[The German snowball effect : An increasing aftercare problem in bariatric treatment]. / Der deutsche Schneeball-Effekt : Ein zunehmendes Nachsorgeproblem in der bariatrischen Therapie.

BACKGROUND: The surgical treatment of obesity in Germany is a rapidly developing field which is strictly controlled by national guidelines. OBJECTIVE: Depiction of the burden on obesity centers by the exponential increase in numbers of patients following bariatric treatment. METHODS: In a retrospective study the numbers of outpatients at this university obesity center (founded 2007) were descriptively analyzed. Outpatient visits were documented annually and divided into two groups: primary visit and follow-up visit. The frequency of bariatric operations as well as their acceptance/cost coverage by health insurances were evaluated. RESULTS: Overall 318 patients were seen in 2007: 156 primary and 162 follow-up visits. The health insurance rejection rate for cost coverage was 16.8%. There were 1691 outpatient visits in 2016 (2016 vs. 2007: +532%), of which 487 (+312%) were primary and 1204 (+743%) follow-up visits. The health insurance rejection rate dropped to 1.8%, while the frequency of operations increased nearly tenfold. CONCLUSION: With the increasing acceptance of bariatric surgery, a relatively low number of specialized centers have to deal with an exponentially rising follow-up frequency. In consideration of the extent of the obesity epidemic an adequate follow-up constitutes a socioeconomic problem, which can only be solved in an interdisciplinary setting under structural integration.