There are thousands of type 2 diabetics who are obese. In many case, these individuals became diabetic after they developed the weight gain. It is well known that when a diabetic is obese or overweight, insulin resistance will develop and the blood sugars become very hard to control. In addition, obesity itself is associated with numerous complications such as arthritis, reflux, risk of high blood pressure, high levels of cholesterol and triglyerides.
Obesity is also a risk factor for heart disease. Thus when obesity and diabetes are combined, the risk of complications is extremely high. In the last decade, it has been observed that when diabetic lose weight, most of these complications disappear or subside. In fact the blood sugars drop to within normal and the quality of life is markedly improved. Thus today doctors do recommend weight loss for all obese type 2 diabetics. The difficult part is that many of these diabetics simply are not able to lose weight with medications or with changes in life style. Hence, another means of losing weight is via bariatric surgery. Today there are several types of weight loss procedures which can help obese diabetics.
Unlike the past, these weight loss procedures have been refined and most are done through small holes in the skin. The recovery is fast, there is minimal pain and the weight loss is immediate. There is no doubt that surgery is much superior to drugs when it comes to weight loss. However, not all diabetics can undergo weight loss surgery. Obese diabetics patients are always at risk for complications when they undergo any type of surgery. Over the years, certain criteria have been developed to ensure patient safety by selecting the right patient.
Candidate for bariatric surgery
The surgeons do agree that just looking at an obese patient is not adequate to determine his/her eligibility for weight loss surgery. The current guidelines in North America for selecting patients for weight loss surgery include the following:
- Individuals who have failed to lose weight with drug therapy. The drug therapy should have been tried out for at least 3-6 months
- Individuals who have failed to lose weight after enrolling in an intense exercise program of more than 12 month duration
- Individuals who have a BMI in excess of 40 kg/m2
- Individuals with a BMI between 35 and 40 kg/m2 and also have one or more co morbid conditions. This may be uncontrolled diabetes, arthritis, poor life style or bed ridden.
These criteria are simply guidelines and the ultimate judgment on who can undergo weight loss surgery belongs to the surgeon. In each and every case, the individual is told about potential complications and possible benefits. All individuals who attempt to undergo surgery for weight loss must be realistic, be able to comprehend what is at stake and remain committed to an exercise program.
Who should not undergo bariatric surgery?
Of course, not all diabetics can undergo surgery. There are diabetics who should not undergo bariatric surgery. These include the following individuals:
- Those with a mental health problems like a psychotic illness, e.g. schizophrenia
- Those who have an active substance abuse problem
- Those who have shown to be non-compliant with following instructions or taking their medications with uncontrolled depression which has been difficult to treat with drugs
- Those who are at high risk of heart disease
What are the results like?
Most studies done on obese diabetics who have undergone weight loss surgery reveal that the procedures do work and are associated with significant weight loss. More important in many diabetics, the blood sugars have become normal and some had even had to discontinue their medications. Overall, the consensus is that weight loss surgery is of great benefit for obese diabetics.
So should an obese diabetic undergo weight loss surgery?
Bariatric surgery is no piece of cake. While one can have the best surgeon, the patient must also play an important role in the process. Besides simply eating less and exercising more, one also needs to change one’s lifestyle. This means having to sacrifice friends, family and a lot of food. The most difficult part of the post surgical period is to make sure that the weight is not regained.
