Is Weight-Loss Surgery for You? Pros and Cons


Last week I reviewed[1] the different types of bariatric surgery, along with the criteria for determining who is eligible. Surgery is never anything to enter into lightly, but bariatric surgery offers hope for millions of overweight and obese people who, for various reasons, are unable to lose enough weight to improve their health.

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Weight-loss surgery: A cure for diabetes?
We know that, right now, there’s no cure for diabetes (Type 1[2] or Type 2[3]). There are plenty of effective treatments for managing diabetes, including lifestyle and medication, but none of them are a cure. However, researchers are excited about bariatric surgery for Type 2 diabetes, as studies are now showing that it may lead to the remission of this condition.

Pretty much everyone with Type 2 diabetes who has bariatric surgery shows an improvement in their diabetes control, as evidenced by:

• Lowered blood glucose and A1C[4] levels

• A lowered dose of diabetes medicine

• Improvement in diabetes-related health issues, such as high blood pressure[5]

Why does this type of surgery work? Well, one of the obvious reasons is that it leads to weight loss. Weight loss decreases insulin resistance, allowing the body’s own insulin to do its job better. But even right after surgery, before the person has lost any weight, diabetes can improve. It’s thought that bypassing part of the gastrointestinal tract via gastric bypass surgery helps decrease insulin resistance. Another possible reason is that these bariatric procedures trigger gut hormones, such as glucagon-like peptide-1 (GLP-1), to stimulate the beta cells in the pancreas to release insulin in response to glucose. Many people who have bariatric surgery are able to completely get off their diabetes medicine before they’re discharged from the hospital.

How successful is bariatric surgery?
According to the American Society for Metabolic and Bariatric Surgery (ASMBS), more than 90% of people who have bariatric surgery are able to maintain a weight loss of 50% or more long-term. A review of more than 600 studies shows that surgery improves diabetes control in more than 85% of people who have it and leads to diabetes remission in 78% (the different types of bariatric procedures have different remission rates). Bariatric surgery may also lead to a longer life: In one study, the surgery led to an 89% greater reduction in mortality rate (number of deaths) compared to those who didn’t have the surgery.

Is there a downside to weight-loss surgery?
The thoughts of losing a lot of weight, getting off diabetes medicines, and living a longer life are certainly appealing. But before moving forward with this surgery, make sure you have all the facts and understand that there are some possible downsides.

Unrealistic expectations. Having the surgery doesn’t automatically mean that excess weight simply melts away. The amount of weight a person loses depends on a number of factors. In general, after gastric bypass, the average weight loss is about 61%; other procedures lead to about a 47% weight loss. Weight loss is hindered if one doesn’t follow the strict eating plan and exercise regularly, as prescribed. The pounds don’t necessarily melt off after surgery; the procedure helps, but you still need to follow an eating and exercise plan. On another note, you’ll need to be prepared for how your life might change if you do lose a lot of weight.

Side effects. Be prepared for possible side effects, such as constipation, dumping syndrome (in which consuming sugary foods and beverages leads to nausea, vomiting, and weakness), gallstones, wound infections, leaking in the connections made by the surgery, hernia, and even malnutrition. Not everyone gets these, but they can happen.

Eating plan. Immediately after surgery, you’ll be allowed just 2 to 3 ounces of fluid at a time. You’ll then move on to pureed foods, then soft foods, and then more solid foods. You’ll literally need to learn how to eat again, as you must eat small amounts, chew your food thoroughly, drink liquids separately from your meals, and strictly limit fatty and sugary foods. You will also need to take vitamin and mineral supplements. This eating plan is permanent, by the way.

Weight regain. It may seem hard to believe, but it’s possible to gain or regain weight after having bariatric surgery. This may happen for a number of reasons, including a return to old eating habits, a problem with the procedure, or a medical issue.

Obviously, bariatric surgery has its pros and cons. It’s not a decision to enter into lightly, so if you’re thinking about it, make sure you have a top-notch surgeon and medical team. Also, make sure that you have a support system in place. You can learn more about bariatric surgery and where to find a surgeon on the American Society for Metabolic and Bariatric Surgery’s website[6].

Endnotes:
  1. Last week I reviewed: http://www.diabetesselfmanagement.com/Blog/Amy-Campbell/is-weight-loss-surgery-for-you/
  2. Type 1: http://www.diabetesselfmanagement.com/articles/diabetes-definitions/type-1-diabetes
  3. Type 2: http://www.diabetesselfmanagement.com/articles/diabetes-definitions/type-2-diabetes
  4. A1C: http://www.diabetesselfmanagement.com/articles/diabetes-definitions/hba1c
  5. high blood pressure: http://www.diabetesselfmanagement.com/articles/diabetes-definitions/the-pressure-is-on
  6. American Society for Metabolic and Bariatric Surgery’s website: http://www.asmbs.org

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

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