For obese individuals whose type 2 diabetes is poorly controlled, weight-loss surgery may be a lifesaving option. In fact, an operation may be more effective than traditional treatments like drugs, diet, and exercise according to two recent studies reported in The New York Times.
When patients had weight-loss surgery, they not only had a better chance at remission of their diabetes, but they required fewer drugs to control the condition. And as a bonus, the patients' blood pressure and cholesterol levels dropped, too.
The studies, which appeared in the New England Journal of Medicine, were pioneering in that they were the fist to compare traditional medical treatments with weight-loss surgery.
But though the individuals in the study enjoyed positive health results following surgery, the jury is still out on whether weight-loss surgery is the magic answer and should be used more frequently to treat individuals with diabetes who need to lose a great deal of weight.
Such surgery can cost anywhere from $11,500 to $26,000, according to the American Society for Metabolic and Bariatric Surgery, as reported in The New York Times. Some 200,000 of these types of surgeries take place annually in the U.S.
While every surgery carries a risk, the death rate is actually quite low. "It's one of the safest types of surgeries that we perform," says Francesco Rubino, MD, of the Metabolic and Diabetes Surgery Center at NewYork-Presbyterian Hospital/Weill-Cornell Medical Center in New York City. (He performed some of the operations in one of the two studies.)
Weight-loss surgery is about as risky as gall bladder surgery, Rubino says. "It's not as risky as having diabetes with the risk of heart attack and stroke," he says. "And many patients with Type 2 diabetes end up going on insulin at some point. Insulin given to someone who is already obese is not good since insulin often causes weight gain."
Just what are your options should you decide to opt for surgery to bring about weight loss? "There are a number of different procedures," says Randy Seeley, Ph.D., who runs the Cincinnati Diabetes and Obesity Center at the University of Cincinnati.
- Roux-en Y gastric bypass. The most common form of gastric bypass, this involves a cut being made at the top of the stomach. A portion of the stomach is used to create a small pouch, which is attached to the small intestine. "You could think of it as about the size of your thumb," Seeley explains. "Nutrients go into the tiny pouch, rather than going into the duodenum." Fat absorption is greatly reduced, too. Theoretically, this surgery is reversible.
- Gastric band surgery (or Laparoscopic adjustable gastric banding). For this, an inflatable band is put in place that divides the stomach in two parts. The band, when pulled tight, acts like a tightening belt, restricting the intake of food a person can consume. "People like it because theoretically it is removable, though it is not trivial to undo," Seeley says.
- Sleeve gastrectomy. For this newer type of weight-loss surgery, the stomach's structure is modified so that it resembles a tube. It effectively limits the number of calories your body can absorb. "The stomach looks like a bag, and the surgery turns that stomach into a sleeve," Seeley explains. While this procedure is often the prelude to another procedure, a biliopancreatic diversion with duodenal switch, the biliopancreatic diversion may not be needed if the person loses enough weight with the sleeve gastrectomy.
- Biliopancreatic diversion with duodenal switch. In this complex surgery, which requires many parts to complete, some 80 percent of the stomach is removed. Still remaining is a valve that releases food into the small intestine and a small portion of the small intestine.
Sources:
Grady, Denise. "Surgery for Diabetes may be better than standard treatment." 26 March 2012. The New York Times.
http://www.nytimes.com/2012/03/27/science/to-combat-diabetes-weight-loss-surgery-works-better-than-medicine-studies-find.html?pagewanted=all
Roux-en-Y stomach surgery for weight loss. Medline Plus. U.S. National Library of Medicine, National Institutes of Health.
http://www.nlm.nih.gov/medlineplus/ency/imagepages/19268.htm
Mingrone, Geltrude et al. "Bariatric surgery vs. conventional medical therapy for Type 2 diabetes." March 2012. New England Journal of Medicine.
http://www.nejm.org/doi/full/10.1056/NEJMoa1200111
"Gastric Bypass Surgery: What you can expect." Mayo Clinic.
http://www.mayoclinic.com/health/gastric-bypass/MY00825/DSECTION=what%2Dyou%2Dcan%2Dexpect
