Could bariatric surgery — reducing the size of the stomach with a gastric band or surgery — be the solution that patients diagnosed with diabetes type 2 are seeking? The benefits and difficulties were explored at the recent Medtronic briefing for members of the MJA and Guild of Health Writers, as Bruna Tomsic reports.
According to the BMJ Analysis, 27 per cent of adults in the UK are obese and the numbers keep rising every year. And as Professor of Obesity, Diabetes and Endocrinology, Rachel Batterham told the meeting, one-third of 11-year-olds are overweight or obese.
However, it is a global issue, too. Professor Batterham pointed out: “One person dies every 6 seconds of diabetes type 2 around the world,” and patients also face a higher risk of cancer, blindness, stroke or cardiovascular disease. She describes diabetes as the “greatest global problem which keeps increasing and won’t just go away”.
The Chair of Bariatric and Metabolic Surgery, Professor Francesco Rubino, admitted that as a young surgeon, he blamed patients with type 2 diabetes, believe their lifestyle choices were responsible for their condition. However, he now realises that biology plays a big part and has already helped patients fight the disease.
Writing in Scientific American, Professor Rubino said that “An impressive 89 per cent of surgery patients with diabetes were not taking insulin five years after their operation.” He argues: “The surgery is cost-effective considering that some of the patients may start taking their medication from the age of 20, up until they are 70. With the surgery and following the guidelines after, patients will reduce or stop taking their medication, meaning that the solution is for a lifetime.” However, as Professor Batterham pointed out, the NHS Five Year Forward Programme looks at diabetes in the short term and questioned its relevance for a condition which can span decades.
They both agree there is still a lot of work to be done, starting from educating young surgeons, CCGs and medical students, about the way how bariatric surgery works. They stressed it is not an easy way out, but in the long-run it is a cost-effective solution which has been shown to improve the patient’s life expectancy — although access to care, and the equipment needed to deliver the surgery, needs to be improved to avoid a “postcode lottery”.
Critics argue there are alternatives, that people should live a healthy lifestyle, have a balanced diet and exercise, or that prevention is better than cure. But the experts argue that when patient’s BMI is so high it is endangering their life, and conventional weight-loss regimes have failed, they need to be able to receive an effective treatment. Paul Stevenson, a patient who has benefited from bariatric surgery told the meeting: “It is easy to judge if you don’t know.” Just over a year ago, he weighed 321 kg (over 50 stone) and was advised he had to lose around 10 stone before undertaking surgery. But since the procedure he has been able to completely change his lifestyle and now exercises five days a week, and it able to maintain a healthy diet throughout. Now, around 13 months after the surgery, he has lost 18 stone and no longer needs diabetes medications. Mental health played a huge part in his disease, but surgery was coupled with the support he needed from health professionals.
The experts added that bariatric surgery does not work for everybody as our individual biology will influence our response, but that is true of many therapies — and for patients like Paul Stevenson the procedures are transformative. He says: “I can now prove that the surgery reduces diabetes and now I am actually living, not existing..”