Weight-loss surgeries touted for fighting diabetes
Bypass operation overlooked: expert
Gastric bypass surgery should be used more often to control diabetes, something international guidelines are likely to reflect next year, the World Diabetes Congress in Vancouver heard Wednesday.
Dr. Philip Schauer, director of advanced laparoscopic and bariatric surgery at Cleveland Clinic, has published a number of studies showing gastric bypass and gastric sleeve operations are more effective in bringing diabetic symptoms like high blood sugar under control than lifestyle changes and medication alone.
“These operations have effects other than weight loss to improve diabetes,” he says.
But surgery is generally restricted to people who are at least 100 pounds overweight and isn’t typically employed with diabetes in mind. It shouldn’t be the first treatment offered, he says, but can be part of the arsenal to fight diabetes in people who are unable to control high blood sugar levels, which can lead to heart disease, kidney damage, blindness and limb amputation.
The International Diabetes Federation is now considering changes to its guidelines on gastric bypass surgery.
Schauer expects the federation to lower suggested limits to include people with a body mass index, or BMI, over 30 who also have uncontrolled diabetes.
That would mean people who are only 50 pounds overweight might be considered for weightloss surgery.
Current guidelines from the Canadian Diabetes Association say people with a BMI over 35 could benefit from surgery if lifestyle interventions — diet and exercise — aren’t working.
Helping control diabetes has been an unintended benefit of weight-loss operations, the reasons for which are only now becoming clear, said Dr. Lee Kaplan of Harvard Medical School in the same symposium on treating obesity attended by about 500 delegates.
Kaplan’s research with mice has shown that physiological changes after surgery go far beyond merely reducing the size of the stomach.
It alters the makeup of microorganisms throughout the digestive system known as the microbiota.
Hormones that trigger hunger are reduced while the production of bile acids and hormones that cause a feeling of fullness increase, leading to sustained weight loss. The changes can be passed along through transplanting fecal material from mice with gastric bypasses to germ-free mice that then receive similar benefits of weight loss, he said in describing his work.
The main outcome from this line of research will be how to pinpoint the changes to the human microbiome after gastric bypass, which could then be reproduced without surgery, Kaplan says, an area that’s now poorly understood.