Weight-loss surgeries or bariatric procedures have been in vogue for the past few years as a sure-shot way to lower body weight in those who are morbidly obese, for whom lifestyle and dietary modifications are not very effective.
Of late, bariatric procedures have been generating a lot of interest among the general public because it is now well established that apart from its dramatic effect on body weight, these procedures can bring about long-term remission of or even completely resolve Type 2 diabetes. The procedures now have health insurance cover too.
Are we looking at a surgical “cure” for diabetes?
Despite the large body of evidence demonstrating that bariatric procedures change the body’s metabolism and achieve almost complete remission, which is normal blood glucose levels without medication for at least one year, of diabetes for up to 15 years, experts still maintain that this is not a procedure for everyone.
The American Diabetes Association’s (ADA) 2014 guidelines say that bariatric surgery may be considered for adults with a body mass index above 35, who have Type 2 diabetes. But the current evidence is insufficient to recommend this procedure generally, the ADA says.
Though several bariatric procedures can achieve the metabolic shift, the most common procedure done by surgeons here is the sleeve gastrectomy. In this procedure, the size of the stomach is reduced to 15 or 20 per cent, to lower calorie intake. Other than gastric banding, all other procedures are irreversible and involve changing the anatomy of the gastrointestinal (GI) tract, to effect metabolic change.
Debate is on
The exact mechanism by which bariatric procedures alter the metabolic system is still being debated.
“Sudden weight loss aside, the long-term remission of diabetes and normalisation of other metabolic parameters could have a lot to do with the hormonal changes induced by the changes in the GI tract. These are new, expensive procedures for us and evidence about the long-term outcome of these are still emerging. Current evidence is very encouraging but to promote bariatric procedures as a simple fix for diabetes would be dangerous,” cautions Sreejith N. Kumar, a senior physician.
