title: [Challenges in building a surgical obesity center].
abstract: BACKGROUND
  It is estimated that approximately 1 million adults in Germany suffer from grade III obesity. The aim of this article is to describe the challenges faced when constructing an operative obesity center.
  
  
  METHODS
  The inflow of patients as well as personnel and infrastructure of the interdisciplinary Diabetes and Obesity Center in Heidelberg were analyzed. The distribution of continuous data was described by mean values and standard deviation and analyzed using variance analysis.
  
  
  RESULTS
  The interdisciplinary Diabetes and Obesity Center in Heidelberg was founded in 2006 and offers conservative therapeutic treatment and all currently available operative procedures. For every operative intervention carried out an average of 1.7 expert reports and 0.3 counter expertises were necessary. The time period from the initial presentation of patients in the department of surgery to an operation was on average 12.8 months (standard deviation SD ± 4.5 months). The 47 patients for whom remuneration for treatment was initially refused had an average body mass index (BMI) of 49.2 kg/m(2) and of these 39 had at least the necessity for treatment of a comorbidity. Of the 45 patients for whom the reason for the refusal of treatment costs was given as a lack of conservative treatment, 30 had undertaken a medically supervised attempt at losing weight over at least 6 months. Additionally, 19 of these patients could document participation in a course at a rehabilitation center, a Xenical® or Reduktil® therapy or had undertaken the Optifast® program. For the 20 patients who supposedly lacked a psychosomatic evaluation, an adequate psychosomatic evaluation was carried out in all cases.
  
  
  CONCLUSIONS
  The establishment of an operative obesity center can last for several years. A essential prerequisite for success seems to be the constructive and targeted cooperation with the health insurance companies.
authors: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
authors: L
authors: L
authors: Fischer
authors: Z
authors: Z
authors: El Zein
authors: T
authors: T
authors: Bruckner
authors: K
authors: K
authors: Hünnemeyer
authors: G
authors: G
authors: Rudofsky
authors: M
authors: M
authors: Reichenberger
authors: K
authors: K
authors: Schommer
authors: C N
authors: CN
authors: Gutt
authors: M W
authors: MW
authors: Büchler
authors: B P
authors: BP
authors: Müller-Stich
mesh_terms: D050110:Bariatric Surgery / Q000191:economics; D015992:Body Mass Index; D003131:Combined Modality Therapy; D015897:Comorbidity; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis / Q000458:organization & administration; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D005858:Germany; D006782:Hospitals, Special / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D008006:Licensure, Hospital / Q000191:economics / Q000458:organization & administration; D009313:National Health Programs / Q000191:economics; D020380:Needs Assessment / Q000458:organization & administration; D009765:Obesity / Q000453:epidemiology / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration; D012051:Reimbursement Mechanisms / Q000191:economics / Q000458:organization & administration; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D017211:Treatment Failure
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