Wednesday, January 23, 2008

To cut is to cure? Caution regarding surgical cure for obesity

Significant buzz has been generated in the press (NY times) and on the Net (KevinMD) regarding a recent study in JAMA that showed that 2 years after surgery ( a lap band procedure) most (73%) of Type 2 diabetics were off all diabetes treatments, compared to 13% of the patients with diet and exercise. The authors used the term "remission", though some media (AP wire) are reporting this as a diabetes cure.
It should not be surprising that more patients who got the surgery were able to get off their diabetes medications because the patients with the surgery lost substantially more weight. Other published studies show the superiority of bariatric surgery over conventional methods for sustainable weight loss. However, before you consider asking your physician for a surgery referral to cure your diabetes, consider the following:
1. This study was done in patients who had diabetes less than 2 years. The longer you have diabetes, the more the cells in your pancreas that produce insulin (beta cells) die off. You can't regain these, even after weight loss. I have many patients who have had successful bariatric surgery but were unable to get off all their diabetes medicine, because their diabetes had already progressed too far.
2. Sustained weight loss beyond two years after bariatric surgery has not been fully established. Certain patients do quite well for years after surgery, but some patients do gain this weight back. Obesity is a major problem for our country, and the internal (genes, hormones) and external (poor diet, stress, lack of exercise) forces that contribute to obesity are quite powerful, particularly for the American lifestyle. Though surgery may be an excellent tool that can lead to successful weight loss, it is no more a cure for obesity than it is for diabetes.
Medications for obesity have been disappointing thusfar. It is possible that a combination of current and soon to be available medications may do better. However, nothing works without agressive lifestyle changes that must be sustained over years.
If you are obese (BMI of >40 or BMI >35 with conditions like diabetes- calculate yours here ), you may be a good candidate for surgery. Do everything you can to lose weight with diet and exercise. If that doesn't work, IN ADDITION to diet and exercise (and possibly medication), surgery may be a good option for you. This study suggests that if you have only had diabetes for a few years, you may be able to get off some medications. However, to prevent the weight from coming back and re-developing diabetes, you must keep up with a healthy lifestyle.

2 comments:

Dr.Shannon. Dr.Shana said...

There are instances when a person grows fat after a particular illness or surgery or even after having some kind of medication. This kind of weight gain can be termed as side effect of such surgeries or illness. However, this kind of weight gain can also be defeated with the means of an effective weight loss regimen. And if one is keen on taking the short cut and having the weight loss drugs, then one has to have the prescription. http://www.phentermine-effects.com

Anonymous said...

Thoughts about Obesity

Obesity has been defined as when excess body fat accumulates in one to where this overgrowth makes the person unhealthy to varying degrees. Obesity is different than being overweight, as it is of a more serious concern. As measured by one’s body mass index (BMI), one’s BMI of 25 to 30 kg/m is considered overweight. If their BMI is 30 to 35 kg/m, they are class I obese, 35 to 40 BMI would be class II obese, and any BMI above 40 is class III obesity. Presently, with obesity affecting children progressively more, the issue of obesity has become a serious public health concern.
Approximately half of all children under the age of 12 are either obese are overweight. About twenty percent of children ages 2 to 5 years old are either obese are overweight. The consequences of these stats on our children are very concerning, considering the health issues they may or likely experience as they get older.
Worldwide, nearly one and a half billion people are either obese or overweight. In the United States, about one third of adults are either obese or overweight. It is now predicted that, for the first time in about 150 years, our life expectancy is suppose to decline because primarily of this obesity problem.
Morbid obesity is defined as one who has a body mass index of 30 kg/m or greater, and this surgery, along with the three other types of surgery for morbid obesity, should be considered a last resort after all other methods to reduce the patient’s weight have chronically failed. Morbid obesity greatly affects the health of the patient in a very negative way. It has about 10 co-morbidities that can develop if the situation is not corrected. Some if not most of these co-morbidities are life-threatening.
One solution beneficial in many cases of morbid obesity if one’s obesity is not eventually controlled or corrected is what is known as gastric bypass surgery. This is a type of bariatric surgery that essentially reduces the volume of the human stomach in order to correct and treat morbid obesity by surgical re-construction of the stomach and small intestine.
Patients for such surgeries are those with a BMI of greater than 40, or a BMI greater than 35 if the patient has co-morbidities aside from obesity. This surgery should be considered for the severely obese when other treatment options have failed. The standard of care illustrating as to whether this surgery is reasonable and necessary should be clarified.
There are three surgical variations of gastric bypass surgery, and one is chosen by the surgeon based on their experience and success from the variation they will utilize. Generally, these surgeries are procedures related to gastric restrictive operations or mal-absorptive operations.
Over 200,000 gastric bypass surgeries are performed each year, and this surgery being performed continues to progress as a suitable option for the morbidly obese. There is evidence that this surgery is particularly beneficial for those obese patients that have non-insulin dependent Diabetes Mellitus as well.
It is believed that the results of this surgery to correct morbid obesity greatly limits or prevents such co-morbidities associated with those who are obese. Yet about two percent of those who undergo this surgery die as a result from about a half a dozen complications that could occur. However, the surgery reduces the overall mortality of the patient by 40 percent or so, yet this percentage is debatable due to conflicting clinical studies at times.
Age of the patient should be taken into consideration, as to whether or not the risks of this surgery outweigh any potential benefits for the patient who may have existing co-morbidities that have already caused physiological damage to the patient. Also what should be determined by the surgeon is the amount of safety, effectiveness, and rationale for a particular patient regarding those patients who are elderly, for example.
Many feel bariatric surgery such as this should be considered as a last resort when exercise and diet have failed for a great length of time.
If a person or a doctor is considering this type of surgery, there is a website dedicated to bariatric surgery, which is: www.asmbs.org,

Dan Abshear