A New Reason for Weight Loss Surgery?

If you have diabetes, maybe you should have weight loss, or bariatric surgery.  That's one conclusion of two new studies published this week in the New England Journal of Medicine, looking at two different types of surgery: gastric bypass or gastric sleeve.  As I talk about in this week's YouTube, the gastric sleeve operation is a good deal less invasive, but isn't nearly as effective for either weight loss or diabetes control.  Yet as Rick and I rather cynically conclude in this week's PodMed, the success of both types of surgery with regard to blood sugar control offers job security to those surgeons who perform these operations, as both obesity and diabetes skyrocket worldwide. 

In one of the studies, 150 overweight or obese people with elevated hemoglobin A1c (HbA1c) levels were randomized to either intensive medical therapy alone or to medical therapy plus either a traditional gastric bypass operation or the less invasive gastric sleeve.  In the second study 60 patients were randomized to medical therapy alone, or one of the two types of bariatric surgery.  Both studies demonstrated benefits with regard to the need for medical therapy for glucose control.  In the first study, 42% of patients who had gastric bypass surgery achieved a hemoglobin A1c level of 6.0% or less at 12 months of follow up, 37% of patients in the gastric sleeve group and 12% of the medical therapy alone group.  In the second study 75% of those who had the gastric sleeve operation and 95% of those who had the gastric bypass had achieved remission of their diabetes.

Does this mean that people who have diabetes should consider such surgery for control of their blood sugar?  Right now, those who wish to undergo either operation must meet eligibility criteria, including an elevated body mass index.  But just how high does your BMI have to be in order to qualify for the operation, particularly when taken in conjunction with elevated HbA1c?  That number seems to be dropping all the time.

Another consideration is the well-known impact diabetes has on long term health, including the risk of heart attack and stroke.  Does the cost/benefit ratio tip in favor of bariatric surgery when substantial reduction of this risk is taken into account?  It's interesting and noteworthy that both studies were presented at the American College of Cardiology meeting in Chicago this week.  Clearly the cardiologists are also paying attention.

Finally, I was privileged to talk with Thomas Magnuson, bariatric surgeon extraordinaire at Johns Hopkins Bayview, a center of excellence for this type of surgery, about these studies.  He reminded me that it was surgeons, nurses and other members of the health care team taking care of patients undergoing bariatric surgery who originally noted the dramatic reduction in blood sugar that takes place within days of the surgery, a real curiosity since it indicates that weight loss is clearly not the mechanism by which blood sugar is modified in people with diabetes.  Since then much research has been stimulated on exactly what the pathway might be, and the relative success of gastric bypass versus gastric sleeve seems to support one hypothesis involving hormones produced in the stomach and small intestine.  Research is ongoing, but perhaps will give rise to an better understanding of blood sugar control and the eventual development of a better way to control it, perhaps avoiding surgery altogether.

Other topics this week on PodMed, all from NEJM (!), include two studies looking at antibody treatments for psoriasis, a study looking at outcomes of bypass surgery versus stent placement for coronary artery disease, and the safety of stent  placement at community hospitals.  Until next week, y'all live well.

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Pacific Bariatric December 30, 2012 at 6:19 pm

This is all great information regarding weight loss surgery and the risks associated. Also important is learning about whether or not you are a qualified candidate for the surgery. At Pacific Bariatric, we conduct free seminars for you to attend and ask questions. Our physicians are also onsite. Contact us for further information about these seminars to locate one near you.


healthfreak742.thoughts.com November 15, 2012 at 7:35 pm

face a problem at each meal: four ounces of food doesn. If you are not in the pink of health, then weight loss
surgery is obviously not for you as you may not only fail in losing weight but ended up
losing your life as well. All studies show the positive effects of
bariatric surgery and could help type 2 diabetes and obese patients receive free insurance coverage for weight loss surgery.


DongHo December 14, 2012 at 3:01 pm

Joy, while to many people, the soitulon to losing weight is simple - don\'t eat as much and exercise regularly - the reality is that eating disorders are complex and multi-layered. Unravelling the root cause involves examining everything from genes to environment to emotional issues. Eating is so intricately woven into the fabric of our daily lives that extricating that which is emotional unhealthy eating from that which fuels our bodies is a difficult task.Statistics show that for the morbidly obese, there is a less than 2% chance of sustaining weight loss from diet and lifestyle change alone and I think it is irresponsible to keep giving that message to someone like myself who has lost and regain large amounts of weight, each time gaining more than I started with. That is the reality, we are doing more harm to our bodies by continuing this pattern while developing life threatening co-morbidities. We don\'t need education, we are already very knowledgeable about how to eat properly from years of dieting.Perhaps if the health care system would pay for extensive therapy to help deal with the deep seated and long term emotional issues that many have, it might help, but that can takes years - years that many obese individuals don\'t have. I also had the Vertical Sleeve Gastrectomy and have lost 164 pounds. I have a new life, renewed health and will be costing the health care system a lot less money.Lorraine


mackenzie October 12, 2012 at 1:46 pm

Great post. My sister is thinking about getting weight loss surgery in Oklahoma. I don't think she needs it but she does. I never really understood why someone would want to put themselves through a surgery like that but this post has definitely opened my eyes. Thanks so much for sharing.


Haris November 9, 2012 at 11:37 am

Hi, i'm three months post op yaeterdsy and made 50 lbs lost also. I have 50 to go but i know i will make it. You have done great and this is old so you are probably done with the weight loss and now on maintenance. Can't wait to get there, should be soon. Thanks for sharing, good job jeani


weight loss surgery October 12, 2012 at 7:33 am

Weight loss surgery is an ideal option especially for those people who do not get success in weight loss process by doing exercise and diet. This surgery also improves blood pressure and cholesterol level in a better way. Thanks for sharing this amazing information.


Jungsile November 9, 2012 at 4:21 pm

Anthony .Your post still makes the assumption that most plpoee who are overweight simply eat poorly by choice and don't exercise because they're lazy'. I have an idea for all of us out here who don't weight over 300 lbs. Let's all take a backpack, fill it with lard until it puts our weight at about 300-350 lbs. For most of us, that means we'll be carrying around about 150-200 lbs. Now, carry that with you everywhere you go, even when you sleep. Next, decrease your calorie intake, being careful to balance your diet so as not to lose too much protein, have too much fat and also get just enough carbohydrates to still maintain some energy. While decreasing your caloric intake, also increase your movement by getting at least 90 minutes of aerobic activity, in at least 22 minutes long increments, and some weight training, at least an hour a week, preferably two. Be sure to leave the backpack on while you do that, and regardless of how hungry you may get because of the increase in activity do NOT eat any more.Now that you're doing that, you'll be allowed to take 2-3 lbs of lard out of the backpack per week. No more than that, however, or you'll have to take a penalty of increasing the weight the following month by 3 lbs.However, after every three months you'll have to increase your exercise or decrease your calorie intake because your metabolism will try to become stable . Also, you'll probably have to cut sugar out of your diet entirely and keep fat to an absolute minimum, which means that when you're at every party, every dinner out, every family get together you can never eat any dessert, drink any alcoholic beverage nor even look at a thoughtfully prepared meal, including your birthday and Thanksgiving. This will probably be hard for your piers to understand, as they took a great deal of time and effort into making that delicious dip that you absolutely must not even try.Now, I realize that carrying this backpack around with you will not only be uncomfortable, it will be ungainly and unattractive. People may look at you as if you're not like them and, since they're not wearing backpacks filled with lard, simply cannot understand whey you do.Of course, this may make you a little depressed. Should that happen, and you don't have the money to see a doctor to get antidepressants, you'll have to decrease the weight you subtract each week by 1 lb. If you do see a doctor and he doesn't recommend therapy to you, even with the anti-depressants, you must subtract .5 lbs a week from your weekly decrease.I personally am not obese. I've never had gastric bypass surgery. I am fairly strong and healthy and my lifestyle choices include not eating a lot of junk, because it makes me feel like crap to do so. I also, however, will not judge an obese person because I have never personally worn that much fat on my body. I can not say what is right for any one person or another. I assume that they, like me, live a much more complicated life than what the sitcoms on TV want to tell us exist.I stand by my assertion that had that doctor been more professional, he could have HELPED this woman, as my father was helped. His frustration does not, in any way, excuse his behavior. This woman most likely still needs help and I hope that she's found a doctor that has worked with other health care professionals (nutritionist, counselors, perhaps more) that can also help this woman to coordinate their efforts to get her healthy.I'm not saying that being obese makes a person a victim, what I'm saying is that a doctor cursing at an obese woman DOES make HER a victim. If eating right and exercise was the simple, easy solution to obesity, then how can you all explain Oprah, Kirstie Alley and so many of the Biggest Loser contestants gaining the weight back? After all, they changed their lifestyle .It really is not that simple. Never has been, wishing it were isn't going to make it so.P.S. My boyfriend pointed out that a perfect size shouldn't be a size 2. He feels that a size 8-10 is probably the healthiest. Even putting vanity sizing into the equation, Marylin Monroe at her sexiest was probably a size 6 or 8.


Joe June 8, 2012 at 9:08 am

If you're overweight and can't lose pounds with a healthy diet and exercise, surgery might be an option for you. Obesity surgery is usually for men who are at least 100 pounds overweight and women who are at least 80 pounds overweight. If you are somewhat less overweight, surgery still might be an option if you also have diabetes, heart disease or sleep apnea.


Asmahniza October 11, 2012 at 1:56 am

Generally speaking, iunsrance companies do not like to pay for bariatric surgeries, for many reasons:1. It is much, much healthier if you lose weight the old fashioned way diet and exercise.2. It is much, much cheaper for the iunsrance company if you lose weight the old fashioned way.3. If you're not going to diet and exercise after the surgery, you may eventually gain weight back anyway.4. The surgery often has lots of complications, which cause more health problems.5. The complications also cost the iunsrance company more money.So, yeah, you will have difficulty getting iunsrance to pay for the surgery, but if you persist, and if your doctor is willing to fight with the iunsrance company, you may get it paid for.It is obvious from your well-written question that you are a very intelligent person. Please do a lot of research into this before you have major surgery.From CBS News:Gastric Bypass Surgery Gone BadStudy: 1 In 50 People Die Within A Month Of SurgeryFrom WebMD:Is Gastric Bypass Surgery Worth the Risk?


Mina December 14, 2012 at 2:11 pm

Being fat is not like being african/american, male/female. YES to the pepole with thyroid problems, its not fair being lumped together with those that just don't have a healthy lifestyle. Lifestyle/choice For those with a medical condition, I know it can be regulated to a large degree. you may never be the perfect size 2 but its also not an excuse to mushroom up to 300 lbs in most cases.I am NOT overweight and get you're so lucky' all the time. SCREW LUCK. I eat sensibly, I exercise regularly, I stay active. If my weight starts to go up (5lbs in a month) I ask WHY.Simplifying the solution CAN be the answer. Why are there fat kids on the playgrounds. Bad eating habits ???(pattern of eating or food choices). In our house (we were poor), there were no bags of cookies, fritos or twinkies. We had milk, juice or water not koolaid or pop. We had fruit that was affordable, not the latest thing (strawberries in December??? what the heck is a KIWI) We didn't get a ride to our friends place, we walked or rode a bike. We walked to the rec centre to go swimming or skating, not get dropped off by mom or dad. Heck we even walked to school right up to grade 12.Blame the manufacturers, blame the food producers, blame the chemicals, blame the school, blame the insensitive pepole, but never take responsibility for your own destiny that is the world we live in today.80 years ago, obesity was a rarity (fat man at the side show), now its endemic .did we all develop diseases and disorders to blame or did WE CHANGE OUR EATING AND LIFESTYLE.sign me:No tolerance for the whiny fat pepole that DO nothing about their problem. 100% support for those that make the effort and try hard and 99% support to those that are overweight, know it but don't blame others all the time. You are still beautiful pepole.

Bariatric Vitamins March 30, 2012 at 1:10 pm

I thoroughly enjoyed this article. Thank you for sharing!


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