Type 2 Diabetes- Weight Loss Surgery Should NOT be the Last Option

“Assessing The Obese Diabetic patient For Bariatric Surgery: Which Candidate Do I Choose?”

 

So, you are diabetic and obese, the time has come to that stage where you are looking for weight loss options; whether it is surgical or non-surgical. While many people who are obese and diabetic do not consider weight loss to be their first option, it is now becoming a fact that “for diabetic morbidly obese patients, surgery should not be considered as the last option but as an appropriate treatment”.

 

One such paper that researched this area concluded, “it is clear that bariatric-metabolic surgery is an effective treatment for type 2 diabetes when compared with non-surgical medical treatment”. In conclusion, the research found that in the surgical group, there had been a 63.5% remission rate compared to only 15.6% in the non-surgical group.

 

While a variety of factors would need to be taken into account when assessing whether surgery is a viable option, such as patient-risk factors and surgical factors, it is clear that weight loss surgery has an effective impact on type-2 diabetes. The authors of the research paper state those who fail with the non-surgical options remain morbid and obese and their diabetes unaffected.

 

So what are your options? On one hand, non-surgical options have their draws, however, on the other hand, bariatric surgery should not be considered as the last resort for obese patients. The surgery can have a significant impact on weight loss and type-2 diabetes. In fact Professor Michel Gagner, Professor of Surgery, Herbert Wertheim School of Medicine, stated that bariatric or metabolic surgery “should be performed as a mass treatment as a means of treating millions of patients with diabetes and other metabolic diseases”.

 

Multiple studies have examined the efficacy of lifestyle intervention and have found very little positive effects or benefit in regards to type-2 diabetes. Ideally a risk stratification should be provided to identify pre-diabetes conditions in obese subjects in order to identify high risk individuals to potentially prevent the occurrence of type 2 diabetes and its related systemic complications. In an ideal world prevention would be better than solutions for a cure but until we seriously address our lifestyle surgery will still remain an appropriate treatment for obese diabetic patients.

 

Diabetes Metab Syndr Obes. 2015; 8: 255–262.

Published online 2015 Jun 8. doi:  10.2147/DMSO.S50659

 

Authors: M.Rafaelli, L.Sessa, G.Mingrone & R.Bellantone

 

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Threat Of Type 2 Diabetes in Children

Obese Toddler Diagnosed With Lifestyle Related Diabetes

 

It is shocking to hear in the media today that our children, the future generation are at threat of developing what was considered a midlife disease in type 2 diabetes.

 

An obese toddler from the US who weighs the same as an average 11-year-old has been diagnosed with lifestyle-related diabetes.

The three-year-old girl is one of the youngest people ever to have the type-2 form of the condition, according to her doctor.

Dr Michael Yafi, from Houston in Texas, said that when he made the diagnosis the anonymous girl tipped the scales at 35kg (5st 7lb).The family had “poor nutritional habits, with uncontrolled counting of calories and fat”. Both parents were obese, but there was no family history of diabetes. Her parents were told to control her food portion sizes, count calories and increase the amount of exercise she did plus she was given the drug metformin to bring her blood sugar under control.

Six months later the girl had lost 9kg (1st 7lb) and her blood sugar levels were within the healthy range.

Dr Yafi said the growing obesity epidemic meant doctors should be alert to lifestyle-related diabetes even in young children. “Reversal of type-2 diabetes in children is possible by early screening of obese children, early diagnosis, appropriate therapy and lifestyle modification,” he said.

Fifteen years ago it was rare even for an adolescent to have type 2 diabetes as it was thought to be a mid-life disease. This highlights how important it is that children get a healthy start to life, which includes a healthy diet and regular exercise.

The obesity epidemic and childhood obesity has now taken over as the biggest health challenge of our time.

Complications and Re-hospitalisation After Gastric Bypass Surgery

Prevalence of Self-reported Symptoms After Gastric Bypass Surgery

 Importance:

Population-based studies on the prevalence of symptoms after Roux-en-Y gastric bypass (RYGB) surgery are sparse. Knowledge about possible predictors of these symptoms is important for further prevention.

Objectives:

The study looked to examine patients’ overall well-being and the prevalence and predictors of medical, nutritional, and surgical symptoms after RYGB surgery, and their association with quality of life.

Design, Setting, and Participants:

A survey was conducted from March 3 to July 31, 2014, among 2238 patients who underwent RYGB surgery between January 1, 2006, and December 31, 2011, in the Central Denmark Region. A comparison group of 89 individuals who were matched with patients according to sex and body mass index but who did not undergo RYGB surgery were surveyed as a point of reference. Data analysis was conducted from September 1, 2014, to June 25, 2015.

Main Outcomes and Measures:

Prevalence and severity (based on contacts with health care system, ranging from no contact to hospitalization) of self-reported symptoms following RYGB surgery. Prevalence ratios of symptoms associated with different predictors were computed. The association between number of symptoms and quality of life was investigated using the Spearman rank correlation coefficient.

Results:

Of 2238 patients undergoing RYGB surgery, 1429 (63.7%) responded to the survey. Among these patients, 1266 (88.6%) reported 1 or more symptoms a median of 4.7 years after RYGB surgery.

Mean age at the time of the survey was 47.1 years (range, 26.9-68.0 years), and 286 were men (20.0%).

A total of 1219 of 1394 patients (87.4%) reported that their well-being was improved after versus before RYGB surgery, while 113 (8.1%) reported reduced well-being.

Symptoms after RYGB surgery were reported by 1266 patients (88.6%); 966 patients (67.6%) had been in contact with the health care system about their symptoms vs 31 [34.8%] of those in the comparison group, and 416 (29.1%) had been hospitalized vs 6 [6.7%] of those in the comparison group.

The symptoms most commonly leading to health care contact after RYGB surgery were abdominal pain (489 [34.2%]), fatigue (488 [34.1%]), and anaemia (396 [27.7%]).

The risk of symptoms was higher among women, patients younger than 35 years, smokers, unemployed persons, and in those with surgical symptoms before RYGB surgery. Quality of life was inversely associated with the number of symptoms.

Conclusions:

Most patients reported improved well-being after RYGB surgery, but the prevalence of symptoms was high and nearly one-third of patients were hospitalized, 4- to 5-fold more than among the comparison group. Predictors of symptoms included young age, female sex, smoking, and experiencing symptoms before RYGB surgery. Development of weight loss procedures with fewer subsequent symptoms should be a high priority.

JAMA Surg:  Published online January 06, 2016. doi:10.1001/jamasurg.2015.5110

Authors: Sigrid Bjerge Gribsholt, MD; Ane Mathilde Pedersen, MD; Elisabeth Svensson, PhD; Reimar Wernich Thomsen, PhD; Bjørn Richelsen, DMSc

Not Too Old For Weight Loss Surgery!

Not Quite Over The Hill Yet!

It has long been a controversial topic of whether it is indeed safe and effective for people over the age of 60 to undergo surgery, particularly in the form of laparoscopic gastric banding. In many countries, it is a well-established statistic that a significant portion of the over 60 population are obese. In Australia alone, it was established that 20% of people aged over 60 are obese. Thus it has become a pressing question as to the effectiveness and safety of gastric banding, especially when one considers that obesity contributes to sleep apnoea, arthritis, urinary incontinence and several types of cancer, to name but a few.

old-people

In order to answer this question, a clinical research paper took 113 patients over 60 years of age and followed them for a period of 9 years, reporting on changes in their quality-of-life and any complications and changes in obesity. The results of the research paper produced hope for the elderly and set the framework for encouraging those who are overweight and over 60 to use the gastric band.

 

Not only were there no fatal complications, but there was no gastric band related complication that could not be solved. Moreover, over the years there was a large improvement in mental health, with the increase in mental health being over the population norm. Outlook on life and depression had changed over time and the number of patients on anti-depressants dropped by a relatively significant percentage.

 

Before the gastric band was placed, back and lower limb pain were common ailments in this group of people and by the end of the study, back pain was better or much better in nearly half of all the patients and there was also an improvement in hip/knee pain.

 

Of the diabetics within the group, 74.2% reported an improvement in their condition, with 43.8% of diabetics using less diabetic medications. In addition, half of affected patients reported improvement in their hypertension, sleep apneal or other respiratory condition.

 

By the end of the study, all the patients were asked whether they would recommend the gastric band to other obese patients over 60, to which 92.1% said ‘yes’.

 

The conclusion drawn from this research is that gastric banding in obese patients over 60 can markedly improve quality of life in each of physical, mental, emotional and social contexts. The procedure was classified as safe and well tolerated in this age group and lead to improvements in medical co-morbidities.

 

So, if you are over 60 years old and are considering weight loss surgery, keep in mind that the researchers stated that gastric banding is the most appropriate bariatric procedure for your age group due to its inherent safety and efficacy.

 

REF: OBES SURG (2011) 21:10-17

DOI 10.1007/s11695-010-0158-3

Authors:

Anthony Clough

Laurent Layani

Abha Shah

Lucas Wheatley

Craig Taylor

Changes in Depression Post Gastric Band: A Possible Cure?

Overweight and Feeling Fed Up? Chase away the blues with gastric banding, a cure?

DepressedIn the past, the long-term effects and consequences on depression that weight loss surgery has, has been unclear. In particular, there was no evidence of how gastric banding would impact on patients’ suffering from depression and insecurity. However, all of this has been changed by a landmark study published in the Obesity Surgery Journal.

 

The researchers took 248 morbidly obese patients “seeking gastric banding” and asked them to complete questionnaires for “symptoms of depression and self-acceptance. Of this number, 128 patients were treated with gastric banding and 120 were not.”  As was expected, the patients who were morbidly obese were suffering from more of the clinical symptoms of depression than the average for the rest of the population. After 5 to 7 years, the scientists and psychologists reassessed the patients who had gastric banding and those who had not.

 

The results were astounding. After 5 to 7 years, not only had the patients who had gastric banding lost more weight, but they had “improved significantly in depression and self-acceptance”. However, when compared to the patients who had not received the gastric band, there had been very little, if any, development in their depression levels.

 

What the study also found was that the symptoms were most alleviated when the patient lived together with a partner and was therefore not alone, and had a high pre-operative depression score.

 

While the researchers admitted that the results are not conclusive proof of the causal link between obesity and depression, the improvement in “psychological variables was because of the considerable weight loss. The treatment for being overweight was associated with an improvement in depression”.

 

After much success, the researchers concluded, “morbid obesity is associated with depressive symptoms and low self-acceptance. Gastric banding results in both long-term weight loss and improvement in depression and self-acceptance” and that even after 5 to 7 years, “the weight loss achieved by surgery was associated with a greater reduction in depressive symptoms and an increase in self-acceptance”.

 

REF: OBES SURG (2008) 18:314-320

DOI 10.1007/s11695-007-9316-7

Authors:

  • Marion Schowalter
  • Andrea Benecke
  • Caroline Lager
  • Johannes Heimbucher
  • Marco Bueter
  • Andreas Thalheimer
  • Martin Fein
  • Matthias Richard
  • Hermann Faller

 

Love Life Spiced Up After Weight Loss Surgery!

Success of Surgery Depends On Patients’ Support Network

 

According to a recent study published in the Obesity Surgery journal which looked at patients success after surgery and titled “Following Bariatric Surgery: An Exploration of the Couples’ Experience” they discovered that the surgery can lead to greater intimacy between couples.

 

The study by Mary Lisa Pories and colleagues from East Carolina University is thought to be the first on obesity’s impact on relationships since 2000. The research team interviewed 10 couples about how surgery had affected the partners and all of the patients with their significant others viewed the surgery itself and lifestyle adjustments afterwards to be part of a team effort. They highlighted ways in which the partners supported and helped the patients’ care for themselves and stayed on track with the new routine.

 

Other themes that emerged included the adjustment that was needed to adapt to the partners significant weight loss. The couples found that they had more energy and needed to both adjust to new eating habits. On an emotional level the couples reported more positive moods and increased self-esteem. They also reported sharing greater intimacy and affection and being able to resolve conflict. Their sexual relationships also improved and in many cases became more enjoyable!

 

Mary Lisa Pories believes that a better understanding of how weight loss surgery impacts the dynamics of a couple’s relationship could help multi-disciplinary teams support patients and their partners more effectively. “This research provides greater insight into the experience of the couple than has been previously reported” the author concluded and that “All of the couples felt their post-operative success was due to a joint effort on the part of both members of the couple”

 

Reference: OBES SURG DOI 10;1007/s11695-015-1720-9

Authors: Mary Lisa Pories, Jennifer Hodgson, Mary Ann Rose, John Pender, Natalia Sira and Melvin Swanson