Gastric Bypass Surgery Halts Diabetes

Gastric bypass surgery

Gastric bypass surgery makes the stomach smaller and allows food bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.

The most common gastric bypass surgery is a Roux-en-Y gastric bypass.

An Obese teenagers who have gastric bypass surgery not only lose weight but see their type 2 diabetes disappear, a new study finds.


Also called bariatric surgery, the procedure works by limiting the size of the stomach and thereby reducing the amount of food one can eat. In this study, researchers used the Roux-en-Y method, which involves placing an adjustable band to block off most of the stomach. The band limits how much food the body absorbs.

"Previous studies have shown frequent remission of type 2 diabetes in adults following bariatric surgery, but until now, no research had been done to provide information about outcomes of adolescent diabetics who are considering surgical weight loss," said lead researcher Dr. Thomas H. Inge, an associate professor of surgery and pediatrics at Cincinnati Children's Hospital Medical Center

"Our study found that, in most cases, teens can lose one-third of their weight and come off diabetes medications with remission of their diabetes one year after bypass surgery. This is certainly not the case for similar diabetic teenage patients who did not undergo surgery," Inge noted.

The report is published in the January issue of Pediatrics.

For the study, Inge's group looked at 78 teens with type 2 diabetes. Eleven patients underwent gastric bypass surgery, while the other 67 patients received usual care for their diabetes.

For the teens who had surgery, not only did they have an average 34 percent reduction in their weight, but their diabetes went into remission. Teens that did not have surgery saw an average weight loss of less than two pounds and still needed their diabetes medication.

"In addition to the impressive weight loss and type 2 diabetes results, patients undergoing the gastric bypass surgery also showed significant improvement in blood pressure, insulin, glucose, cholesterol and triglyceride levels," Inge said.

Type 2 diabetes takes a huge toll on the body, and the earlier it starts, the more of an impact it can have, Inge explained.

"These early surgical research findings suggest that diabetes may not be a diagnosis kids have to live with for the rest of their lives," Inge said. "They may not have to face diabetic retinopathy, progressive coronary heart disease and renal failure. In fact, there is good reason to be optimistic about their future cardiovascular health."

"If you are a type 2 diabetic and morbidly obese, gastric bypass surgery should be considered in the treatment pathway," Inge added.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, thinks that while surgery is effective it does not deal with the cause of the obesity epidemic among teens.

"Bariatric surgery is clearly effective in treating severe obesity, preventing and reversing type 2 diabetes, and even extending survival when applied to adults," Katz said. "That similar benefits ensue when the procedure is applied to adolescents is important, but by no means surprising."

Despite the success of surgery, these results should be viewed with caution, Katz said.

"A large and growing proportion of all children and adolescents are subject to obesity, and its complications," Katz said. "Surgery can mitigate those complications, but can we really condone ushering more and more young people through the OR doors for a major surgical procedure to fix what policies and programs that foster healthful eating and regular activity could have prevented in the first place?"

Gastric bypass surgery is an effective last resort for severe obesity in adolescence, as in adulthood, Katz said. "But a last resort it should be, and we should do all we can to minimize the need for this procedure by combating the root causes of obesity in our society."

More information

For more on gastric bypass surgery, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.
The most common gastric bypass surgery is a Roux-en-Y gastric bypass.
In normal digestion, food passes through the stomach and enters the small intestine, where most of the nutrients and calories are absorbed. It then passes into the large intestine (colon), and the remaining waste is eventually excreted.
In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).
This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach).
See a picture of a Roux-en-Y gastric bypass.
What To Expect After Surgery
This surgery usually involves a 4- to 6-day hospital stay (2 to 3 days for a laparoscopic approach). Most people can return to their normal activities within 3 to 5 weeks.
Gastric bypass surgeries may cause dumping syndrome. This occurs when food moves too quickly through the stomach and intestines. It causes nausea, weakness, sweating, faintness, and possibly diarrhea soon after eating. These symptoms are made worse by eating highly refined, high-calorie foods (like sweets). In some cases you may become so weak that you have to lie down until the symptoms pass.
Why It Is Done
Although guidelines vary, surgery is generally considered when your body mass index is 40 or higher or you have a life-threatening or disabling condition related to your weight.
Your doctor may only consider doing gastric bypass surgery if you have not been able to lose weight with other treatments.
The following conditions may also be required or are at least considered:
* You have been obese for at least 5 years.
* You do not have an ongoing problem with alcohol.
* You do not have untreated depression or another major psychiatric disorder.
* You are between 18 and 65 years of age.
All surgeries have risk, and it is important for you and your health professional to discuss your treatment options to decide what is best for your situation. How Well It Works
Most people who have gastric bypass surgery quickly begin to lose weight and continue to lose weight for up to 12 months. One study noted that people lost about one-third of their excess weight (the weight above what is considered healthy) in 1 to 4 years.1 Some of the lost weight may be regained.
The laparoscopic approach showed similar results, with 69% to 82% of excess weight lost over 12 to 54 months.2
Risks
Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.3, 4
Fewer than 3 in 200 (1.5%) people die after surgery for weight loss.3
After a Roux-en-Y gastric bypass:5, 3
* An iron and vitamin B12 deficiency occurs more than 30% of the time. About 50% of those with an iron deficiency develop anemia.
* The connection between the stomach and the intestines narrows (stomal stenosis) 5% to 15% of the time, leading to nausea and vomiting after eating.
* Ulcers develop 5% to 15% of the time.
* The staples may pull loose.
* Hernia may develop.
* The bypassed stomach may enlarge, resulting in hiccups and bloating.
What To Think About
In a gastric bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. This can lead to long-term problems, such as osteoporosis. To prevent vitamin and mineral deficiencies, you may need to work with a dietitian to plan meals, and you may need to take extra vitamin B12 as pills, shots, or nasal spray.
There is also a possibility that you may develop gallstones after gastric bypass. Sometimes the gallbladder is removed as part of the surgery. But if your gallbladder is not removed, then you may need to take medicine to prevent gallstones.4, 6
Early studies of the laparoscopic approach to surgery for obesity suggest that it reduces recovery time and postsurgery complications.2
Gastric bypass surgery: What can you expect?
Find out what to expect, including the benefits and risks, if you choose to have gastric bypass surgery.
Weight-loss (bariatric) surgery changes the anatomy of your digestive system to limit the amount of food you can eat and digest. The surgery aids in weight loss and lowers your risk of medical problems associated with obesity.
Gastric bypass is the favored bariatric surgery in the United States. Surgeons prefer this surgery because it's safer and has fewer complications than other available weight-loss surgeries. It can provide long-term, consistent weight loss if accompanied with ongoing behavior changes.
Gastric bypass isn't for everyone with obesity, however. It's a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle. Before deciding to go forward with the surgery, it's important to understand what's involved and what lifestyle changes you must make. In large part, the success of the surgery is up to you.
How is gastric bypass surgery done?
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Image of gastric bypass surgery Gastric bypass surgery
In gastric bypass (Roux-en-Y gastric bypass) the surgeon creates a small pouch at the top of your stomach and adds a bypass around a segment of your stomach and small intestine.
The surgeon staples your stomach across the top, sealing it off from the rest of your stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. The pouch is physically separated from the rest of the stomach. Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch.
This connection redirects the food, bypassing most of your stomach and the first section of your small intestine, the duodenum (doo-o-DEE-num). Food enters directly into the second section of your small intestine, the jejunum (jay-JOO-num), limiting your ability to absorb calories. Even though food never enters the lower part of your stomach, the stomach stays healthy and continues to secrete digestive juices to mix with food in your small intestine.
Some surgeons perform this operation by using a laparoscope — a small, tubular instrument with a camera attached — through short incisions in the abdomen (laparoscopic gastric bypass). The tiny camera on the tip of the scope allows the surgeon to see inside your abdomen.
Compared with traditional "open" gastric bypass, the laparoscopic technique usually shortens your hospital stay and leads to a quicker recovery. Fewer wound-related problems also occur. Not everyone is a candidate for laparoscopic gastric bypass, however. Talk to your doctor about whether this approach is appropriate for you.