Is Bariatric Surgery Really the Answer?
The incidence of type 2 diabetes continues to increase worldwide with no immediate remedy on the horizon. Addressing or alleviating some of the potential risk factors for type 2 diabetes has become the prevailing strategy for combating this ever-increasing epidemic. Overweight and obesity is one of the leading risk factors for type 2 diabetes, and along with diet and exercise it is one of the most common risk factors targeted for delaying onset or controlling the disease in those diagnosed (American Diabetes Association, 2012). Since 90% of all diabetics are overweight or obese, this is clearly an area of great concern. Bariatric surgeries to facilitate weight loss, such as gastric bypass, laproscopic adjustable gastric banding (lap band), and gastric sleeve surgery, are now being proposed as a means of curing or resolving type 2 diabetes prevalence (Science Daily, 2009).
Evidence reveals that diabetes does go away for some people following gastric bypass surgery, in some cases even before significant weight loss (Science Daily, 2012). Is this a lasting effect and does it mean that the individual has been cured of type 2 diabetes? Buchwald et al. (2009) established that clinical and laboratory manifestations of type 2 diabetes are resolved or improved in the majority of patients following bariatric surgery, but there was no indication of long lasting effects. In fact, a recent study revealed that "although gastric bypass surgery reverses type 2 diabetes in a large percentage of obese patients, the disease recurs in about 21% of them within 3-5 years" (Science Daily, 2012, para. 1), which indicates that the long-term effects of the procedure are questionable at best.
Although there is an established link between weight loss and diabetes management, does it mean that we have reached a point where drastic measures are seen as the only solution? Comparing the cost of bariatric surgery with long-term diabetes care might lead many to support bariatric surgery as a legitimate way to reduce type 2 diabetes prevalence, but one must also consider if that would be merely trading one problem for another? According to Arterburn et al. (2012), improvements in risk factor reduction and lifestyle changes in diabetics have not lowered the most significant diabetes-related outcomes: heart attacks, strokes, and deaths. This leaves us to ponder the following question: What is the real solution to the type 2 diabetes epidemic?
References
American Diabetes Association (2012). Your risk: Who is at greater risk for type 2 diabetes? Retrieved from http://www.diabetes.org/diabetes-basics/prevention/risk-factors/
Arterburn, D. E., Bogar, A., Sherwood, S. S., Coleman, K. J., Haneuse, S., O'Connor, P. J. ...Selby, J. (2012). A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obesity Surgery. doi:10.1007/s11695-012-0802-1
Buchwald, H., Estok, R., Fahrback, K., Banel, D., Jensen, M. D., Pories, W. J., & Sledge, I. (2009). Weight and type 2 diabetes after bariatric surgery: Systematic review and meta-analysis. The American Journal of Medicine, 122(3), 248-256.e5. doi:10.1016/j.amjmed.2008.09.041
Science Daily (2009). Potential for resolving type 2 diabetes with bariatric surgery. Retrieved from http://www.sciencedaily.com/releases/2009/03/090303082809.htm
Science Daily (2012). Gastric bypass surgery helps diabetes but doesn't cure it, study suggests. Retrieved from http://www.sciencedaily.com/releases/2012/11/121126142957.htm
Hey Kristy
ReplyDeleteThis topic raises so many questions, such as when is surgery necessary, will patients develop nutritional deficiencies and how long will they stay in remission? The data that has been complied on diabetes and bariatric surgery has mostly been observational studies which lack control groups. The benefits of surgery compared to diabetic therapy has yet to be determined if surgery weighs out over traditional therapy (Sangeeta, 2010). There is a related link between weight loss and diabetes management but I don’t believe that we have to turn to drastic measures, such as surgery if we can help a person lose weight through other means. This is a great controversial topic.
Tracy
Sangeeta, K. (2010). Bariatric surgery for type 2 diabetes: Weighing the impact for obese patients. Cleveland Clinic Journal of Medicine, 77(7), 468-476. doi: 10.3949/ccjm.77a.09135 Retrieved from http://www.ccjm.org/content/77/7/468.long
Hi Kristy,
ReplyDeleteGreat points! I believe this is very controversial. My biggest concern with bariatric surgery is that many patients gain the weight back. Sometimes all of it plus some and sometimes they don't gain it all back but enough to put them back at unhealthy weights. I've spoken about it with our medical director and RDs at work and they have shared their experiences with working with patients who have gained the weight. Morbid obesity is such a psychological issue that if those issues are not addressed the weight can return. The stomach can expand again and/or the patient has figured out how to "bypass" by changing their eating habits to allow them to intake high amounts of calories (for example, they can drink a milkshake but it can contain 1000 calories!)
I found this on a bariatric surgery from the Universtiy Of Michigan Bariatric Surgery Program:
"It is possible to gain all, and more of your weight back following gastric bypass surgery if you are not willing to change your lifestyle to include healthy dietary choices eaten in moderation and incorporating activity/exercise into your daily life. " I wonder if patients are fully aware of this when they commit to such a serious procedure.
http://www.med.umich.edu/bariatricsurgery/about/bypass/postop.shtml
Hi Kristy,
ReplyDeleteThere is growing evidence that bariatric surgery may effectively cure Type 2 diabetes. It is known that this is a controversial topic and lifestyle modifications should be the cornerstone of management in all patients with Type 2 diabetes. Whilst bariatric surgery is recognized as an invasive, expensive procedure requiring rigorous assessment, it has the potential to cure the majority of patients with Type 2 diabetes. It is cost-effective and significantly reduces the risk of diabetic complications and comorbidities. Whilst surgical treatment for Type 2 diabetes is still in its infancy, there are huge implications for future research with the potential of solving a growing epidemic. Also there is a major issue must be considered that related to bariatric surgery is whether it is safe. As with any operation there are associated risks, but these should be assessed in light of the perceived benefits (Coleman & Phillips, 2010).
References:
Coleman, J., & Phillips, S. (2010). Bariatric surgery: a cutting-edge cure for Type 2 diabetes? Journal of the New Zealand Medical Association,123 (1311). Retrieved from http://journal.nzma.org.nz/journal/123-1311/4025/
Kristy, I found this controversy related to diabetes control very interesting. There is a lot of internet discussion about this topic. Using bariatric surgery for weight –loss as a way to control Type 2 diabetes seems to be a growing controversy. Most studies reported that while it helped reduce diabetes initially, in a large percent of patients diagnosed before their surgery the diabetes returned. The New York Times reported that if weight-loss surgery was done before the diabetes was considered “advanced” the patient had a much better outcome. This report added that even though it might not be a long-term answer to diabetes, weight loss in itself was a benefit to the patient. This is definitely a controversy that will continue for some time. Thanks, Kay
ReplyDeleteReference
O’Connor, A., (November 28, 2012). Weight Loss Surgery May Not Combat Diabetes Long-Term. New York Times. Retrieved December 2, 2012, from http://well.blogs.nytimes.com/2012/11/28/weight- loss-surgery-may-not-combat-diabetes- long-term/
Your post really hit home. Today, my mother-in-law came home from the hospital after spending a month there recovering from a stroke. She now has to monitor her blood sugar regularly because it was found that she has diabetes. While in the hospital, she talked about how she was going to change her habits and drink less soda, eat less sweets and exercise more. The stroke left her unable to walk without assistance and she cannot move her left arm. After church, we went to visit her and when we tested her blood, it was 350. What did she eat for breakfast? She had cake and soda! When I reminded her that she should not be eating those types of foods, her sister quickly said, “Just take your diabetes pills.” That is our mentality in today’s society. We want a quick fix- pills, surgery, etc. Surgery may be the best option for some who have demonstrated drastic lifestyle changes in diet and exercise with little weight loss. Most, however, need to first demonstrate a commitment to change before they undergo a surgery that will not produce the intended results.
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