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Diabetes And Bariatric Surgery

ManipalHospitals • December 13, 20170 Comment

Overweight and obesity, as we know, is a huge problem worldwide. More and more people of all ages are now obese or overweight all over the world. Obesity affects people of all ages and all socio-economic groups. Apart from the physical problems that obesity brings with it, there are a number of medical problems that occur which lead to the decrease in quality of life and ultimately reduced life-span. There are a number of things that are misunderstood about obesity. These misconceptions are a big hurdle preventing people from getting help for their problem. Unfortunately, many doctors also have the same misconceptions about obesity which prevents them from giving the right advice to their obese patients. The first and biggest misconception is that obesity is entirely the fault of the person affected. The truth is quite the opposite. Obesity is a disease just like any other disease like high blood pressure, gallbladder stones or uterine fibroids etc. In fact, WHO has officially classified it as a disease for many years now. What we need to understand is that our weight, normal or high, is tightly controlled by our body hormones. That is why most people will maintain the same weight for years together. People who are affected by this disease have a genetic propensity for obesity.

Then there are environmental triggers like stress, disordered sleep or untimely meals, pregnancy, aging and many drugs or medicines which act upon the patient and cause them to gain weight. Once the weight gain happens, the fat cells itself act like a hormone secreting organ and sustain obesity. By this time the hormones are so deranged that the body “thinks” that the new higher weight is normal and it tries to maintain it at all costs. Obesity can be prevented “before” it starts, but once established it is like any other chronic disease. It needs treatment. The second misunderstanding is that everybody can lose weight if he or she tries hard enough. Once we understand that obesity and overweight are a result of severe hormonal disturbances, we will realize that reducing weight is not a simple arithmetic of calories in and calories out. It is true that diet modification, exercise, and medicines can help in weight reduction. But the total weight loss is only modest in most of the patients, usually only 10-15%. For somebody who is only 10-15 kg overweight, this is more than enough and nothing more needs to be done.

These patients can lose this extra weight and also maintain it if they follow the same lifestyle. For somebody who needs to lose a lot more weight, say 40-50 kg or more, this approach, which is called medical management, will give very poor results. This is because in these patients the hormonal disturbance is more severe. Hence these patients need something else. They need Bariatric Surgery. The third thing that we need to understand is that obesity gives rise to many other medical problems or disease. The main diseases that are a direct result of obesity and the hormonal disturbances associated with it are Type 2 Diabetes Mellitus, High Cholesterol, High BP, Sleep Apnea and excessive snoring, Fatty Liver and later on cirrhosis, PCOD, and Infertility, Knee and Back problems, to name a few. We also need to understand that when obesity is treated, these diseases also become better, and in a large majority of the patients, disappear. Diabetes is one big example. Diabetes just disappears in a large majority of obese patients who are treated with Bariatric Surgery. In fact, the need for medicines and insulin for controlling blood sugar goes down in the first few days after surgery. Even before significant weight loss occurs. And in appropriate patients, the benefit is long lasting - more than 10-15 years. In fact, there is a large body of research which has shown that for achieving a good control of diabetes. Bariatric Surgery is much better than optimum medical treatment and intensive lifestyle modification under professional supervision. The effect of Surgery on diabetes, that is complete stoppage or marked reduction in medications for diabetes, lasts for more than 10-15 years. Similarly, Sleep Apnea or OSA is completely cured in 95% of patients after Bariatric Surgery. In fact, most patients see improvement in a week after the operation. In the same way, High BP, High Cholesterol, PCOD and all the other problems improve after Surgery and the effect is sustained.

Last but not the least, it is widely believed that this surgery is extremely complex and risky. Well, any operation carries a certain amount of risk, no matter how small it is. Part of the risk is related to anesthesia and the patient’s medical problems. The other part is related to the operation itself. Bariatric surgery, if done in a well-equipped center by a good surgeon, is extremely safe. In fact, it is as safe as surgery for a hernia or gall-bladder or a hysterectomy. The anesthesia risk is mostly due to the patient’s weight and other diseases like diabetes, sleep apnea etc. Actually, this surgery will benefit these very patients the most. Patients who have diabetes or sleep apnea or other problems due to their obesity are the ones who need this operation the most and they are the ones who will have the best results. In conclusion, it is very important to understand that obesity is not a self-afflicted condition and the affected person is not to blame. It is a complex disease just like any other chronic disease and the reason is hormonal disturbances. There is ample proof of this.Also, obesity leads to a number of diseases like diabetes, sleep apnea, PCOS etc. Mild overweight and obesity can be effectively managed with diet and lifestyle modifications alone if maintained for a long period of time. But severe obesity, especially with other diseases like Diabetes, OSA, High BP, PCOD etc. is better and more effectively managed with Bariatric Surgery. In fact, all the scientific bodies dealing with guidelines about treating diabetes now recommend that Bariatric Surgery should be considered early for the treatment of diabetes in appropriate patients because it gives better short and long-term results than lifestyle modification and optimum medicines, including insulin. Moreover, effective treatment of obesity by Bariatric surgery leads to dramatic improvement of all these diseases, often even before there is sizeable weight loss. This ultimately leads to massive improvement in the quality of life and, in the long-term, increase in lifespan by 5-10 years.

Dr. Sumit Talwar,
Chairman of Bariatric Surgery Dept.

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