Doctor's Review: Medicine on the Move

December 18, 2017
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The heavy impact of weight-loss surgery

At the beginning of May, the First Canadian Summit on Metabolic Surgery for Type II Diabetes was held in Montreal and it left those of us in attendance both surprised and energized. The first surprise was its title. What the heck is metabolic surgery and why would it benefit people with type II diabetes?

Metabolic surgery is a new term for bariatric surgery. Data shows that for the obese, bariatric surgery is the best way to obtain significant weight-loss as well as long-term weight maintenance. Results from a Sweden study (Swedish Obese Subjects)1 showed that after 10 years, patients who had had gastric bypass still weighed 25-percent less than before the surgery, while those who didn’t have the surgery (control group) weighed only two-percent less.

Having Roux-en-Y gastric bypass surgery will result in a resolution of type II diabetes in 84 percent of patients.2,3 The resolution in diabetes happens almost instantaneously so it’s not the result of losing weight. It’s believed that the changes in gut hormones are the cause of this turnaround. Currently, more research is being done to pinpoint the changes in the gut and to the hormones so that a variation of this surgery could potentially be offered to anyone suffering from type II diabetes if their BMI is as low as 30. The variation would result in normal blood sugar levels, with little or no weight loss.

The other amazing research presented was the lower risk of dying of cancer.4 Researches realize that it may be easier to detect cancer in a thinner person, but they don’t think this would account for all the reduction in risk.

Another surprise is that in Canada in 2007, 6783 patients were waiting for metabolic/weight-loss surgery.5 Only 1313 procedures were preformed, with an average wait time of five years (some centres waits of up to 13 years). Since the wait time is so long, it makes sense to get your patients on the list. Then the team — FM, endocrinologist, dietitian, psychologist, kinesologist and surgeon — can work together to prepare the patient for surgery. Weight gain during the waiting time could be minimized, making long-term success even greater.

The National Institutes of Health recommends that the surgery should be available to patients with a BMI over 40 regardless if they have any comorbidities or a BMI of 35 to 39.9 with any of the following: type II diabetes, hypertension, hyperlipidemia, sleep apnea, osteoarthritis and asthma.6 Currently it’s estimated that about 900,000 Canadians have a BMI over 40.

Most of the summit attendees already worked in metabolic-surgery programs and a poll of the surgeons revealed that most of their patients are self-referred. They’re not learning about the surgery from FMs, endocrinologists or even cancer specialists, but from family, friends or the Internet.

This article was accurate when it was published. Please confirm rates and details directly with the companies in question.

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