In the article titled "Surgery may cure diabetes in overweight" (url: http://www.azcentral.com/news/articles/0123obesity-diabetes0123.html ) it states that a common procedure called stomach-band surgery may be an effective treatment for obese individuals with diabetes. According to the Centers for Disease Control (2003), diabetes and obesity are two prominent issues to be dealt with by the American population. More than 44 million are considered obese in the U.S., and 17 million have diabetes.
In the reported study, fifty-five diabetic and obese patients underwent stomach-band surgery. The majority of the participants experienced a remission in their diabetes (the report stated that most patients achieved normal blood tests, and most even stopped taking their diabetic drugs). As intelligent researchers and scientists, we should be skeptic of new treatments and take many issues into consideration.
For example, (1) do the benefits override the risks of stomach-band surgery? and (2) why could stomach-band surgery be more beneficial than other types of weight loss surgery?
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9 comments:
Interesting...I wonder if there will be a large increase in the number of overweight individuals relying on surgery for weight loss.
I have some questions (up for anybody to answer):
Does this only work on obese individuals with already diagnosed diabetes?
If you were a doctor, would you prescribe this treatment first, or would this be a last resort option (knowing that surgery is more dangerous in obese individuals)?
In response to Zoe, it would be one of the last treatment methods I prescribe for diabetes management. I always thought that type II diabetes was a disease that was incurable. Does anyone know the mechanism behind this?? Does it have to do with a decrease in adipose tissue to the GI endocrine system returns to pre-obesity state?
In response to Zoe, if I were a doctor, I would not prescribe stomach band surgury as the first treatment for a patient with type II diabetes. Rather, I would restrict the patient's diet and encourage them to begin an excercise program. If this method failed over time, I believe I would eventually prescribe the stomach band. In response to Van, I believe that because stomach band surgury is less invasive than many other weight loss surguries, such as gastric bypass, it is a less drastic alternative and remains quite effective.
In response to Van's second question:
There is an unfortunately limited number of forms of 'weight loss surgery'--excluding some form of bariatric surgery, the only other effective option is liposuction (which is more a treatment of the symptoms of obesity rather than the true cause). As far as bariatric surgeries are concerned, stomach-banding is the least invasive surgery in terms of procedure, and thus is often associated as being the most 'effective' form of treatment for obesity. Stomach banding also has the advantage of being the most cost effective and the most reversible procedure because it doesn't surgically impact the stomach; the other forms of bariatric surgery are all significantly more permenant, but these forms also show certain benefits that stomach banding does not.
An interesting quality other bariatric surgeries is that they fully eliminate a portion of the stomach (primarily the fundus) that is responsible for the majority of the secretion of a hormone known as ghrelin. Ghrelin is released and helps to stimulate the appetite; thus, by performing more extensive bariatric procedures such as stomach stapling (instead of simple banding), the Ghrelin-producing cells can be eliminated and satiety will be achieved more immediately, helping to allow the patient to experience satiety with a smaller amount of food. (However, from what I can find there is nothing that examines what the impact of eliminating a large amount of ghrelin-producing cells would have on reducing the symptoms of type II diabetes..)
But bariatric surgery is something that isn't (even legally) employable in any form unless the patient meets a certain degree of criteria. Thus, surgical intervention is clearly something reserved for those desperately in need after being unsuccessful with more modest forms of treatment.
In response to Zoe:
Bariatric surgery is often employed in patients who have symptoms of diabetes type II but who have not yet been diagnosed with it in order to prevent the development of full-blown insulin resistance. Thus, it is probably the case that surgical intervention with patients with symptoms of diabetes type II (ie hyperglycemia, dyslipidemia, etc.) will reduce the risk factors as weight is reduced.
Greg brings up an interesting point here...if obesity is inflammatory, would liposuction decrease the risk of developing type 2 diabetes? Just something to think about!
Kind of going off kimih492, I also thought diabetes was incurable, or at least a cell insensitivity to insulin, and was wondering if anyone knew how surgery provides a cure for obese patients. Is this only for patients who are diabetic due to their obesity or for anyone who has diabetes II and is obese as well. Do you (anyone) think there would be a moral/ethic implication of this cure--i.e diabetics purposely becoming obese inorder to get the surgical cure as the article said currently the surgery is restricted. I know its sounds far off, but it is something to consider, live with diabetes and insulin shots or get big and get the surgery which will eliminate (in a sense) the obesity and get rid of the disease
Just a general thought: any type of surgery (ie liposuction, gastric bypass or even a noninvasive stomach band surgery) carries with it any/all kinds of stress you can think off: 'will this work?' etc...and from my understanding, stress in general depresses the immune system so in effect decreases the release of TNFa (and other cytokines). Im wondering whether the stress and psychological effects as well as the actual surgery make this an effective method to decrease type II diabetes (or so the article suggest)?
One thing I'm curious about is whether surgery will be taking over the diet industry. Around town I've actually seen ads on bus stops advertising surgery as a "get skinny fast" idea. It's great that surgery can result in better health, but will people begin to take advantage of this technology just for their personal benifits of how they look?
In response to Dr. Cohen's inquiry, I read in a Medical Hypotheses article that liposuction would play a role in improving insulin sensitivity in overweight patients. Some how (the pathway is undefined), the effects of the surgical procedure disrupts the insulin insensitivity pathway, thereby decreasing the risk of type 2 diabetes in obese patients.
Liposuction and diabetes type 2 development risk reduction in the obese patient
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