We all know that type 2 diabetes (T2DM) makes up the majority of diabetes chunk. Adding to it, obesity in T2DM poses a challenge in achieving and keeping the diabetes goals. So, obesity and diabetes pose threat mutually to one another.
Diabetes + Obesity = Diabesity !!!
Diabesity, is a double-edged sword. Surgical weight loss is the quick and effective remedy. Since, diabetes is longstanding and progressive, a close supervision and strict adherence helps in subduing the clinical severity. However, road blocks in long-term supervision and compliance can result in worsening of the situation leading to silent complications and aggressive socioeconomic burden.
So is a quick-fix surgery a good option?
Bariatric surgery has a good success rate (90%).
Long lasting benefits over risks:
- Reduced to normalised sugar control and overall health
- Notable clinical reduction in medication.
- In some cases, total elimination of anti-diabetic medicines.
Benefits over risks – Definitely, every surgery has its own risk. Every surgery is different. Every individual is different.
Nonetheless, in most of the cases, the risk of surgery is far lesser than the risk of continued worsening of diabesity. The risk of bariatric surgery is comparable to that of widely accepted gall bladder surgery.
In the position statement of International Diabetes Foundation (IDF), bariatric surgery is considered to be the powerful tool to treat patients with diabesity. However, the position statement also suggests the features of the ideal candidate for the same.
So is surgical weight loss a good idea for you?
Your doctor will take a final call on this. Here, I will pen down the considerations for surgical weight loss.
Guided by the position statement of IDF,
- You are the right candidate if you are obese with a BMI 35 or more?
- If your BMI is somewhere between 30 to 35, surgery is a choice only when other medical therapies don’t work.
Failed alternate weight loss regimen
When behavioural and medical routes fail your doctor may recommend surgical weight loss. Provided the benefits of the surgery outweigh the risks involved.
Weight loss benefits extend beyond T2DM. Obese or overweight patients with either of the conditions benefit well –
Hypertension, osteoarthritis, sleep apnea or other breathing problem, lipid abnormalities, non-alcoholic fatty liver disease, digestive disorders, or heart disease.
Why is surgery so effective?
The benefits are attributed to reduced physical space in the stomach and a little extent to hormonal changes too.
After gastric by-pass surgery, the food particles by pass most of the stomach and partially the small intestine. Similar effects are seen in duodenal switch.
Sleeve gastrectomy involves partial removal of stomach through a vertical incision. Another option is adjustable gastric band (AGB) that ties away the upper portion of the stomach.
All, these procedures enable weight loss owing to reduced food transit space. Eventually, patients experience benefits on sugar control due to weight loss, better glucose metabolism and favorable gut hormonal changes. However, the benefits with AGB is largely attributable only to weight loss.
What is the recovery time?
Most patients experience lack of energy after surgery.
Most people hit back at work in a week or two. In case your work demands a lot of physical activity or running errands, it is better you take off for a longer period. Your doctor will help in this decision.
Heavy weight lifting after surgery does not result in hernia, as against common idea. Hernia may otherwise is still possible due to infection. Therefore, it is important to take your medicines and supplements as advised by your doctor.
It is good to stay active however, slow and steady is the key. Do low impact exercises for the first month and then slowly building on from there. Listen to your body and you will do fine.
Water workouts will have to wait till you get a green signal from your surgeon. Else, you do not want the infections.