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When to Consider Weight Loss Surgery

By Rhonda Mann
Beth Israel Deaconess Medical Center Staff

Somewhere along the line, Denise Webb's health had spun out of control. Her diabetes and blood pressure were at critical points-even her own doctor wasn't sure what to do.

"I was on the maximum medication for both and the next step was a heart attack," says Denise. "I was looking at my grandchildren and thinking, I'm never going to see them grow up."

After much thought, she decided to have weight loss surgery in May of 2005. Since then, she has dropped 107 pounds - and most of her medications.

"I went from three diabetes medicines down to just one, and now my levels are so good, my doctor is considering taking me off that," she says enthusiastically. "My blood pressure is perfect. I feel great. I have a whole new life."

Studies have confirmed that weight loss surgery can have a huge impact on diabetes. In August of 2008, Utah researchers published data in the New England Journal Of Medicine showing those who had the traditional form of the surgery called gastric bypass, experienced a 92 percent lower death rate from diabetes compared to obese patients who did not. The surgery also lowered their risk of dying of heart disease.

Dr. Dan Jones, Chief of Minimally Invasive Surgery and Director of the Bariatric Program at BIDMC

"There are many health complications of obesity - heart attacks, back pain, knee pain, cancer," explains Dr. Dan Jones, Director of the Bariatric Surgery Program at Beth Israel Deaconess Medical Center, clinical partner of the Joslin Clinic. "But diabetes is one of those things that wakes you up and patients say 'hey, this is bad.'"

Dr. Jones says well over half of the diabetic patients he sees who get the newer, minimally invasive form of weight loss surgery, known as the Lap-band procedure, are in remission from their disease two years later. For those who have gastric bypass, the benefits can happen even quicker. Hormonal changes within the first two to three days post-surgery leave patients needing less insulin - and most, he says, are usually off their medications within six months.

"We say the diabetes is in remission-not cured-because we know if the patient puts the weight back on, the diabetes comes back," says Dr. Jones.

Dr. Martin Abrahamson, Medical Director of the Joslin Diabetes Center, agrees.

"Weight loss surgery in appropriate candidates leads to remission of disease in more than 50 percent of subjects," he states. "In those who do not go into remission, glucose control is improves, usually with fewer medications or lower doses of insulin."

The same benefits can often be seen if patients are able to lose weight on their own, without surgery. But Dr. Jones says most will need to lose 20 percent of their excess body weight to see this type of benefit, and most people have trouble doing that with diet and exercise alone.

"A lot of patients see weight loss surgery as sort of a failure-somehow they didn't try hard enough to lose the weight," he explains. "Truth is it has little to do with the patient's effort and more to do with the genetics and hormones."

The surgery does carry risk, though, and having diabetes increases the risk. The risks include infection, bleeding, and in rare cases, death. Those with diabetes may have a weaker heart and the disease can impact the healing process. Patients must also be mentally and emotionally ready for the surgery and the permanent change in eating habits. In the Utah study, those who underwent weight loss surgery had a 58 percent higher death rate from accidents and suicide compared to the control group.

"The decision to have this surgery can only be made after careful evaluation," says Dr. Jones.

Weight loss surgery should only be considered if you are at least 100 pounds more than your ideal weight; if you have been overweight for years and all attempts to lose weight through medical diets have failed; if you are prepared to make substantial changes in your lifestyle; and are willing to be continually monitored by a team of specialists.

As a result of her weight loss, Denise Webb says she finds it much easier to do things she knows will help her overall health, including keeping her diabetes in check. She once had trouble walking from the couch to the kitchen, but now she looks forward to exercise.

"My husband used to drop me off in front of a store and now I tell him - park far away and we'll walk," Denise explains. "I love it."

Above content provided by Beth Israel Deaconess Medical Center in partnership with the Joslin Clinic. For advice about your medical care, consult your doctor.

Posted January 2010

Contact Information

Weight Loss Surgery Center
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, 3rd Floor
330 Brookline Avenue
Boston, MA 02215