If you are considering weight loss surgery to help control your diabetes, chances are you already know a great deal about this disease. Whether you have Type 1 or Type 2 diabetes, whether you know your diabetes to be genetically caused, age-related, of autoimmune origin, or related to diet and weight, you are probably also aware of the possible complications that may threaten your health and even your life.
Bariatric surgery has emerged as an effective and realistic treatment option for obesity-related diabetes, particularly Type 2 diabetes. This type of surgery is usually considered for obese diabetics with a Body Mass Index over 35. After surgery, the patient’s insulin sensitivity increases, requirements for injected insulin are reduced, and he or she responds better to oral medication. Successful weight-loss surgery followed by changes towards a healthy lifestyle can cause the condition to go into remission.
Though both the Roux-en-Y gastric bypass (RYGB) and the Lap-Band procedures offer positive results for weight reduction and remission of diabetes, RYGB seems to be slightly preferable. Bariatric procedures of the bypass type also help by stimulating the secretion of gut hormones that increase insulin secretion and sensitivity. Improved blood sugar control often occurs in bariatric patients even before major weight is lost.
Surgical treatment has been shown to be most effective in patients with recent onset of diabetes, i.e., less than five years. Proper diet, oral medication, and a substantial plus durable weight loss through surgery can often lead to diabetes remission in relatively young and fit diabetics.
What is meant by heart disease?
‘Heart disease’ and ‘cardiovascular disorder’ refer to any condition in which the heart’s ability to function properly is impaired; such conditions are the leading cause of death in the United States. Some commonly diagnosed heart conditions include:
- Cardiomyopathy – Weakening of the heart muscle or a change in its structure, impairing its pumping of blood. Symptoms include shortness of breath, swelling of feet, irregular breathing, and loss of appetite.
- Aortic stenosis – The aortic valve does not open fully, restricting the flow of blood.
- Arrhythmias – The pulse is either too fast (tachycardia) or too slow (bradycardia) due to impairment in the electrical impulses that coordinate the contractions of the heart muscle.
- Coronary heart disease – The small blood vessels that supply oxygenated blood to the heart become congested with plaque and fatty materials.
- Heart attack/myocardial infarction. The heart muscle becomes starved of oxygen when its own blood vessels become blocked.
Though some of these disorders are hereditary, many risk factors for heart conditions—including obesity—are controllable:
- Smoking increases a person’s risk of heart conditions by up to four times.
- High cholesterol increases the risk of heart disease; other conditions such as high blood pressure and diabetes increase this risk.
- Hypertension or high blood pressure adds to the heart’s workload, causing the heart muscle to become thicker and lose flexibility.
- Physical inactivity is a known risk factor. Physical activity of any kind can help control cholesterol, blood pressure, and even diabetes.
- Diabetes poses a serious risk in initiating cardiovascular conditions. A high number of obese diabetics succumb to some form of heart disease.
OBESITY AND HEART DISEASE
Obesity is linked to several chronic conditions including diabetes, arthritis, hypertension, and heart disease. Being overweight increases blood cholesterol and triglycerides and decreases HDL or “good cholesterol,” which is known to lower the risk of heart disease and stroke. Obesity can also lead to diabetes, which raises the risk of heart disease.
BARIATRIC SURGERY FOR OBESE HEART PATIENTS
There is an intrinsic link between obesity and several dangerous conditions including heart disease. Weight loss goes a long way in helping to protect the heart, and bariatric procedures have an established track record of achieving significant and sustained weight loss. Bariatric surgery induces weight loss by restricting the amount of food intake, the amount of food that can be metabolized, or both. These surgeries offer a serious alternative for obese patients who have not been able to lose weight through dieting and exercise.
AMISurgery offers a number of options, including adjustable gastric band (AGB), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with a duodenal switch (BPD-DS), and vertical sleeve gastrectomy (VSG).
Research shows a significant drop in predicted cardiovascular risk for patients who have undergone bariatric surgery as compared to obese individuals who have not. Weight loss after surgery takes some of the strain off the heart, reduces the severity of diabetes, and lowers the risk of heart failure. Biochemical markers and indicators for heart disease, for example cholesterol, show a drop after surgery. However, there is still not enough evidence to prove that weight loss surgery can actually prevent cardiovascular events.
At this point, we’ve all learned a lot about cholesterol, from our doctors and from advertisements for foods, drugs, and exercise equipment. The Internet offers a huge amount of information on this subject, but the take-home message is that, though cholesterol is necessary to our body’s proper functioning, too much is a bad thing, clogging arteries and leading to heart disease among other ill effects. We know we should minimize our dietary intake of low-density lipid (LDL) cholesterol and increase our intake of high-density lipid (HDL) cholesterol.
CHOLESTEROL AND OBESITY
There is a direct correlation between obesity and abnormal cholesterol levels, including elevated LDL and decreased HDL. Particularly for obese individuals with a history of coronary heart disease, this poses further heart health risks. Since obesity also contributes to conditions such as diabetes and hypertension, which affect cholesterol metabolism, every effort should be made to fight obesity. Research tells us that even minor efforts to lose weight have beneficial effects on the heart and can reduce cholesterol levels.
BARIATRIC SURGERY TO CONTROL CHOLESTEROL
Losing weight through bariatric surgery and making important lifestyle changes can turn back the clock on several potentially deadly conditions such as hypertension, diabetes, and high cholesterol levels. Within a few months of gastric bypass surgery, patients have been shown to have almost normal cholesterol and triglyceride levels. The loss of weight reduces the load on the heart, its performance improves, and the correction of cholesterol imbalance helps clear plaque and brings down risks associated with cholesterol deposits in the arteries.
Sleep apnea occurs when breathing during sleep either stops for a period or becomes reduced or labored. Though sometimes caused by neurological problems (central sleep apnea) or prescription drugs, the much more common variety is called obstructive sleep apnea (OSA). The breathing passage becomes blocked; oxygen levels drop because attempts to breathe are unsuccessful, and the subject may gasp for air, disrupting normal sleep. Sleep apnea can introduce or worsen conditions such as high blood pressure, congestive heart failure, and mood disorders.
OBESITY AND OBSTRUCTIVE SLEEP APNEA
In obese patients, though other factors are believed to contribute, OSAS is often blamed on fat deposition around the throat. One treatment for OSA is to keep the airways open using machines that control air pressure; the most well known is the continuous positive airway pressure machine, or CPAP.
The prevalence of OSA among the severely obese ranges from 50% to 90%, leading to the assumption that effective treatment of obesity could help treat OSA. Indeed, studies have shown that a 15% reduction of baseline body weight can substantially increase the pharyngeal cross-sectional area and dramatically reduce the severity of OSAS in morbidly obese patients.
BARIATRIC SURGERY AND SLEEP APNEA
If changes in diet and exercise are unsuccessful in bringing about significant and lasting weight loss, bariatric surgery can be considered. These treatments significantly improve and in some cases completely cure sleep apnea. It is recommended that CPAP therapy be continued for about six months after the surgery. After 12 months, the situation can be reassessed to determine whether CPAP is still necessary.
CANCER AND OBESITY
Well-known risk factors for cancer include age, smoking, family history, exposure to radiation, as well as infection with certain viruses and bacteria. However, medical experts believe that obesity may be in some way related to around one-fourth of the major cancers diagnosed in America.
The National Cancer Institute found that people with morbid obesity (a body-mass index or BMI over 40) are more likely than healthy-weight people to develop a variety of cancers: esophageal, kidney, colon, breast, and uterus. In fact, one study published in the New England Journal of Medicine found that people living with morbid obesity were significantly more likely to die from their cancer than healthy-weight people.
By now, we are all familiar with the recommendations for healthy lifestyle choices, all of which also apply to minimizing the risk of cancer: eliminate excess weight, engage in daily physical activity, avoid junk food, reduce the amount of red meat and alcohol in the diet, eat more vegetables and fruit, and limit the amount of food with preservatives.
BARIATRIC SURGERY AND CANCER RISK
Cancer and obesity do seem to be linked, but there is hope. One recent study showed that women who intentionally lost 20 or more pounds and were not currently overweight had cancer rates at the level of healthy women who never lost weight. Several clinical studies found that bariatric surgery reduced mortality in patients by 29% to 89% when compared to a group of people living with morbid obesity who had not had the surgery.
We know more about depression than ever before, but because the condition takes many forms depending on the person, a list of possible symptoms like the following is often used:
- Lower quality of life
- Lack of interest in, and withdrawal from, usual activities
- Feelings of hopelessness
- Lack of energy
- Difficulty concentrating
- Difficulty making decisions
- Insomnia or excessive sleep
- Stomach aches and digestive problems
- Sexual dysfunction
- Thoughts of death, suicide, or self-mutilation
DEPRESSION AND OBESITY
Research tells us that depression and obesity are closely linked, but their relationship is a two-way street: Obesity can lead to depression, and those suffering from depressive disorders are at risk for obesity.
The inter-relationship between the conditions is complex and involves physiological, psychological, and psychosocial aspects. However, it is clear that reducing weight helps in overcoming depressive tendencies that may arise from social stigmatization that obese individuals have to face. Depressed and obese individuals can experience chronic stress and may exhibit a dysfunctional response to the situation; the response being to gorge themselves with food; particularly comfort food that is often very high on calories. Also researchers conjecture that depression can lead to a weight gain because of the antidepressant medication interfering with the normal functioning of the endocrine system.
Bariatric surgery is proven to help individuals lose weight, and patients who are both obese and depressive benefit from this surgery. Bariatric surgery is not a direct treatment for depression, but its positive effect is documented by improvement in post-surgery markers of depression.
Enhanced self-esteem following bariatric surgery and necessary lifestyle changes have been shown to help patients suffering from depression. However, continued medication is required to keep the disorder at bay. Because depression is also associated with diabetes, one of the co-morbidities related with obesity, bariatric surgery to curb obesity is a worthwhile treatment procedure.
Acid reflux, also known as gastroesophageal reflux disease (GERD), occurs when acid from the stomach splashes up into the esophagus. Over time, this can lead to: esophagitis (inflammation), which can cause difficulty swallowing, ulcers, and scarring; Barrett’s esophagus, or damage to the lining of the esophagus, which has been shown to lead to cancer; and esophageal cancer (adenocarcinoma), which is associated with a low survival rate: only 12% of patients survive for more than five years.
Numerous studies have shown that laparoscopic Roux-en-Y gastric bypass (LRYGBP) gives morbidly obese patients very good control of their GERD. These patients may be better served by LRYGBP than other surgical treatments for GERD because of the additional benefit of significant weight loss. In addition, other researchers have found that RYGBP is both safe and effective at treating reflux esophagitis in patients with less severe obesity.
Osteoarthritis is a degenerative condition of the joints that worsens over time, causing pain and limiting mobility. Though its causes vary, the most common ones include genetic factors, obesity, diabetes, Lyme disease, gout, and rheumatoid arthritis.
OSTEOARTHRITIS AND OBESITY
Obesity is a known risk factor for osteoarthritis of the knee and hips, because excessive weight on these joints wears away the protective cartilage and accelerates disease progression. Complications from obesity also hamper treatment and limit the options available to doctors; surgery to treat the condition takes longer, and the success rates for joint replacement are lower than among patients with normal weight.
Apart from weight reduction and surgery there are no specific treatment methodologies to halt the breakdown of cartilage. However, because even a small loss in weight can help relieve pain in the weight-bearing joints, it is important to make lifestyle choices that include exercise and a healthy diet with fewer calories. Weight loss both helps reduce pain in patients who already have osteoarthritis and lowers the risk in those who are at risk.
Bariatric surgery, with its promise of reliable and lasting weight loss, offers obese patients with osteoarthritis a reduction in the severity of their pain, reducing their dependence on painkillers and steroids. It may also slow the progress of the disease, greatly extending their years of pain-free mobility.
Among women in particular, morbid obesity greatly increases the risk of urinary stress incontinence. A large, heavy abdomen and relaxation of the pelvic muscles caused by the extra weight are thought to weaken the bladder’s valve, allowing the leakage of urine with coughing, sneezing, or laughing. Though urinary incontinence may occur regardless of age, gender, or BMI, it tends to be more severe in the obese.
Obesity is also a major risk factor for fecal incontinence, as its severity increases with BMI. Age is also a factor. A young obese individual may have strong enough sphincter muscles to voluntarily regulate the process of excretion. Muscles weaken as we age, making elderly obese persons more likely to face incontinence.
There is also a co-relation between diabetes and incontinence. Given that obese individuals are often diabetic, their risk of incontinence is higher. Specifically, diabetic women taking insulin are at greater risk than diabetics not dependent on insulin.
WEIGHT LOSS AND INCONTINENCE
Just as weight gain can worsen existing symptoms of incontinence, weight loss can help reverse the situation. Thus, losing weight allows patients to better manage and control not only incontinence but also diabetes, hypertension, and arthritis.
URINARY INCONTINENCE AND BARIATRIC SURGERY
Bariatric surgery has been found to improve urinary stress incontinence. Less weight is placed on the bladder, and other physical changes take place to improve this condition. In fact, research shows that obese patients who underwent gastric bypass surgery had significantly fewer incidents of stress incontinence. In fact, a 2000 study of 500 patients showed 97 percent resolution of urinary stress incontinence in patients after weight loss surgery.