Diabetes: Diabetes Remission In Obese Patients More Likely With Weight Loss Surgery?

By Laura Brooks on 01/25/2008
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This headline has been splashed all over the Internet and media.  But does this preliminary study take into account health risks associated with weight loss surgery or the percentage of patients who regain weight?

Weight Loss Surgery vs. Healthy Lifestyle Change

The results of an Australian study conducted by Dr John B Dixon and colleagues, of Monash University, Melbourne have been published in the January 23rd issue of the Journal of the American Medical Association (JAMA).

Over 2 years, a small test group of 60 patients, (55 of whom completed the study), gastric banding was compared to conventional diabetes treatment in people with type 2 diabetes.

Apparently, weight loss in the surgical group was responsible for a remission rate 5 times higher and a drop in blood sugar that was 4 times that found in the control group.

But What About The Long Term?

While researchers acknowledge that a larger, more diverse population and longer followups will be needed to confirm these results, they believe this study shows that "intensive weight loss" rather than "simple lifestyle change" is more effective when combating type 2 diabetes.

Will such a strategy really work in the long term?  Some people regain a significant amount of weight after a success gastric surgery, which would put them at risk for type 2 diabetes again. In addition, a good portion of obese patients who undergo surgery develop gallstones, nutritional deficiencies, have more serious complications due to the operation itself or will require a secondary surgery.

"After 10 years, only 1 out of 5 people have kept the weight off. A review of studies on stomach stapling (vertical banded gastroplasty) notes that 60% of excess weight (the weight above what is considered healthy) was lost, although a large portion of people regained the lost weight after 3 to 5 years.

About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis. And about 1 out of 5 people may need a second operation because the connection between the stomach and the intestines narrows (stomal stenosis), leading to nausea and vomiting, or because of an increase of gastroesophageal reflux after eating." (WebMD)

While surgical weight loss for obese patients with type 2 diabetes may be greater than healthy lifestyle changes in the short term, so are the risks.  Traditionally, surgery has been recommended for the morbidly obese only after conservative measures such as diet, exercise, and medication have failed. With America’s growing obesity problem, I hope this and other similar studies won’t pressure patients into ‘bypassing’ careful consideration before undergoing weight loss surgery.

4 Responses (Add Yours)

  • Ourdia says:

    I really wish that overweight and obese people who suffer from diabetes could permanently lose their excess weight, maintain a healthy weight and reverse their medical condition after gastric surgery or drastic temporary healthstyle changes. Unfortunately, this does not happen. Studies show again and again that only permanent lifestyle changes can have these results in the long run. Why is it that we live for years with unhealthy habits and expect drastic changes overnight in our health and appearance after a surgery or a few days of watching our diet? Unless you are morbidally obese, gastric surgery is going to be effective in the long term ONLY if you make those lifestyle changes as well. The best path to a healthy life, healthy weight and reversing diebetes is to make small, steady changes that you can stick to. What if it takes a whole year or even two to reach your dream weight and be healthy in the process? Is that so bad if it means you don’t have to have surgery? This year or these two years will come to pass regardless of what you do, and going slowly but surely down the path of slow weight loss will bring the result you seek. How many people do you know who underwent gastric surgery or went on a quick weight loss program and reached and maintained their goal? Me neither.

  • laura says:

    Thanks for the great comment, Ourdia! It’s seems to be human nature to want the “quick fix,” but the more we try and fail at what are fundamentally only short-term external solutions, the more frustrated and desparate we become. If we can first make peace with our bodies and a deep commitment to our health – instead of just ‘being thin’ – it’s easier to be patient for results.

  • Margaret says:

    I am 44, and was diagnosed with type 2 diabetes 4 years ago. In the past year and a half I have successfully lost 30% of my body weight (from 220 to 155) through diet and exercise, and have gone into full remission. My blood glucose levels are well within the normal range and I no longer take medication.

    I personally believe that diet and exercise are the best “cure” for type 2 diabetes, but it has taken an enormous amount of energy and time to lose the weight: 4-6 hour long sessions at the gym weekly and 8-10 miles of walking every day, as well as very strict adherence to a controlled carbohydrate, low fat, low-glycemic high fiber food plan. No sweets or artificial sweeteners at all. And I will have to stick with an equally rigorous exercise and food plan to be able to maintain the weight loss.

    Not everyone who has diabetes is in good enough health or has the internal or external resources in their life to be able to make these kinds of changes, and for those folks surgery may be a better option. But I am also frustrated with the fact that few people with diabetes receive the intensive, long-term support and lifestyle change counseling they need to be successful at weight loss through diet and exercise. Unfortunately many diabetes health care providers assume their patients will not be successful at making changes and don’t advocate for achieving stricter glycemic and weight control (e.g. it’s OK to eat some sweets). Also, some of the dieticians I have encountered don’t really understand enough about diabetes themselves to be able to give their patients an effective road map to success. The diabetes education I received through a major metropolitan hospital system was quite poor in that regard.

    Until people with diabetes (and more generally, people trying to lose weight) get better information and effective support, I think long-term change will be out of reach of many.

  • laura says:

    Hi Margaret,

    I agree with you that more long-term support should be readily available for more diabetes patients.

    In the meantime, I encourage people to find a local support group, walking group, online communities, and other free programs that may be offered locally.

    It takes some work (and sometimes courage) to find and join these groups, but they can be highly effective in making long-term lifestyle changes.

    The good news is that even obese diabetic patients who lose twenty percent of their body weight can achieve significant health benefits, decreased risk of complications from diabetes, or even reversal of the disease in some cases.

    The bombardment of “quick fix” promises in the media make sticking to a life-long commitment much more difficult. Finding – or even creating – a support network can make all the difference for long term success.

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