... Although they do not directly treat the subclinical chronic inflammation which ultimately causes type II diabetes, hypertension, obesity, and dyslipidemia, many studies are showing that Stomach band surgery and Roux-en-Y gastric bypass result in remission of diabetes in a matter of months or even days. What at first seems like a safe "quick-fix" or weight loss fad being promoted by surgeons for its immediate results (for $17,000 to $30,000), may be a legitimate way to directly reduce excess caloric intake and result in glycemic improvement from weight loss, rather than altering insulin resistance or beta cell activity directly. This has shown to have high success rates, with low risk of complications due to surgery, while avoiding pharmacological strategies tampering with the complex relationships between the pancreas, liver, muscles, fat, gut, brain(hypothalamus), and even the skeleton(osteocalcin). Until biomarkers can be identified to predict early disturbances in insulin sensitivity, or the complex inflammation signaling pathways can be better understood, this may be the best current way to avoid the high costs associated with weight loss therapies. After all current lifestyle and pharmacological strategies usually result in small amounts of weight loss in diabetics.
Questions: What limitations should be considered regarding the patient before permitting this surgery... B.M.I. requirements, age, all other forms of lifestyle treatments must fail first.
Are gastric bands actually a better method than Roux-en-Y gastric bypass or biliopancreatic diversion?
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I have some knownledge about the different weight loss surgeries and from everything I have read the gastric lap band surgery is a preferred method. This is because it involves no surgical cutting of the stomach and/or intestines, it can be adjusted from outside the body (apparently there's some apparatus outside the body where you can adjust the restriction of the stomach..weird), and also it's reversible i.e. it can be removed and the patient will return to the same state prior to the surgery. There is a BMI requirement for weight loss surgery. I belive its a BMI greater than either 35 or 40, which has to be sustained for a year minimum. Age is taken into consideration but its not a dominating determinant of whether or not a patient can or cannot have weight loss surgery.
Although these surgeries are a plausible solution to obesity, it seems that the medical field almost encourages these conditions by providing a loophole! You mentioned future identification of a biomarker to predict early insulin disturbances. What is the percentage of obese people who develop type II diabetes, and how does BMI correlate into these figures? Could BMI be used as a predictor for inclination to diabetes?
The lap band with adjustable control could have deleterious effects as it does raise the potential for infections or abuse by the user/patient in avoiding the effects of decreasing their ability to eat.
BMI is not always the best indicator in obesity or need for the surgery but it is unfortunately the most common.
After some more searching for possible biomarkers, i found a good article that found strong results with three different plasma molecules. "Elevated levels
of E-selectin, ICAM-1, and VCAM-1
raised the relative risk of diabetes by 1.5- to 7.5-fold. Associations of E-selectin and ICAM-1 with diabetes were independent of the confounding effects of usual risk factors for diabetes, and E-selectin remained a powerful predictor even after the potentially mediating effects of obesity, inflammation,and levels of insulin and hemoglobin A1c were accounted for." These biomarkers all reflect endothelial dysfunction.
More on this article can be found here:
http://jama.ama-assn.org/cgi/reprint/291/16/1978
To answer Gabrielle, BMI is just a correlation between height and weight. It can sometimes be a good indicator of obesity, and thus risk for diabetes, but sometimes overweight does not necessarily mean unfit. Furthermore, BMI has some flaws and should not be heavily depended upon in many circumstances. Much of this I learned in 445.
Also, I agree that stomach reduction should be used as a "last resort" for clinically obese individuals. Otherwise it does emphasize an easy way out when its effects may only be temporary and be more directed on decreasing caloric intake, which many patients may not understand. As PSIO majors we know the importance of excercise and diet, but will these patients understand when they can get a simple surgery? Doctors should definately emphasize to these patients the importance of all the other factors needed to keep them healthy...
Here are some statistics regarding weight loss surgeries. My concern is how many of these surgeries were performed without regard to other options.
Weight Loss Surgery Soars in U.S.
Jan. 11, 2007 -- Weight loss surgery is soaring in the U.S., especially among baby boomers and women, a government report shows.
Weight loss, or bariatric, surgery is for morbidly obese people and those who are obese with serious medical conditions related to their weight. Perhaps the best known type of this surgery is gastric bypass surgery.
The new report shows bariatric surgery was nine times more common in 2004 than in 1998 in the U.S.
In 1998, 13,386 bariatric surgeries were performed on people of all ages. That figure rose to 121,055 in 2004.
Most of those operations were gastric bypass surgeries, according to the report by the Agency for Healthcare Research and Quality (AHRQ).
Boomers Lead Trend
The fastest growth in bariatric surgery was among people aged 55-64, but younger adults and teens also became more likely to opt for it.
"This report shows that more Americans are turning to obesity surgery and that an increasing number of younger people are undergoing these procedures," says AHRQ Director Carolyn Clancy in an AHRQ news release.
"As the rate of obesity continues to climb, the health care system needs to be prepared for continued escalation in the rate of this surgery and its potential complications," Clancy says.
Bariatric surgery was 20 times more common among people aged 55-64 in 2004 than six years earlier (772 surgeries in 1998; about 15,800 in 2004).
People 45-54 had more than a tenfold increase in bariatric surgeries, rising from 3,320 in 1998 to about 35,900 in 2004.
Younger Adults Getting Weight Loss Surgery
Meanwhile, weight loss surgery grew sixfold in adults 18-44 during the years studied.
In 2004, more than 36,700 of those 35-44 got bariatric surgery, as did more than 30,400 adults 18 to 34.
Teens and older adults are also being caught up in the trend.
In 1998, there were too few bariatric surgery patients in these two age groups to count, says the AHRQ.
In 2004, 349 teens aged 12-17 and more than 1,400 adults 65 and older got bariatric surgery.
Men, Women Getting Weight Loss Surgery
Bariatric surgery increased for both sexes but was more common among women. Women accounted for about eight in 10 bariatric surgery patients in 2004, the study shows.
The number of bariatric surgeries performed on men rose more than eight times higher during the years studied, from 2,527 in 1998 to nearly 21,000 in 2004.
Bariatric surgeries performed on women increased more than nine times, from nearly 10,860 in 1998 to about 99,300 in 2004.
Bariatric surgery can have complications, but the report shows a drop in the hospital inpatient death rate.
In 2004, 230 patients died in hospital stays in which bariatric surgery was performed, down nearly 80% from 1998, according to the report.
http://weightloss.immunodefence.com/2007/01/weight_loss_surgery_soars_in_u.html#more
I believe that the requirement for weight loss surgery in the US is you have to be 100 lbs over weight or have a BMI of 35 as well as have diabetes or HBP.
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