Treatment of Type2 DiabetesWeight Loss

Bariatric Surgery is a Critical Tool for Type 2 Diabetes Treatment

Modern techniques have reduced complications and average weight loss is substantial; making the case for widespread coverage of this elective procedure

Gregory Walton, MD, FACS of WeightWise Bariatric Surgery located in Edmond, Oklahoma

We spoke with Gregory Walton, MD, FACS of WeightWise Bariatric Surgery — — located in Edmond, Oklahoma which leads the US in providing high quality / best value bariatric services.

Weight Loss via Diet is Virtually Impossible

“Once someone’s BMI is at 35, it is almost impossible to lose significant weight and keep it off for 2 years.  Only 2-3% of people don’t regain weight quickly.

“The problem is inappropriate hunger.  For millennia, humans have striven to survive and survival has been primarily about hunger.

The hormonally mediated drive to satiate hunger is causing us problems in our modern world of ubiquitous and cheap food.

Low-Fat Foods are not Helping

“In the ’70s there was a strong push by the medical community and government to reduce fats in food.  This was driven by concerns about cholesterol and heart disease. As a result, the food industry reformulated its products and substituted carbohydrates (mostly sugar and corn syrup) for fats.

“The problem is that while fats suppress hunger, carbohydrates increase hunger based on the wider swings in blood sugar levels.

“The result has been more obesity in our population.

Obesity is a Degenerative Disease

“Obesity stresses your heart, lungs, kidneys, liver and other organs.  Its impact is cumulative so the longer you are obese, the more complications you will have and the shorter your lifespan.

There are forty diseases that are caused by or made worse by obesity.  Type 2 Diabetes is a direct result of obesity.

“Obesity surgery, however, is not curative.  It will help you lose weight and this weight loss will remove stress from your organs and extend your life.  

“This palliative care is somewhat like a stent for your heart which will improve cardiac function and extend your life. Similar to stents and heart disease, obesity surgery combined with dramatic lifestyle changes can lead to lifelong success.

Five-Year Outcomes of Gastric Bypass

A study just published in the New England Journal of Medicine evaluated the health effects of Roux-en-Y gastric bypass in a cohort of adolescents (161 patients enrolled from 2006 through 2012) and a cohort of adults (396 patients enrolled from 2006 through 2009). Source

  • The percent weight change for adolescents was -23 to -27% and for adults, it was -27 to -31%.
  • Remission of type 2 diabetes occurred in 86% in adolescents vs. 53% in adults.

Cost of Procedures

“Our prices for pre-paid bundled operations are clearly stated on our website —  These prices include the surgeon, assistant surgeon, anesthesiologist, and an uncomplicated hospital stay.

  • Roux en Y Gastric Bypass – $15000
  • Laparoscopic Duodenal Switch – $15000
  • Laparoscopic Gastric Sleeve – $9995

“Metabolically there are some nuanced differences, but these three operations make up the bulk of operations in the US currently.

Visuals of Each Procedure

Schematic of Roux en Y Gastric Bypass
Schematic of Laparoscopic Duodenal Switch
Schematic of Laparoscopic Gastric Sleeve

Preparation is Key to Avoiding Complications

“Weightwise has a rigorous process to educate and vet candidates for bariatric surgery.  This is to avoid complications from the surgery.

  • In addition to education, a person must lose 5-10% of their weight to reduce stress on their organs and demonstrate that they understand how they will have to live after the operation.  
  • If they have sleep apnea or other sleep issues, these are also addressed before the surgery.  
  • No one is accepted unless their A1c is below 8%.

“We don’t turn people away, we just don’t operate until we get them into a safe surgical state of health and education for safe operations and long term success.

History of Bariatric Surgery

“Bariatric surgery began in the ‘70s and was considered a significant procedure with long recovery time and high risk with a mortality rate of 3-4%.  

Several factors changed this markedly in the mid-’90s.

  • Laparoscopic surgery was introduced which is substantially less invasive/risky compared to open gastric surgery
  • A better understanding was developed of an obese person’s physiology
  • More elegant anesthesias became available
  • Surgeons learned to reduce complications by preparing and educating patients prior to surgery

Today, the operation is considered very low risk, comparable to gallbladder removal.

Approximately 180,000 bariatric surgeries are performed annually in the US with the large majority being laparoscopic.  This volume of surgeries has been constant for 3-4 years and represents about 1% per year of the very obese population.

History of Weightwise

“Toby Broussard, MD and I met our first day of residency in Birmingham, AL.  We both practiced regular general surgery but started doing some bariatric surgery – mainly because we learned the operations during residency (very uncommon in the early ‘90s).  We each realized (separately) that doing bariatric surgery correctly required a different office paradigm to be really good at it.

We are both board-certified general surgeons and have become almost exclusively bariatric surgeons over the last 13 years.   We operate in a 30-bed hospital and have completed about 7000 bariatric operations with a 0 mortality and very low rate of serious complications.

We started offering bundled services to cash pay patients in 2009.  Despite the savings, most big insurance companies still cannot make a check out for bundled services.  We often work with single employers or progressive TPA’s or “consultants.”

Because we are relatively small, we have an excellent relationship with the hospital and the hospital has very little administrative overhead compared to larger hospitals.  

We believe our highly focused approach in a low overhead setting is the future of elective surgical care.  

Future of Bariatric Surgery

“Bariatric surgery has a remarkable track record of treating Type 2 Diabetes.  Between 70-80% of patients experience complete remission and have normal A1c’s after their weight loss.

Nonetheless, it has historically been an elective surgery, similar to cosmetic surgery.  The health benefits, however, of the resulting weight loss are being recognized by health insurance plans and coverage is increasing.

The negative social stigma associated with bariatric surgery has largely vanished because of the overwhelming data supporting the efficacy and safety of the operations.

All of these factors should significantly increase the role of bariatric surgery going forward.  

Martin is the Founder of SelfRx Media and editor-in-chief of Type 2 Nation. He's passionate about sharing knowledge with people with Diabetes.

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