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Is weight-loss surgery an option?

Bariatric Surgery

 

Some of our members know the importance of losing weight to improve their health and quality of life, and they haven't achieved it yet despite a lifetime of trying. Is bariatric surgery an option?

 

For many people living with diabetes, losing weight is an important strategy for improving health and quality of life. When repeated attempts at healthy eating and regular exercise aren't enough for weight loss, bariatric surgery, otherwise known as weight loss surgery, may be an option. 

 

When it comes to diabetes, bariatric surgery may be a key treatment for people who are obese (have a BMI over 35kg/m2), and have difficulty keeping blood glucose levels in target range.

 

Bariatric surgery can have beneficial effects for arthritis, sleep apnoea, type 2 diabetes, high blood pressure and high cholesterol.

 

There are three main types of bariatric surgery. These are adjustable gastric bands (lap band), partial or sleeve gastrectomy (gastric sleeve) and gastric bypass (Roux-en-Y or biliopancreatic diversion).

 

The ways weight loss is achieved differs according to the different surgeries. Most of these operations are keyhole (laparoscopic) surgery.

 

This table outlines what the different types of surgery do in the body:

 

Procedure

Description

Mechanism for weight loss

 

 

Restricts food intake

Stimulates nerves or changes hormones that suppress hunger

Delays digestion of food and reduces absorption of nutrients

Adjustable gastric band

Adjustable band placed around the upper part of the stomach to create a small pouch

 

 

Partial (sleeve) gastrectomy

2/3 of the stomach is removed

 √ 

√ 

 

Gastric bypass (Roux-en-U) & biliopancreatic diversion

Part of the stomach is removed and parts of the small intestine are repositioned

√   

    

      

 

The ideal type of surgery for someone will depend on many factors including how much weight needs to be lost, whether the procedure needs to be reversible, budget and follow up commitments, among other things.

 

So why would someone with diabetes want to have bariatric surgery?

 

The bottom line is to lose weight to improve blood glucose levels. Weight loss reduces insulin resistance in the body, a key component of type 2 diabetes.

 

People can expect to lose around a half to one kilo of weight each week in the first year after surgery.

 

Depending on an individual's response to surgery, they will need to reduce medications for diabetes, blood pressure and cholesterol.

 

These levels can improve drastically because of the effects of surgery. Up to three out of four people will have blood glucose levels in the normal range without needing medication.

 

Kade Brindell from Brisbane underwent a gastric sleeve operation in March 2016.

 

With type 2 diabetes and high blood pressure, Kade weighed about 170kg, and was keen to improve his health for his future. His GP recommended changes to his diet and exercise and in three months, he lost around 10kg, taking him down to 160kg.

 

At this point, his GP asked if he had ever thought about having weight loss surgery to help him toward a healthier life.

 

Kade did some research on the procedure and talked to a colleague who had the operation.

 

"A person I worked with had just had a gastric sleeve operation. They came back to work and had lost a lot of weight and were talking about the price, but also the benefits of doing it. They said it was the best decision they ever made."

 

Kade realised the potential benefits for his type 2 diabetes and long-term health, and decided to explore this further with his GP. "I really started thinking about it more and I was worried about making sure about being around for my family."

 

What about the cost?

 

After Medicare rebates, a person can expect to pay approximately $2,000 to $5,000 with private health insurance or $10,000-$15,000 without insurance for a gastric band.

 

For gastric sleeves and bypass, the cost is around $15,000-$20,000 without insurance or $4,000-$6,000 with private health insurance.

 

Talk to your private health insurer about their own rebates for weight loss procedures and with surgeons to get a good understanding of all the costs involved.

 

Some surgeons offer direct options for finance, or you may choose to use an external lender to obtain finance to cover the out of pocket cost of your procedure.

 

Because Kade had type 2 diabetes and high blood pressure, he was able to access his superannuation to cover the out-of-pocket cost of the operation, not covered by his private health fund. Kade spent about $10,000 of his super to pay for the procedure.

 

In September last year, just six months after the operation, Kade had lost another 27kg, taking his weight loss total to 50kg in just a year. The aim overall is to lose about 50 per cent to 65 per cent of excess weight.

 

Healthy eating and physical activity are still extremely important after the operation.

 

This is to make sure the weight loss is successful in the long term, but also to ensure good general health.

 

The long-term dietary changes required will depend on the type of surgery done. For example, the gastric band is adjustable and allows the ability to change the band based on foods consumed and any side effects experienced.

 

After surgery, long-term vitamin and mineral supplementation is essential to meet nutrient requirements and prevent conditions like osteoporosis and anaemia.

 

"The biggest thing was even though I've had the surgery, you still have to do the work post-surgery. You've got to make sure what you're putting in is good food," Kade said.

 

After surgery, people who have regular follow up with the team of doctors and dietitians experience more weight loss and less side effects and complications than those who do not.

 

Research is now looking at the long-term effects of the surgery. Follow up studies show that weight loss is successful and sustained, and that positive effects on type 2 diabetes and high blood pressure are experienced.

 

This research is beginning in adolescents as well, with similar benefits displayed. However, more studies with more people and longer periods after surgery are required to confirm this. 

 

Bariatric surgery will not cure type 2 diabetes.

 

It may help people to reduce or eliminate medications for diabetes, but this does not mean that the person no longer has diabetes.

 

Regular health checks are still important. Kade no longer takes any medications for his diabetes or high blood pressure, his sleep apnoea has improved and he has more energy.

 

"I get up at 5 in the morning and go for a walk, with this extra energy I get more things done quicker."

 

Like any surgery, bariatric surgery has risks. There are more likely to be complications the older someone gets, the more overweight they are and if they have other medical conditions.

 

Your doctor can discuss these risks with you and help you to make a decision about whether bariatric surgery may be an option for you. 

 

Here's a link to a video about Kade's journey.

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