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When it comes to your health, it’s empowering to know you have the option to take control. Change can be a good thing if it means a step towards your healthiest and happiest self, and if you’re living with diabetes, it may be time to consider bariatric surgery as an option towards getting yourself there.
Bariatric surgery is also sometimes referred to as weight-loss surgery, but that’s not the only reason why bariatric surgery is done, according to Michel Murr, MD. “The more important benefits of bariatric surgery are the improvements of general health and quality of life,” he says, specifically those with the following conditions can see dramatic improvement after weight loss, to the point of not requiring medications:
- Fatty liver
- Sleep apnea
- Degenerative joint disease
Common Types of Bariatric Surgery
The most common bariatric operations are gastric bypass and gastric sleeve (or sleeve gastrectomy). Both of these procedures can be performed laparoscopically or robotically through small incisions, reducing pain and minimizing recovery time after surgery.
With gastric bypass surgery, a small pouch is created from the top portion of the stomach, which is then connected directly to the small intestine. Ingested food that goes into the esophagus and the pouch and then goes into the small intestine and bypasses the stomach (that’s why this is called gastric bypass!). This operation not only reduces the amount of food that can be ingested but it also has a profound impact on how the body metabolizes foods and carbohydrates.
With a gastric sleeve procedure, the stomach is divided into two compartments and the larger compartment is removed. The stomach pouch that remains is the shape and size of a small banana and is no longer capable of storing large portions of food. The effects of gastric sleeve on metabolism are less obvious than in gastric bypass.
According to Dr. Murr, “We’ve perfected doing these operations with minimally invasive techniques (laparoscopic or robotic) which reduces post-surgery pain and the length of hospital stay.” Additionally, at AdventHealth Tampa we utilize opioid-free anesthesia, nerve blocks and non-narcotic pain medications to enhance recovery. Generally speaking, most patients leave the hospital one day after gastric sleeve and one and a half days after gastric bypass.
Once a patient is back home, it takes seven to 10 days to return to a full schedule of daily activities at home, and generally the patient can be back to full-time work within four weeks. During recovery time, Dr. Murr says it’s important for the patient to “adjust to new eating habits and focus on their wellbeing.”
Some people may be concerned about the risks or side effects of bariatric surgery, but Dr. Murr explains that these types of operations are typically associated with a very low risk of death and complications — such as bleeding ulcers and bowel obstruction. According to the American Society of Metabolic and Bariatric Surgery, the risk of death following this surgery averages 0.13%, which Dr. Murr says is “considerably less than most other operations, including gall bladder and hip replacement surgery.”
Who Is a Candidate for Bariatric Surgery?
If you have a body mass index (BMI) greater than 40 kg/m2 (approximately 100 pounds overweight), you may be a candidate for bariatric surgery. Patients with a BMI of 35–39 kg/m2 and a major medical condition such as diabetes, hypertension or sleep apnea are also candidates for surgery.
You’re never too old to be considered for bariatric surgery, and at AdventHealth we consider young adults as early as 16 years of age as candidates for surgery, provided a high level of maturity, Dr. Murr advises.
Living with diabetes can be difficult, and Dr. Murr believes bariatric surgery could be a great solution. He explains that patients with diabetes and obesity have what’s called “insulin resistance” because upper abdominal fat blocks the action of insulin and raises blood glucose levels.
Shortly after bariatric surgery, insulin resistance resolves, and blood glucose levels return to normal. The majority of patients will not need insulin injections within two weeks after surgery and all other diabetic medications within three months.
According to Dr. Murr, “For patients with obesity and poorly controlled diabetes, gastric bypass is a much more effective operation in turning off insulin resistance and putting diabetes into remission, compared to the gastric sleeve or medical treatment.”
Dangers of Living With Diabetes
Diabetes is a progressive disease that can lead to severe personal health consequences. Patients with diabetes may have lower production of insulin, in addition to insulin resistance, if they are obese. While non-surgical options should always be considered first, unfortunately “diet and lifestyle modifications are less effective in controlling body weight and blood glucose in patients with BMI >35,” Dr. Murr says.
“There is overwhelming, strong evidence that bariatric surgery is the most effective treatment for diabetes in patients with obesity. The American Diabetes Association guidelines recommend a consultation with a bariatric surgeon for patients with a BMI >35 and poorly controlled diabetes,” Dr. Murr advises.