Weight Loss Surgery Prevents Diabetes

It is well-recognized that obesity is a significant risk factor for the development of type II diabetes, and that weight loss surgery is an effective treatment. Newly published research in the New England Journal of Medicine suggests that bariatric surgery can also help to prevent the development of diabetes in non-diabetic obese patients. Patients who underwent gastric banding, gastric bypass or vertical banded gastroplasty were followed over 15 years, and their incidence of diabetes was compared with patients who did not have surgery. Surgical patients were about 80% less likely to develop diabetes. Gastric banding was as effective as gastric bypass in helping to prevent diabetes.

Drs. Keith Wright and Gerardo Carcamo, with South Texas Surgeons in San Antonio, are available for consultation to discuss these exciting results and to help you determine if weight loss surgery is right for you.

Lap-band VS Gastric Bypass For Diabetes Treatment

Research recently presented at the annual meeting of the American Association of Clinical Endocrinologists demonstrated efficacy in laparoscopic adjustable gastric banding as an option for obtaining long-term weight loss, and as an effective treatment in obese individuals with type 2 diabetes. Compared to patients who had the gastric bypass, Lap-band patients had more gradual weight loss, maintained more muscle mass, and better preserved their basal metabolic rate. This suggests that Lap-band patients may have an improved ability to maintain their weight loss over the long term. Another advantage the Lap-band may have over the gastric bypass is that the FDA has approved the procedure for diabetic patients with a body mass index (BMI) as low as 30. These patients are not generally referred for the gastric bypass. Drs. Keith Wright and Gerardo Carcamo with South Texas Surgeons are available for consultation to further discuss this research in more detail, and to help you decide if weight loss surgery is right for you.

Lap-band And Diabetes

An estimated 25.8 million people in the United States have type 2 diabetes, according to the American Diabetes Association. As astonishing as the figure is, experts predict that a diabetes epidemic is looming, fueled in part by swelling obesity rates. Obesity has long been associated with the development of type 2 diabetes, which is caused by the body gradually losing its ability to use insulin properly to convert blood sugar into fuel. Research has shown that weight loss surgery (gastric bypass and Lap-band) is an effective treatment for obese patients with diabetes, with two recent studies demonstrating the effectiveness of surgery published in the New England Journal of Medicine earlier this year. Most recently, a 2 year interim report of the on-going 5 year APEX study demonstrated that the Lap-Band is highly effective in treating diabetes. Over 95 percent of the patients in the study saw improvement in their glucose control. Specifically, 48.5 percent of the patients were able to stop taking their oral diabetes medication, and another 47 percent were able to reduce their diabetes medication following surgery. Only 4.5 percent of the patients had no improvement in glucose control and they were the patients that had diabetes for the longest period of time and also shed less weight, on average, than the "remission group".

Findings such as these are encouraging, as we face growing rates of diabetes. While diet and weight loss are foundational to diabetes management, lifestyle recommendations are often difficult to achieve and sustain. Weight loss surgery, such as gastric banding, combined with healthy food and diet can allow you the ability to achieve your weight loss needs and improve diabetes.

Drs. Keith Wright and Gerardo Carcamo with South Texas Surgeons are available for consultation to discuss these findings in more detail to help you decide if the Lap-Band is right for you.

Gastric Bypass VS Gastric Banding

A recent publication in the January 2012 edition of Archives of Surgery directly compared patients who underwent gastric bypass surgery with those who had gastric banding (either the Lapband or the Swedish band, known in the US as the Realize band).  They concluded that both procedures were safe, and yielded good long-term weight loss after 6 years.  They also stated that the weight loss following gastric bypass was superior to gastric banding.  I would like to discuss these conclusions as they relate to actual weight loss, safety, and cost.  

Long-term excess weight loss 6 years after surgery was reported as 78.5% for the bypass vs. 64.8% for gastric banding.  While significant statistically, it is important to note that this amounts to only a 10-20 pound difference over the 6 year period.  The question that patients and surgeons alike have to answer is, “What increased risk am I willing to accept for an additional 10-20 pounds?”

 In this study, short-term complications were higher with the bypass, and long-term complications were higher with the gastric band.  Of note, the Lapband device and surgical technique reported by the authors would be considered old technology today in the U.S.  With the introduction of the Lapband AP System and better surgical techniques, the complication rates with the Lapband have decreased even further today.  For instance, the band erosion rate reported in the 253 Swiss patients was 7.7%, while our erosion rate for over 4000 patients here at South Texas Surgeons is less than 0.5%.  In addition, most Lapband complications can be readily handled in an elective, outpatient setting.

 Cost is always an important consideration for patients looking into weight loss surgery.  The Lapband is frequently performed as an outpatient procedure, with very little time lost from work.  Although insurance premiums continue to increase for many Americans, benefits for weight loss surgery are frequently difficult to obtain or interpret.  Even when benefits are available, high deductibles and other insurance requirements are significant roadblocks for surgery.  We are very sensitive to this at South Texas Surgeons, and work hard to keep patient costs to a minimum.  We do our best to work with all insurance plans, and offer the Lapband with an inclusive follow-up period for under $10,000 in order to make this life-changing procedure financially feasible for patients without insurance coverage.

 In summary, the Lapband offers good long-term weight loss that closely compares to that of the gastric bypass.  By increasing safety and decreasing costs (both direct costs and decreased time lost from work for recovery), the Lapband offers a compelling alternative to more invasive surgery.

Weight Loss Surgery Patients 30% Less Likely To Suffer A Heart Attack

It has been shown that shedding excess body weight can significantly improve health and even reduce or resolve many health conditions associated with obesity. At South Texas Surgeons, we offer affordable and effective surgical weight loss options, such as the Lap Band and Realize Band, to facilitate our patients in living healthier lives. Recently, a long-term Swedish study demonstrated another health benefit of bariatric surgery; the study found that obese people who had weight loss surgery were less likely to later suffer a heart attack or stroke--or to die from one--compared to obese people who were treated without surgery. The study evaluated about 4000 obese people treated at hundreds of heath care facilities in Sweden from 1987--2001. During this time-frame, half of the people received bariatric surgery, while the other half was treated with routine care, which included guidance on making healthy lifestyle changes. The researchers followed the patients for an average of 10 years. When they accounted for the initial health differences between people who did and did not get surgery, they found that in the years following surgery, patients were about 30 percent less likely to have a first-time heart attack or stroke than non-surgery patients, and half as likely to die from one. Additionally, those who received surgery lost an average of 16 percent of their starting weight over the 15 years following the procedure, while the control group didn't consistently lose or gain weight over time.

The study did not find a significant relationship between cardiovascular events and the degree of weight change in the surgery or control group. One theory is that bariatric surgery has health benefits that are independent of the amount of weight lost, such as improvements in diabetes, which could decrease heart risks. These findings highlight that there are several benefits of weight loss surgery, some of which are independent of the degree of the surgically induced weight loss.

At South Texas Surgeons, we provide a complete and multidisciplinary approach to the surgical care of our patients. You can visit our website to learn more about our program or sign up to attend one of our free seminars.