June 5, 2013
Weight-loss surgery can help to control diabetes better than diet and exercise alone in people with mild to moderate obesity, a new study finds. The study focused on 120 people with diabetes. They were about 50 to 70 pounds overweight. Weight-loss surgery usually is used for people who are at least 100 pounds overweight. Less obese people also may qualify if they have weight-related conditions, such as diabetes. The new study randomly divided people into 2 groups. Both groups got an intensive diet and exercise program. One group also received gastric bypass surgery. In the next year, people in the surgery group lost an average of almost 60 pounds. In the non-surgery group, weight loss averaged 17 pounds. About 75% of the surgery group and 30% of the other group reduced blood sugar levels to normal or near normal. About 6% had serious problems as a result of surgery. These included infections, intestinal blockages and bleeding. One person died of surgery complications. The Journal of the American Medical Association published the study. The Associated Press wrote about it June 5.
By Reena L. Pande, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Diabetes greatly increases a person's risk of heart and blood vessel disease. It also can lead to eye problems, kidney disease, nerve damage and other medical issues. As the obesity epidemic rages in the United States, the number of people with diabetes continues to increase.
Treatment for diabetes includes medicines, such as pills or injections of insulin. But lifestyle changes, such as weight loss, are really the cornerstone of treatment. There is good research to show that losing weight can improve diabetes control. But lifestyle changes are very hard to maintain. For the right person, a more invasive approach, such as gastric bypass surgery, may be the most effective way to lose weight.
Most weight-loss surgeries reduce the size of the stomach and slow digestion. In gastric bypass surgery, doctors actually create a bypass around the stomach. This reduces the size of the stomach so that it holds less food.
A newly published study looked at the effects of gastric bypass on diabetes control and other factors that increase the risk of heart disease. In the study, 120 obese adults with diabetes went through either gastric bypass surgery or intensive lifestyle changes.
During the 12-month study period, those who had gastric bypass achieved greater weight loss. They lost 26% of body weight, compared with 8% body weight loss in the lifestyle group. People who had surgery needed fewer medicines to control diabetes. In the end, their diabetes was under better control. These major benefits were largely the result of greater weight loss in the surgery group.
There are many theories as to why gastric bypass surgery helps to control diabetes. One of the benefits comes from actual weight loss. Some people lose 50 to 100 pounds or more. Gastric bypass may also change the levels of certain hormones released from the stomach that have an effect on how the body manages weight.
What Changes Can I Make Now?
The first step is to find out whether you have diabetes. Some of the symptoms of diabetes include:
Diabetes can be diagnosed with a simple blood sugar test. One test requires fasting. You must not eat anything for 8 hours or more before the test. With this test, a blood sugar of 126 milligrams per deciliter (mg/dL) or more suggests diabetes. With a non-fasting test, a normal sugar level is less than 200 mg/dL.
Treatment of diabetes can include any or all of the following:
While it may sound like a good solution, it's important to remember that gastric bypass surgery isn't for everyone. As with all surgeries, there are risks and side effects. Not everyone qualifies. Factors that should be considered include:
It's important to remember that weight-loss surgery is only one part of the solution. It is still important to make changes in diet and exercise that allow you to live a healthy life.
What Can I Expect Looking to the Future?
There are risks and benefits to all medical treatments. Research suggests that weight-loss surgery does result in major weight loss and can help control diabetes. This is balanced by cost and the risks of undergoing major surgery.
Future studies are needed to better understand which people with diabetes or other conditions are likely to benefit most from weight-loss surgery. Major lifestyle changes are critical. For some people, the addition of weight-loss surgery may be the right way to go to achieve better health.
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