Bariatric Surgery for remission of Diabetes – who would have thought?

Obesity is a major contributor to preventable lifestyle-related deaths worldwide, and addressing this issue requires a significant effort. The prevalence of obesity and its associated metabolic conditions, such as diabetes, hypertension, and fatty liver, has reached endemic levels. This is just the beginning of a much larger problem, and raising public awareness is crucial in order to overcome this growing burden.
Did you know that 90% of Type 2 diabetes patients are either obese or overweight? This indicates a strong connection between obesity and diabetes, which scientists refer to as ‘Diabesity’. Unfortunately, this modern epidemic has affected 25% of the industrialized world. However, the good news is that it is preventable, and the metabolic syndrome and its side effects can be reversed with the right measures.

Hazards of obesity:
Obesity is the condition where the body accumulates excessive amounts of fat, which can lead to various diseases such as high cholesterol (dyslipidaemia), Type 2 diabetes, high blood pressure, heart disease with risks of stroke, and cancer.
Obese individuals are more likely to experience breathing disorders, such as sleep apnea, a serious sleep disorder that causes breathing to repeatedly stop and start.
Health conditions such as gallbladder disease, fatty liver disease, gynaecological issues like infertility and irregular periods, as well as sexual health problems such as erectile dysfunction, can significantly impact one’s quality of life.
Osteoarthritis is also a common condition that often affects the knees, making it difficult to perform even simple tasks.

Fight against obesity:
India is considered to be the diabetic capital of the world, and it is crucial for us as a nation to take action to reverse this. The keys to achieving this are maintaining a healthy lifestyle, following a balanced diet, and exercising regularly. By making lifestyle modifications early on in the course of obesity, medication may not be necessary. It’s easier to reverse the harmful effects of obesity without medical supervision when we’re just starting to gain weight, making it the best time to implement lifestyle changes and exercise.
When our BMI exceeds 30 kg/m2, we are considered obese and may need medical help to achieve optimal results. However, with proper supervision, we can reverse the effects of obesity at this stage. If morbid obesity sets in, with a BMI over 40 kg/m2, there is a high chance that medical and conventional therapies will fail. In this case, Bariatric Surgery becomes necessary and is the most beneficial option for our health. Therefore, it is better to prevent obesity than to cure it.

What is Bariatric Surgery?
Bariatric Surgery is a weight loss procedure that involves restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or a combination of both. It also leads to positive hormonal changes that bring about various health benefits.
Nowadays, weight loss surgeries are typically done through minimally invasive laparoscopic techniques. Patients can often walk shortly after the surgery and typically stay in the hospital for 2-3 days. Popular procedures include Laparoscopic Sleeve Gastrectomy and Gastric Bypass Surgery, both of which can be done with minimally invasive keyhole surgery.

Current Recommendations for Bariatric Surgery
Indian Guidelines
BMI≥37.5
BMT≥32.5 and at least one or more obesity-related co-morbidities such as type 2 diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities. Gastrointestinal disorders, or heart disease.
Inability to achieve a healthy weight loss for a sustained period of time with prior weight loss efforts.

Benefits of Bariatric Surgery:
Bariatric Surgery can result in significant and sustained weight loss of 40 kg or more, rather than just 10-15 kg. This weight loss can last for years and can also improve or resolve associated diseases such as diabetes, hypertension, and osteoarthritis. Due to its metabolic benefits, it is sometimes referred to as metabolic surgery. The surgery not only improves quality of life, but also helps to increase longevity for high-risk obese patients. Additionally, the surgery can have positive effects on mental health by resolving issues such as depression, anxiety, lack of self-esteem, and singlehood, which are commonly experienced by severely obese patients.
Dr. Vinay Kumar Shaw is the HOD and Senior Consultant, GI, Minimal Access & Bariatric Surgery, Sanar International Hospitals