Bariatric Surgery – Is it the Right Option for You?
By Matthew Garza
Bariatric, or weight loss, surgery could help you achieve a healthier weight and better manage your diabetes. However, this option is not for everyone. Find out what makes you a good candidate for this procedure, what the different types of bariatric surgeries are, and what kind of results could be achieved.
If you have obesity or excess weight, your healthcare team may have discussed strategies to help you reach a healthy weight. These can range from lifestyle changes to medications or even surgery.
“By getting [people with diabetes] to a healthier weight, we can see their diabetes improve significantly,” said Dr. Lloyd Stegemann, the medical director of the Metabolic and Bariatric Surgery program at Bay Area Hospital and South Texas Surgical Hospital in Corpus Christi, Texas, and a board member of the Obesity Action Coalition. “When we look at ways for people to lose weight, bariatric surgery is just one treatment option.”
What is bariatric surgery?
There are several different types of surgeries for treating obesity or excess weight, which can be referred to as bariatric surgery, weight loss surgery, or metabolic surgery.
These procedures can help you achieve significant, sustained weight loss and improve your glucose levels. In addition, studies show that bariatric surgery can reduce your risk for heart disease, microvascular diseases (that can cause damage to your kidneys, eyes, and the nerves in your arms and legs), cancer, and it can improve quality of life.
“For people who have a significant amount of weight to lose, there is no question that surgery is the best way for them to lose it and then keep it off,” said Stegemann.
The vast majority of these surgical procedures either reduce the size of the stomach or alter your digestive system so that food bypasses part of the intestines. In addition, they change some of the hormones in the body that are associated with weight and hunger – this may help people lose more weight and maintain their weight. These surgeries require you to be under anesthesia.
Who is the right candidate for bariatric surgery?
Bariatric surgery is not for everyone. However, the American Diabetes Association’s Standards of Care in Diabetes provides recommendations for who is a good candidate.
The ADA guidelines say that bariatric surgery is recommended if you have type 2 diabetes and a BMI greater than or equal to 40 (or 37.5 if you are Asian or Asian American).
In addition, bariatric surgery should be recommended if you have type 2 diabetes and a BMI between 35.0-39.9 (or 32.5-37.4 if you are Asian or Asian American) and you have not been able to achieve sustained weight loss and improvements in your diabetes-related complications (including hyperglycemia) with lifestyle changes and medications alone.
Finally, if you meet all the above conditions but you have a lower BMI in the range of 30-34.9 (or 27.5-32.4 if you are Asian or Asian American), then bariatric surgery can still be considered.
In any case, the decision to undergo surgery is a major one that requires open communication with your healthcare team and an exploration of all of the available options. “What I always tell people is make an appointment with a bariatric surgeon and just get evaluated,” said Stegemann. “Then you can learn about the different procedures and see what your options are.” He suggests a couple questions that people can ask their healthcare team to learn more:
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Do I qualify for bariatric surgery?
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Am I a safe candidate for bariatric surgery? What are my individual risks for this surgery?
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Which bariatric surgeries does the surgeon or medical center offer?
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Is the medical center accredited in bariatric surgery?
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Does the surgeon or medical center believe in the importance of working on lifestyle changes in addition to surgery?
Stegemann stressed the importance of making sure that people find an accredited center that follows people after surgery and helps teach the valuable lifestyle habits that help improve long-term success.
What are the different kinds of bariatric surgery?
If you and your healthcare team decide that bariatric surgery is the best option, there are several different surgeriesavailable. The two most popular surgeries in the US include:
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Vertical sleeve gastrectomy
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Roux-en-Y gastric bypass
In a vertical sleeve gastrectomy (VSG), also called a “sleeve,” approximately 80% of the stomach is removed, leaving behind a stomach pouch roughly the size and shape of a banana. By decreasing the size of your stomach, the surgery limits the amount of food you can consume, decreases overall hunger, and improves glucose levels.
In a Roux-en-Y gastric bypass (RYGB), or “gastric bypass” for short, the surgeon creates a small stomach pouch the size of a walnut or egg, which is then attached to part of the small intestine, “bypassing” most of the stomach and the upper part of the small intestine. This procedure decreases hunger and improves glucose levels.
What are the major benefits?
For people with diabetes, bariatric surgery can have a host of benefits, lowering the risk for diabetes-related complications.
Research shows that bariatric surgery can significantly improve type 2 diabetes and in many cases it may also lead to type 2 diabetes remission. A consensus statement from leading international diabetes organizations highlighted that remission was achieved by 30-63% of people who underwent gastric bypass (RYGB); the percentage varied based on the study and how many years people were followed after their procedure. Additionally, the STAMPEDE trial, which randomized people with diabetes to either receive bariatric surgery or medical treatment alone, found that after one year more than 95% of participants receiving the surgery saw improvement or remission of their diabetes while only 28% of those not receiving surgery saw the same results.
However, “when we look at the resolution, or improvement of diabetes after surgery, it is time-dependent,” said Stegemann. “The longer someone has diabetes, the harder it is for us to make it go away [enter remission], even with surgery.”
People who are younger, have had diabetes for a shorter period of time, and who have better managed diabetes (do not require insulin, more in range glucose levels, etc.) have a better chance of achieving remission after surgery.
For people with type 1 diabetes, bariatric surgery could help achieve an ideal weight, improve insulin requirements and glucose levels, and lower the risk of obesity-related complications, however type 1 diabetes is not able to be put into remission like type 2 diabetes. However, the research is limited, and larger, longer-term studies are still needed.
Potential risks, complications, and disadvantages
While many insurance plans cover bariatric surfgery. Bariatric surgery does cost significantly more up-front than other treatment options such as lifestyle interventions or medications – these surgeries can range from $15,000 to $23,000, and the person’s share of cost may vary depending on insurance coverage.
Interestingly, “the decision to cover bariatric surgery or not is up to the employer to choose that as a benefit. It is not automatically covered,” said Stegemann. To learn how to advocate for this care, read “How to Advocate for Yourself: Making Employer-Sponsored Health Plans Work for Your Diabetes Care.”
Some research suggests that it may be the most cost-effective or cost-saving option – for example, if your diabetes is in remission for several years after the surgery, you could save thousands of dollars on healthcare appointments, medication costs, and by avoiding complications. In addition, Stegemann said that especially for younger people and those who have had diabetes for a shorter amount of time, these surgeries can add several years to your life and help you avoid a host of complications.
As with any procedure, bariatric surgery does come with some potential risks, and each procedure has its disadvantages. One of these disadvantages is the surgery may be irreversible (as is the case with VSG). There may also be side effects, including reflux and heartburn, vitamin and mineral deficiencies, hypoglycemia, bowel complications, increased risk for developing an ulcer, and “dumping syndrome” after eating or drinking, which can include feeling bloated or too full, nausea, vomiting, abdominal cramps, and diarrhea.
The bottom line
“There’s a lot of misinformation out there [about bariatric surgery],” said Stegemann. “You deserve to find out the truth. Bariatric surgery is not the only treatment available… but it is a tool in the toolbox.” He stressed that it is one of the most effective treatments for people with diabetes and that the earlier in your diabetes diagnosis that a bariatric surgeon can get involved, the better the outcomes usually are.
Talk to your healthcare team about your weight management options, including surgery. Asking questions about the long-term benefits and risks is important to help you and your healthcare provider make an informed decision about whether surgery can help you achieve your ideal weight, better manage your diabetes, and lower your risk for complications.
For more information, read, “How to Lose Weight and Keep it Off” or visit the Obesity Action Coalition for additional resources.
