People with Type 2 diabetes are almost always advised to lose weight, but sometimes just dropping pounds won’t help control the disease.
Some people need, or choose, an intensive approach and enroll in medical weight management programs. Depending on the patient, the program might rely on a specialized diet, such as a liquid protein diet, or surgery, often in conjunction with a fitness program, classes on lifestyle modification and medication.
Is gastric bypass surgery right for me?
For people with Type 2 diabetes, one procedure stands out before the pounds even start coming off. Gastric bypass surgery is a serious step, and patients need to be well-prepared to live with the procedure, experts say.
In gastric bypass surgery, a surgeon creates a small stomach pouch by using surgical staples to section off part of the stomach. This limits the amount of food a person can eat at one time. The new pouch is about the size of an egg. Then the surgeon creates a bypass of the intestine by attaching part of the small intestine to the new pouch. The bypass limits the calories and fat the patient can absorb from food.
The two-pronged approach leads to rapid, significant weight loss. It also disrupts the metabolic processes that cause Type 2 diabetes ““ the body’s inability to properly use insulin to fuel activity.
Unlike other weight-loss surgeries ““ the gastric band procedure and the gastric sleeve procedure ““ gastric bypass works its magic on Type 2 diabetes independent of any weight loss. Gastric band and gastric sleeve both help improve Type 2 diabetes, but their impact is tied to the amount of weight a patient loses.
Still no cure for diabetes
Weight-loss surgery is a tool against obesity and its health consequences, not a cure. People can regain weight, even with a stomach the size of an egg.
Not everyone’s a good candidate for the surgeries. Some people aren’t ready to make the changes necessary to be successful with the surgery; some have eating disorders or food addiction issues that need to be addressed before any surgery or other medical intervention.
“Those patients who are successful with surgery understand that surgery is a tool,” said Dr. Laurie Little, a clinical psychologist and behavior management specialist at St. Elizabeth’s Weight Management Center. “Successful patients have a great support system that makes the lifestyle changes with them, offer encouragement and cheerleading during the tough times.”
Little and her colleagues screen potential patients for eating disorders, mental illness and other issues to determine if surgery is right for them. And while the surgery isn’t an option for everyone, its effects can be profound for the right candidates, she said.
“After surgery, patients are able to do things they have not been able to do for years — or sometimes ever! These changes can be major including reducing or eliminating medications, improving co-morbid conditions, and significantly improving energy, sleep and physical stamina. These changes can also be minor, like being able to tie shoes, fasten seatbelts, shop at regular clothes stores and go for a ride at King’s Island.”
“One-two punch” of diabetes
There’s a double-whammy at work with Type 2 diabetes, said Dr. Bradley Eilerman, an endocrinologist at St. Elizabeth Physicians Regional Diabetes Center. The disease makes it easy for patients to overeat and gain weight; at the same time, that extra weight makes insulin less effective. And if a patient reaches the point where he or she needs to take insulin, the drug can cause additional weight gain.
Cutting calories and increasing exercise are at the core of medically-managed programs, he said. In addition, diabetic patients with BMIs above 27 may also benefit from prescription appetite suppressants.
If a diabetic patient’s BMI tops 35, and the risk of additional weight gain means more health complications, endocrinologists will suggest weight-loss surgery if other means of weight loss haven’t worked, Eilerman said.
Good programs combine diet changes, physical activity, behavior modification and medication, including making sure medications the patient’s already taking aren’t causing weight gain.
