For years, Katy Wiley refused to be photographed. At 5 foot 2 and 210 pounds, she "just wanted to hide." She'd failed at losing weight and controlling her type 2 diabetes with diet and exercise, and even her daily regimen of insulin and Metformin didn't keep her blood sugar levels from being "all over the place." But all that changed after Wiley underwent gastric bypass surgery in 2009. Now 44, she is 75 pounds lighter and no longer requires any medication to control her diabetes, which is in remission. "Now I can’t stay out of photos!" says Wiley gleefully.
Weight-loss, or bariatric, surgery has indeed proved to be something of a miracle for overweight people with type 2 diabetes, resulting in major pound-shedding and, in some cases, critical metabolic changes that almost instantly restore blood sugar levels to normal, allowing patients to toss their meds. One recent study found that 89 percent of participants who underwent gastric bypass experienced complete remission of their diabetes; 57 percent of those remained in remission five years later.
Although surgery may seem like a magic bullet, it is not a decision to be made lightly. Bariatric procedures result in permanent alterations to your digestive system and also require long-term diet and lifestyle changes.
Know Your Weight Loss Surgery Options
The two most commonly performed weight-loss operations in the U.S. are gastric bypass surgery and adjustable gastric banding, also known as "lap-banding." In bypass surgery, the stomach is reduced by over 90 percent to a thumb-size pouch to restrict the amount of food you can comfortably ingest. The pouch is then attached to the lower portion of the small intestine, bypassing most of the stomach as well as about four feet of the small intestine, lowering the number of calories absorbed.
In lap-banding, an adjustable fluid-filled belt is wrapped around the stomach to form a small upper pouch that receives food from the esophagus and a larger lower pouch that drains into the small intestine.
Gastric bypass is safe and effective and is emerging as the preferred option for people with inadequately controlled type 2 diabetes, says Philip Schauer, M.D., director of the Bariatric and Metabolic Institute at the Cleveland Clinic. This is largely due to the metabolic effect that occurs when food bypasses a section of the small intestine. "Bypass surgery stimulates a number of important hormones in the gut that increase the pancreas' production of insulin," says Dr. Schauer. "We often see very dramatic improvements in blood sugar levels in a matter of days post-surgery, before weight loss has occurred."
A study that compared the effectiveness of the two surgeries found that people who underwent gastric bypass lost an average of 64 percent of their excess body weight over a year, while those who had banding surgery lost 36 percent. Three-fourths of people with diabetes who had bypass either had complete remission of their disease or required significantly less medication to keep it under control. (Remission is more likely for those who’ve had diabetes for five years or less than for those who've had it for more than 10.) One-half of participants who opted for banding had comparable results.
Is Bariatric Surgery for You?
The American Diabetes Association currently recommends bariatric surgery for people with type 2 diabetes who have a body mass index (BMI) of 35 and over; banding was recently approved by the FDA for patients with a BMI of 30 and at least one obesity-related health condition, including diabetes. But there's more to preparing for a procedure than meeting established criteria.
"Once we divide your stomach to create a small pouch, we can't easily give it back to you," asserts Kimberley Steele, M.D., a surgeon at the Johns Hopkins Center for Bariatric Surgery, referring to gastric bypass, which accounts for 80 percent of the procedures she performs. "You have to know what you’re getting into because you're committing to living with permanent changes in your digestive system."
Colleen Kennedy, M.D., surgical director for the Methodist Weight Management Institute in Dallas, says it's a very personal decision. "Some people are just uncomfortable with something as radical as gastric bypass," she says. "They might just need help with portion control and choose to go with the band."
As a candidate for weight-loss surgery, you'll undergo a comprehensive psychological evaluation focusing on your weight and eating habits, any history of eating disorders or substance abuse, your expectations for the surgery, your social support system and how well you've adhered to past medication and diet recommendations.
Stay the Course for Long-Term Success
As Dr. Steele puts it, "My work is the day of the surgery. Then the patient's work begins." Katy Wiley says her eating habits have changed dramatically since her surgery. She now eats smaller portions much more slowly, and eats lots more fresh fruits and vegetables. "If I have something too high in fat or sugar," she says, "I get nauseous or have diarrhea. It’s challenging, but much less challenging than when my life revolved around insulin and I worried that diabetes would kill me."
From our sister publication, Diabetes Focus, Winter 2011