Losing weight can help reverse type 2 diabetes

It's no secret that people who are overweight or obese are more likely than others to develop diabetes and have trouble controlling the disease. When diet and exercise aren't effective in weight loss, some people turn to weight-loss surgery, also known as bariatric surgery. These procedures can dramatically improve blood glucose control in many people with type 2 diabetes.

Is weight-loss surgery right for you?

Talk to your doctor to determine if you're a good candidate for the surgery. Your doctor will start by calculating your body mass index, or BMI. BMI is a way of looking at both height and weight to determine if a person is underweight, healthy or overweight. A free BMI calculator is available from Johns Hopkins.

Weight-loss surgery is generally recommended for:

• Healthy people who are obese (BMI greater than 40 kg/m2)

• People who are obese (BMI greater than 35 kg/m2) and who have an underlying health concern, such as diabetes, high blood pressure, sleep apnea, liver disease, heart disease, persistent acid reflux, osteoarthritis or urinary incontinence

The laparoscopic adjustable gastric band procedure has been approved by the U.S. Food and Drug Administration for use in people who are obese (BMI greater than 30 kg/m2) and have an underlying health concern.

Good to Know

The word "laparoscopic" refers to surgeries that are performed with the help of a laparoscope: a long wand with a video camera attached to one end. Surgeons insert this wand through a relatively small hole on the patient’s abdomen, usually near the navel, and watch through a video monitor as the wand is steered toward various organs inside the body. With laparoscopic surgery, the large incisions used in traditional surgery are not needed.

Types of weight-loss surgeries

• Laparoscopic adjustable gastric band: An adjustable band is slipped around part of the stomach. The band can be made looser or tighter after the surgery. The stomach is smaller and holds less food, so the person feels satisfied after eating small portions. Within one to two years after surgery, most lose more than 50 percent of their excess body weight.

• Laparoscopic sleeve gastrectomy: The surgeon removes a large part of the patient's stomach. The patient’s stomach is smaller and can hold less food after the surgery. As a result, the patient eats less and loses weight over time.

• Roux-en-Y gastric bypass: Roux-en-Y gastric bypass is a major surgery that is not performed using a laparoscope. This surgery takes a two-step approach to weight loss: It makes the stomach smaller, and it reduces the amount of food the body can digest. The surgeon removes part of the stomach, making it smaller. The stomach is then detached from its normal junction with the small intestine, where food normally travels after leaving the stomach, and it’s reattached to a lower section of the small intestine. By creating a new route for food to travel through the digestive system, the procedure reduces the amount of nutrients that are absorbed after meals. Within one to two years after surgery, most lose more than 50 percent of their excess body weight; however, some degree of weight regain is common.

What can be expected after surgery?

Most people will notice dramatic improvements in blood glucose control immediately after surgery, even before any weight loss occurs. People who take insulin or pills to control their blood glucose often find that they need much lower doses; in some cases, diabetes medications can be stopped before the person leaves the hospital.

In the weeks and months after the surgery, they should check their blood glucose regularly, especially before and after meals, so that they can become familiar with their body’s new requirements for insulin and other diabetes medications. Blood glucose will become easier to control over time.

Drawbacks and limitations

The benefits of weight-loss surgery are exciting, but people with diabetes should carefully consider the potential short- and long-term complications of the procedure before making a final decision.

Common side effects:

• Weight regain

• Vitamin deficiencies, which doctors will sometimes treat with vitamin supplements

Less common side effects:

• Infection

• Surgical complications that might require additional operations to fix

• A persistent drop in blood glucose an hour or two after eating

• Gallstones

• Loose skin, as a result of the weight loss

Occasionally, people who undergo the laparoscopic adjustable band procedure may experience vomiting, pain, acid reflux or trouble swallowing.

What it all means

Weight-loss surgery can be effective to treat obesity; however, these are major surgeries and people with diabetes should discuss the risks and benefits with their doctors before making a final decision.