you have to weigh under 100 kilos.”