Could weight loss surgery be a solution?

WEIGHT- LOSS surgery — also known as bariatric surgery — has been the last resort for the obese for a number of years.

But extraordinary findings suggest that it can also reverse type 2 diabetes — sometimes even within days and before the patient has lost a significant amount of weight. A major U.S. review of more than 600 studies involving more than 135,000 patients found that surgery completely reversed type 2 diabetes in 78 per cent of patients.

This is because surgery can alter where or how quickly food reaches the bowel (some procedures bypass much of the small intestine). This, in turn, can influence the hormones in the gut that control blood-sugar levels.

‘We can’t quite call bariatric surgery a cure, as some patients may redevelop diabetes again in the future, but we can certainly say it puts patients into remission,’ says Pritak Sufi, a bariatric surgeon at the Whittington Hospital in North London, and the Spire Hospital, Bushey.

‘Surgery has a much better success rate the closer to diagnosis it’s given,’ says Professor David Kerrigan, a bariatric surgeon at Phoenix Health, which provides surgery privately and for the NHS.

Under NICE guidelines, surgery can be considered if your Body Mass Index (BMI) is over 35 and you’ve recently been diagnosed with type 2 diabetes (people of South Asian descent may be referred with a BMI of 28, as it often starts at a lower weight in this group).

While around 250,000 people in England could qualify for bariatric surgery, only 9,000 procedures were carried out in 20102011. This may be partly because some GPs see surgery as a last resort.

There are four types of bariatric surgery commonly performed in the UK, and some are more effective at reversing diabetes than others.

Like any operation, bariatric surgery carries risks — including infection and a risk of dying (although, a report by the University of Birmingham found just 70 people out of 29,285 patients died within 30 days of surgery). Ten to 15 per cent of patients develop gallstones through losing weight so quickly, and 7 to 8 per cent need repeat surgery because of complications, or not getting the desired results. You can also regain weight and the diabetes can return.

GASTRIC BAND HERE a saline-filled silicone band is placed around the top of the stomach, reducing its size by about a 12th. ‘It’s thought the band also stimulates nerves which tell your brain that you are full,’ says Mr Sufi.

Pros: Safe, uncomplicated keyhole procedure, it takes less than an hour and requires a night in hospital, with a week off work. Cheapest technique, easily reversible.

Cons: This doesn’t affect hormones associated with type 2 diabetes, so benefits are limited to those created by subsequent weight loss. On average, 50 per cent of excess weight is lost in 18 months. Half of patients will come off medication completely. A fifth need further surgery within five years for problems such as infection or band slippage. It’s also easy to ‘cheat’ by liquidising foods.

Cost privately: £5,000 (includes two-years’ follow-up).

GASTRIC SLEEVE HERE the largest part of the stomach is removed, leaving a small tube-shaped section. ‘The stomach goes from being shaped rather like a bag to more like a banana,’ says Mr Sufi. ‘ This reduces capacity and removes the part that produces the appetitestimulating hormone ghrelin, so patients feel less hungry.’

Pros: The surgery takes an hour, so is better for high-risk patients such as the extremely obese. Patients lose 60 to 70 per cent of their excess weight over two years and 70 to 75 per cent of patients are ‘cured’ of diabetes.

Cons: The ‘ new’ stomach can stretch if patients overeat. ‘About 10 per cent come back with regained weight within three years,’ says Mr Sufi. The operation requires two to three nights in hospital and up to three weeks off work. Irreversible, and relatively new, so long-term data is lacking.

Cost privately: Around £9,000.

GASTRIC BYPASS THE stomach is reduced to a small pouch and connected to the bowel about 3 to 4ft lower down the intestine than normal. This triggers the release of GLP-1, a hormone that stimulates the release of insulin and makes it more effective.

Pros: The average patient loses 80 per cent of their excess weight within 18 months and up to 80 per cent of patients will be ‘cured’ of diabetes. The other 20 per cent will need less medication. Longterm safety is well established.

Cons: A higher risk of complications, such as internal bleeding, in the first few days. Patients need daily vitamin and mineral supplements for life to avoid deficiency, and a quarter also need injections of vitamin B12. While a bypass can be reversed, it’s not advisable. The pouch can stretch and about ten per cent of patients regain weight.

Cost privately: £10,400.

DUODENAL SWITCH THIS combines a gastric sleeve

and bypass. But it retains the duodenum, the top of the intestine.

Pros: This causes large weight loss (90 per cent of the excess) and also alters hormonal balance, meaning a 90 per cent ‘cure’ rate for diabetes.

Cons: This surgery is only offered to around 2 per cent of patients because of side-effects, notably protein deficiency (because the part of the intestine through which we normally absorb most protein is bypassed) which can lead to loss of muscle mass and weakened immunity. Bowel function can also be problematic and some patients suffer wind and leakage.

Cost privately: Around £11,500.