Surgery, a better solution

For obese people, whose blood sugar levels are way out of control, bariatric surgery offers a new ray of hope. It can provide effective and long-lasting treatment for diabetes and obesity, explains Dr MG Bhat.

The twin epidemic, of type 2 diabetes and obesity, is emerging as a big public health challenge for India. There are over 65 million diabetics and 30 million pre-diabetics in the country. Obesity has also reached alarming proportions, with morbid obesity affecting five percent of India’s population. 

Both the conditions feed on each other and are a result of the modern, sedentary lifestyle, fuelled by a high-fat diet. These place extra stress on the human body and increase the risk of premature death. 

Diabetes can cause serious problems like heart disease, stroke, blindness, kidney failure and amputation. Obesity is associated with high blood pressure, diabetes, heart diseases, respiratory problems and certain types of cancer.

For obese people, whose blood sugar levels are way out of control, bariatric surgery offers a new ray of hope. The procedure is designed to make patients lose weight by making changes to their digestive system so that they eat less, and absorption of nutrients by the body is drastically reduced. It can provide a more effective and long-lasting treatment for diabetes and obesity than the standard therapies of drugs, diet and exercise. 

Research reveals that bariatric surgery can also keep diabetes at bay for many years and even reverse some of the health complications. The improvement in diabetes control is usually long-lasting, with normal insulin levels returning within days of the surgery, long before any significant weight-loss takes place. 

The National Institutes of Health (NIH) of the US Government has recognised bariatric surgery as the only effective treatment to combat severe obesity and maintain weight loss in the long term. It is recommended if the body mass index (BMI) is 36 or higher, or if it is more than 32 with uncontrolled diabetes. Bariatric surgery results in significant weight loss (up to 97 percent of the excess weight) that can be sustained over years. Only 10 percent of the patients gain excess weight after bariatric surgery compared to 98 percent who reduce weight through diet and exercise.

A study by Cleveland Clinic, published in September 2013 in the journal Annals of Surgery, showed beneficial long-term effects of bariatric surgery for people with diabetes. It discovered that obese patients with type 2 diabetes continue to experience the benefits of bariatric surgery up to nine years after the procedure. 

During this period, they continued to improve or reverse their diabetes, as well as lower their cardiovascular risk factors. The researchers identified long-term weight loss and a short duration of diabetes before surgery as among the main factors that resulted in higher rate of long-term diabetes remission. 

They concluded that bariatric surgery can offer durable remission of diabetes in some patients and should be considered as an earlier treatment option for patients having problems in controlling their diabetes.

It is heartening to know that the Government of India has recognised bariatric surgery and passed an order in November 2013, accepting reimbursements for bariatric surgery. Hopefully, in due course, health insurance will also cover it. 

(The writer is a consultant - laparoscopic and bariatric surgery - and medical director, Nova Medical Centers)