Obesity surgery to tame diabetes

Scientists in recent years have discovered that diabetes all but disappears in some obese patients soon after the operation. Many were able to achieve normal blood sugar and ditch their medications.

Stretching the rules
But does the benefit extend to diabetics who are not quite as hefty? Performing surgery on the not-as-obese with the goal of reversing diabetes is provocative. Laboni's surgeon is one of a handful of doctors around the world stretching the rules to see if the weight loss operation helps.

Laboni had gastric bypass surgery last fall at New York-Presbyterian/Weill Cornell Medical Center as part of a study. In gastric bypass or stomach stapling surgery, the stomach is reduced to a thumb-sized pouch that holds less food.

Now 50 pounds lighter, she has stopped taking diabetes medications. Her blood sugar is almost normal.

“I didn’t care if I lost any weight. I just wanted the diabetes to go away,'” said the 45-year-old Connecticut mother of two teenagers.

The twin epidemics of obesity and diabetes are fueling an international public health threat. In the United States, one out of five people with obesity - linked Type 2 diabetes are morbidly obese.

Surgery is generally a last resort after traditional ways to shed the pounds — such as diet and exercise — fail. Even so, there are strict rules for who can go under the knife.
Federal guidelines say surgery candidates must be morbidly obese with a body mass index over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure. Insurers use the cutoffs in deciding whether to pay for the procedure.

BMI is a calculation of height and weight used to estimate body fat. Overweight begins at a measurement of 25, obese at 30 and morbidly obese at 40. A 5-foot-6 person is considered overweight at 155 pounds, obese at 186 pounds and morbidly obese at 248 pounds. The current BMI limits for obesity surgery were set by the National Institutes of Health in 1991.

Philip Schauer of the Cleveland Clinic is among those pushing the BMI envelope. For a study, he’s recruiting 150 overweight and obese Type 2 diabetics with BMIs between 27 and 43. Some will have surgery and their progress will be compared to those who manage their diabetes with medicine. The goal is to see which group can achieve complete remission.

Smaller studies have hinted that stomach stapling and gastric banding — in which an adjustable ring is placed over the top of the stomach to create a small pouch — may work in diabetics who aren’t so fat.