Bariatric surgery is a well-established treatment option for people with type 2 diabetes who are struggling with obesity.
- For many, it provides an effective way to lose weight and improve blood sugars.
- It even results in diabetes remission in the majority of cases.
The reason bariatric surgery is so effective in treating diabetes isn’t entirely clear. But, as we gain more insight into this mystery, one thing that is becoming more clear is that this treatment option is not necessarily for everyone.
Some people may be able to achieve the same results without assuming any surgery risks.
What Is Bariatric Surgery?
Bariatric surgery is a term that refers to any operation that aids in weight loss by changing the digestive tract.
The two most common forms of bariatric surgery are:
- Endoscopic vertical sleeve gastrectomy, in which the size of the stomach is reduced using a suturing device
- Roux-en-Y gastric bypass, in which a small pouch is made in the stomach and attached to the small intestine, thereby allowing most food to bypass digestion in the stomach and absorption in the beginning of the small intestine
These types of surgeries are generally recommended for people who are extremely obese — a BMI of 40 or higher — or for those who have weight-related health problems.
In addition to type 2 diabetes, those suffering from sleep apnea or high blood pressure may also be considered for bariatric surgery even with a BMI as low as 30.
Bariatric Surgery and Type 2 Diabetes
Given the strong relationship between diabetes, weight, food intake, and metabolism, it should come as no surprise that bariatric surgery can be helpful for those living with type 2.
One study of the Roux-en-Y procedure found that diabetes remission was achieved in 50% to 80% of subjects following the surgery. Those who were most successful were younger patients who had had diabetes for a shorter duration and used less insulin.
In addition to reversing diabetes, bariatric surgery has also been shown to reduce major cardiac events and mortality in those living with diabetes.
In addition to type 2 diabetes, there are 39 other diseases that are caused or made worse by obesity. Symptoms and complications of these diseases also, generally, see huge improvements following bariatric surgery.
How Does Bariatric Surgery Improve Insulin Resistance?
There are a number of features about these surgeries that could have a direct positive impact on a metabolic disorder like type 2 diabetes.
For one, most of these surgeries limit how much a person can eat in one sitting and how much food they can digest. This translates directly to fewer blood glucose spikes. Which could aid in keeping blood sugars more stable.
The weight loss that follows the surgery has a positive effect on blood sugar levels and insulin resistance.
But weight loss alone does not account for the amazing results patients have seen from bariatric surgery.
Other postulated explanations for bariatric surgery’s positive effect on diabetes include:
- Changes to hormone amounts released by the gut
- An increase in hormones released by the pituitary gland
- Changes in the amounts of circulating bile acids
- Alterations to the gut biome itself
Dr. Clifford J. Rosen and Dr. Julie R. Ingelfinger hoped to understand some of these explanations with their classical clinical research investigation that compared people with type 2 diabetes who underwent bariatric surgery with weight-loss matched patients who lost weight through diet alone.
These researchers found that both groups showed equal improvement in insulin sensitivity, beta-cell function, and body composition indexes.
They concluded that a reduction in adipose (fat) tissue is solely responsible for the improvements seen in patients who undergo bariatric surgery. And that diet and surgical intervention are both equally effective treatments for type 2 diabetes in obese patients.
Is Bariatric Surgery the Best Option for You?
So, if surgery and diet both lead to diabetes remission, how do you know which option is better for you?
Obviously, any surgery comes with the potential for risks such as infection, bleeding, and blood clots. There are also some long term complications that can arise from bariatric surgery such as gallstones, malnutrition, ulcers, and stomach perforation.
Additionally, Dr. Rosen and Dr. Ingelfinger found that bariatric surgery patients experienced a change in their gut microbiome and reduced branch-chained amino acid concentrations following surgery. The long-term effects of such changes are not yet well understood.
Before you choose to undergo surgery, you need to make sure that the benefits of this treatment option outweigh these risks.
For many people who struggle with obesity, it can be incredibly difficult to lose weight once you hit a certain point. In fact, for people with a BMI over 35, only 2 to 3% are able to lose weight and keep it off.
For people with a BMI over 35, surgery may provide the only effective way to achieve weight loss.
But waiting to get surgery until one has given up on diet and exercise as a solution may reduce the effectiveness of the surgery. After all, those who are the most successful in gaining diabetes remission from surgery are younger people who have only had the condition for a limited time.
So talking with your doctor about bariatric surgery sooner rather than later is in your best interest.
Together, you can form a treatment plan consisting of diet and exercise, and set healthy weight loss goals. You can also discuss ahead of time when surgery might become the best option based on if and how quickly you are achieving these goals.