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

Posted Oct 01 2008 4:31pm
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.
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