The Pros And Cons Of Gastric Bypass Surgery
Gastric bypass surgery involves stomach-stapling that reduces it to a pouch about the size of a small lemon. The stomach is then re-routed to bypass the upper portion of the small intestine. Gastric bypass surgery reduces the amount of food the stomach can handle and calorie absorption.
Adjustable gastric band surgery involves placing a band around the upper portion of the stomach to create a small pouch, restricting food passage. This causes a decrease in food intake.
After both procedures, people must follow a reduced-calorie meal plan to lose weight. For the study, people in the intensive lifestyle change group followed a low-calorie, high-fiber meal plan and were encouraged to be physically active regularly.
Weight loss surgery may improve blood sugar control by altering levels of gut hormones, as well as by speeding up weight loss. It may also alter the balance of microbes in the digestive system in beneficial ways. Courcoulas says more research into the exact mechanisms is needed. And, she adds, so are longer studies about weight-loss surgerys effects. She is currently at work on a seven-year study with researchers from the University of Washington in Seattle, the Joslin Diabetes Center in Boston and the Cleveland Clinic.
What Are The Flaws Of Bmi
Also, the ADA notes that bariatric surgery is recommended in adults with a BMI between 35 and 39.9 who have other health problems, including hyperglycemia, and have not seen lasting weight loss and improvement in those other health problems using reasonable nonsurgical methods, per an article published in January 2019 in Diabetes Care.
“In addition to the BMI criteria, patients undergo a thorough multidisciplinary evaluation that covers nutrition, psychology, and a medical evaluation, says Brethauer. These visits are intended to identify behavioral issues that may impact their success after surgery and to optimize their medical conditions prior to surgery. Insurance companies currently require patients to undergo this multidisciplinary evaluation in order to be approved for the surgery.”
Theres growing evidence thats the case. A meta-analysis of 11 randomized clinical trials published in June 2016 in Diabetes Care reported that type 2 diabetes remission rates following bariatric-metabolic surgery are comparable above and below the 35 kg/m2 BMI threshold.
What Are The Different Kinds Of Bariatric Surgery
If you and your healthcare team decide that bariatric surgery is the best option, there are several different surgeriesavailable. The two most popular surgeries in the US include:
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Vertical sleeve gastrectomy
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Roux-en-Y gastric bypass
In a vertical sleeve gastrectomy , also called a sleeve, approximately 80% of the stomach is removed, leaving behind a stomach pouch roughly the size and shape of a banana. By decreasing the size of your stomach, the surgery limits the amount of food you can consume, decreases overall hunger, and improves glucose levels.
In a Roux-en-Y gastric bypass , or gastric bypass for short, the surgeon creates a small stomach pouch the size of a walnut or egg, which is then attached to part of the small intestine, bypassing most of the stomach and the upper part of the small intestine. This procedure decreases hunger and improves glucose levels.
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Hypothesis : Weight Loss Increases Insulin Sensitivity
The enforced caloric restriction, negative energy balance, and weight loss after bariatric surgery reduce insulin resistance. Consequently, the beta cells can rest because they donât need to produce as much insulin. These effects have been observed after both gastric restrictive procedures and gastric bypass procedures.
Dietary Adjustments After Bariatric Surgery
With their smaller stomachs, people who have had the surgery need to eat very slowly and take tiny bites.
One of the hardest adjustments for patients is that they cannot drink liquids while eating, says Dr. Cha. Patients should drink their fluids at least 30 minutes before or 30 minutes after eating, but it doesnt take long for most people to adjust.
Those who have had the surgery also take vitamins and supplements recommended by a nutritionist who counsels patients after the procedure. Your nutritionist may also recommend meal plans and a specialized diet after your surgery.
From weight loss to overall health benefits, talk to your doctor if youre a candidate for bariatric surgery and how you can be on your way to a healthy lifestyle.
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A Randomized Controlled Trial Of Gastric Banding
The only randomized controlled trial to date that compared standard medical diabetes therapy with bariatric surgery was conducted by Dixon et al.14
Sixty patients with type 2 diabetes were randomized either to receive medical management as defined by the American Diabetes Association guidelines or to undergo laparoscopic adjustable gastric banding.
At 2 years, the rate of remission was 13% in the medical treatment group vs 73% in the surgery group . Patients receiving medical treatment had lost a mean of 1.7% of their body weight, vs 20.7% in the surgical patients . Weight loss was strongly associated with remission of type 2 diabetes after surgery.
This study was controversial in that the medical intervention in this trial was not as aggressive as in the Diabetes Prevention Project and Look AHEAD trials.
Who Is The Right Candidate For Bariatric Surgery
Bariatric surgery is not for everyone. However, the American Diabetes Associations Standards of Care in Diabetes provides recommendations for who is a good candidate.
The ADA guidelines say that bariatric surgery is recommended if you have type 2 diabetes and a BMI greater than or equal to 40 .
In addition, bariatric surgery should be recommended if you have type 2 diabetes and a BMI between 35.0-39.9 and you have not been able to achieve sustained weight loss and improvements in your diabetes-related complications with lifestyle changes and medications alone.
Finally, if you meet all the above conditions but you have a lower BMI in the range of 30-34.9 , then bariatric surgery can still be considered.
In any case, the decision to undergo surgery is a major one that requires open communication with your healthcare team and an exploration of all of the available options. What I always tell people is make an appointment with a bariatric surgeon and just get evaluated, said Stegemann. Then you can learn about the different procedures and see what your options are. He suggests a couple questions that people can ask their healthcare team to learn more:
Stegemann stressed the importance of making sure that people find an accredited center that follows people after surgery and helps teach the valuable lifestyle habits that help improve long-term success.
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Diabetes After Bariatric Surgery
Obesity greatly increases the risk of developing type 2 diabetes, a lifelong disease in which your body does not properly process glucose, a kind of sugar, in your blood.
- The pancreas produces a hormone called insulin, which enables your cells to turn glucose from the food you eat into energy.
- People with type 2 diabetes produce insulin, but their bodies do not use it properly. This is called insulin resistance.
- For some people, losing weight helps them better control their diabetes symptoms.
- In addition to weight, a variety of factors may contribute to the development of type 2 diabetes, including genetics.
- Keep in mind, not all patients will experience an improvement in diabetes after their surgery.
Selection Of Subjects Appropriate For Surgery
One of the most difficult topics in regards to bariatric surgery is which patients should be considered for such procedures. This topic has been debated since the advent of bariatric surgery, and the National Institutes of Health has offered recommendations. The NIH consensus statement on the evaluation, management, and treatment of obesity in adults attempts to define the condition of obesity and overweight, as well as to offer recommendations for management of the disorder, including when surgical intervention should be considered. As described in , body habitus is classified by BMI measurement /inches of height squared, or kg/m2). Individuals with a BMI of 25-29.9 kg/m2 are considered overweight, those with a BMI of 30-34.9 kg/m2 are considered to have class I obesity, those with a BMI of 35-39.9 kg/m2 are considered to have class II obesity, and those with a BMI 40 kg/m2 are considered severely obese.,
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Bariatric Surgery For Patients With Diabetes
Aaron W. Eckhauser, William O. Richards, Michael J. Fowler Bariatric Surgery for Patients With Diabetes. Clin Diabetes 1 July 2007 25 : 8389.
IN BRIEF
Bariatric surgery is becoming increasingly common as a means to control weight in the United States. This article reviews the most common forms of bariatric surgery and their effects on diabetes and other components of the metabolic syndrome.
Obesity is fast becoming one of the most prevalent chronic medical conditions in America. The U.S. Centers for Disease Control and Prevention estimates that there are 60 million obese adults in the United States,or about 30% of the adult population. Perhaps even more ominous is that 16% of children and teens between the ages of 6 and 19 years are overweight, suggesting that the prevalence of adult obesity will continue to increase in the foreseeable future. This major segment of the population is at higher risk of developing many diseases,including diabetes. It is estimated that as many as 280,000 deaths annually may be attributable to adult obesity.
Weight Loss Surgery Benefits
Quality of Life | Diabetes | Fatty Liver Disease | Hypertension | Joint Pain | Mortality | Obesity Associated Cancer | Obstructive Sleep Apnea | PCOS & Infertility
Quality of Life
- Obesity is associated with impairments in quality of life. In particular, obesity can cause increased physical limitations, bodily pain, and fatigue.
- The National Health and Nutrition Examination Survey found that morbidly obese women were four times more likely to be depressed as women with a normal BMI.
- Numerous studies have suggested that individuals report improvements in psychosocial functioning with weight reduction. The most consistent finding in this area is the association between surgical weight loss* and improved quality of life.
- More than 95% of the patients who had bariatric surgery at UCLA reported markedly improved or improved quality of life after surgery in an anonymous survey.
- Obese patients who had bariatric surgery not only live longer, but also live much better.
*Weight loss results can vary depending on the individual. There is no guarantee of specific results. Read full disclaimer >
Diabetes Mellitus
Fatty liver disease
Hypertension and Hyperlipidemia
Joint Pain and Osteoarthritis
Mortality
Obstructive Sleep Apnea
Obesity Associated Cancer
Polycystic Ovary Syndrome and Infertility
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How Bariatric Surgery Can Help People With Diabetes
Managing your weight is an important part of controlling diabetes. Not only does being overweight increase your risk of developing diabetes, but losing weight decreases your risk of complications like kidney and heart disease. In some cases, people who lose weight are able to stop taking diabetes meds.
Simple changes to your diet and exercise plans may be all it takes to get your weight to a healthy range. When that doesnt work, it may be time to check out other options like weight loss surgery. If you have a BMI of 35 or greater and have diabetes, you can qualify for weight loss surgery. It could help you lose weight and reduce complications from diabetes.
Riveting New Data On Bariatric Surgery Results
In the June 2011 Archives of Surgery, a systematic review was published demonstrating that bariatric surgery leads to marked and long-lasting weight reduction, and may be capable of improving or even curing type 2 diabetes. The analysis reviewed findings from nine studies that followed obese patients with diabetes who underwent either gastric bypass or gastric banding for 1 year. Rick Meijer, MD, and colleagues from Amsterdam found that Roux-en-Y gastric bypass led to a reversal rate of type 2 diabetes of 83%. Adjustable gastric banding led to a reversal rate of 62%, and this effect was achieved later after surgery .
The presence of diabetes is a compelling argument to perform bariatric surgery in eligible patients according to nationally recognized criteria for the procedure, says Dr. Gould. Dr. Meijers study showed that glycemic control improved in the months after laparoscopic adjustable gastric banding, but it improved more rapidly and completely after laparoscopic Roux-en-Y gastric bypass surgery. In the end, both types of surgery were capable of improving or even curing type 2 diabetes, but the mechanisms may be different. It appears that surgeons should consider bariatric surgery earlier in the treatment of obese patients with diabetes to improve long-term outcomes.
Surgeons should consider bariatric surgery earlier in the treatment of obese patients with diabetes to improve long-term outcomes.
Jon C. Gould, MD
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Types Of Metabolic And Bariatric Surgeries
The following are the most common bariatric surgeries performed in the United States and their known effects on T2DM. View detailed descriptions of common bariatric surgery procedures.
Roux-en-y Gastric Bypass
Roux-en-y Gastric Bypass is a surgery that alters the GI tract to cause food to bypass most of the stomach and the upper portion of the small intestine. The operation results in significant weight-loss and causes remission of T2DM in 80 percent of patients and improvement of the disease in an additional 15 percent of patients.
Improvement or remission of diabetes with gastric bypass occurs early after surgery and before there is significant weight-loss. The weight-loss independent mechanisms of diabetes improvement after gastric bypass are partially explained by changes in hormones produced by the gut after the surgery, and this is an active area of research in the field of metabolic and bariatric surgery.
Sleeve Gastrectomy
Sleeve Gastrectomy is an operation that removes a large portion of the stomach and, in doing so, causes weight-loss. The remaining stomach is narrow and provides a much smaller reservoir for food.
Sleeve gastrectomy also appears to have some weight-loss independent effects on glucose metabolism and also causes some changes in gut hormones that favor improvement in diabetes. Diabetes remission rates after sleeve gastrectomy are also very high and, in some studies, similar to results seen after gastric bypass.
Benefits vs. Risks
What To Expect After The Surgery
People who have undergone bariatric surgery may witness improvements in their blood sugar levels right after the surgery. The doctors would reduce the dose of medication or stop them completely, depending on the level of blood glucose.
The person may need to follow strict dietary instructions on when, how and what to eat to maintain the lost weight. The recovery may take 3 to 4 weeks. Meanwhile, the person would have to undergo routine follow-ups.
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Understanding The Health Benefits And Risks Of Bariatric Surgery
Severe obesity is a chronic condition that, for many people, is difficult to treat with diet or exercise alone, and increases risks for type 2 diabetes, cardiovascular disease, fatty liver disease, and many other devastating health conditions. Bariatric surgical procedures, which restrict stomach size and/or alter the intestinal tract, have been increasingly performed to treat severe obesity when other interventions have not worked. Additionally, bariatric surgery is used in clinical practice for people who have milder levels of obesity along with type 2 diabetes or other serious obesity-related disease. These surgical procedures can have dramatic benefits such as significant and sustained weight loss, improved control of blood glucose levels, or even reversal of type 2 diabetesespecially when accompanied by exercise and a healthy diet. They also carry substantial risks, and researchers have been evaluating the benefits and risks of different procedures.
Scientists supported by the NIDDK and other organizations have been studying the risks and benefits of bariatric surgery, to help individuals with obesity and their doctors make more informed decisions. Additionally, research on the underlying mechanisms for the effects of bariatric surgical procedures could lead to the development of novel, non-surgical treatments that confer the benefits without the risks of surgery.
Bariatric Surgery And Type 1 Diabetes: Unanswered Questions
- 1Second Department of Internal Medicine, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- 2First Department of Propaedeutic Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Bariatric Surgery For Diabetes
Bariatric surgery refers to a group of surgical procedures that help a person lose weight by changing their digestive system.
These procedures typically make the stomach much smaller, which helps a person feel full sooner and eat less food overall. They also usually limit the ability of the small intestine to absorb calories from food.
Bariatric surgery can also affect certain hormones to reduce a persons appetite and improve how their body metabolizes fat and uses insulin.
Because the bodies of people with type 2 diabetes become resistant to insulin, bariatric surgery may be helpful for treating diabetes.
Some research suggests that bariatric surgery can help people with type 2 diabetes better control their blood sugar levels in addition to improving weight loss, cholesterol levels, blood pressure, and kidney function.
Healthcare professionals are increasingly recommending it for people with obesity and comorbid conditions such as heart disease and diabetes.
Several types of bariatric surgery can decrease the amount of food a person can eat at one time. Some procedures also reduce the absorption of nutrients.
The following sections will look at the different types of bariatric surgery in more detail.
Pathophysiology Of Weight Loss And T2dm Remission After Bariatric Surgery
Metabolic surgery is able to induce and maintain substantial weight loss through a variety of mechanisms, including caloric restriction as a result of the anatomical remodelling of the gastrointestinal tract, increased meal-induced thermogenesis, modulation of hypothalamic neuronal circuits involved in energy balance and appetite regulation, altered taste, food preferences and eating behaviour patterns, as well as altered gut-brain signalling pathways .
With regard to amelioration of the metabolic milieu leading to T2DM remission, the beneficial effects of metabolic surgery are mediated to a significant extent by two important factors the hypocaloric state due to profound caloric restriction, and the significant weight loss achieved. Studies involving patients with T2DM have demonstrated that caloric restriction to the extent observed during the first 10 to 20 days after RYGB has the same immediate effect on insulin sensitivity and blood glucose levels as surgery . However, there is no enhanced incretin effect with caloric restriction alone, and it is essentially impossible for people with obesity and diabetes to maintain this drastic restriction for a prolonged period of time.
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