January is almost over. For many that means the diet and exercise program to lose weight for 2018 has already come and gone. For January is a time that many of us reevaluate our lifestyle habits and health goals. If your weight is greater than a BMI of 35 and you have failed meaningful weight-loss attempts then it is time to consider weight loss surgery.
A recent study from the University of Michigan found that delaying weight loss surgery leads to suboptimal outcomes. Fewer people reach their weight loss goals and resolution of major obesity-related illnesses like type II diabetes (T2DM), hypertension, and obstructive sleep apnea. Surgery has always been relegated the last resort solution to weight loss. Interestingly however, this study found that the delay for surgery results in patients gaining weight reaching higher BMIs along with more chronic and severe co-morbidities. As a result, the weight loss and resolution of T2DM, hypertension, and sleep apnea was less. The bottom line is if your BMI is over 35 and you have tried and failed to lose weight through diet and exercise, then now isthe time when surgery is a very good option for you.
The next question is which surgery would give you the best outcome with the fewest side effects. This is always best decided during a conversation with your surgeon. In general, if your T2DM, hypertension, and/or sleep apnea have been recently diagnosed, there are more treatment options available to you. For example, a sleeve gastrectomy where a portion of the stomach is removed to restrict the amount of food you can eat, is an excellent option for a newly diagnosed patient with high blood pressure or sleep apnea. It is also a good option, in some cases, for patients with T2DM. However, for patients with more advanced co-morbidities who are on multiple medications or high CPAP settings, the sleeve may still be a reasonable option, but less likely to resolve T2DM. The Roux-en-Y gastric bypass remains the gold standard for treating and resolving T2DM, with about 80% of patients going into remission often within days of the surgery. The 20% of patients who do not experience resolution are usually later in the disease process, so the time from diagnosis to surgery is very important.
Patients ask about the effectiveness of the duodenal switch and the single anastomosis duodenal switch as an option for weight loss surgery and resolving T2DM. The classic duodenal switch operation is a two-part procedure. Part of the stomach is removed to restrict food intake and then the first part of the intestine, the duodenum, is bypassed way downstream to the end of the small intestine. This operation limits absorption in the small intestine results in good weight loss, but also severe nutritional problems are common. Consequently, I do not recommend this procedure. The single anastomosis duodenal switch is a modification of the classic operation and it is still considered an experimental procedure. The weight loss seems to be good, resolution of the T2DM is not as good as the gastric bypass, and nutritional deficiencies are still being evaluated. Therefore, I would hold off on this procedure as well.
If we can answer any questions, or help you through the weight loss process, please make an appointment at 303-861-4505 and come see us.
Dr. Tom Brown, Colorado Bariatric Surgery Institute