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Is gastric bypass surgery one way to solve the nation's diabetes epidemic?
A years-long study of obese Utahns shows the surgery hold promise.
Six years after about 400 morbidly obese Utahns had surgery, 60 percent of the patients who had diabetes saw the disease go into remission, compared with the 1 percent remission of a group of obese patients who didn't have surgery.
The findings from the Utah Obesity Study were presented at the Obesity Society conference earlier this month in Orlando, Fla. The society calls itself the leading scientific group studying obesity.
Lead researcher Ted D. Adams, a professor in the Division of Cardiovascular Genetics at the University of Utah School of Medicine, said it's unclear why some patients' diabetes goes into remission. It appears to be related to how the surgery bypasses the small intestine, blocking nutrient absorption and changing hormone levels. Some patients leave the hospital after surgery no longer needing their diabetes medication, he noted, even before they've lost weight.
Still, he doesn't call the surgery a "cure."
"We're not sure how long the remission will occur," he said.
That's also why he doesn't give a blanket recommendation that severely obese patients with diabetes should have the surgery. Individuals need to weigh the risks, including general risks involved with surgery as well as major lifestyle changes, since the stomach can hold just 2 ounces after the operation.
The Utah Obesity Study evaluates patients who have undergone Roux-en-Y gastric bypass, which reduces the size of the stomach and reroutes the small intestine. The person feels full more quickly, and fewer calories are absorbed.
E. Dale Abel, medical director of the Utah Diabetes Center at the U., said he would recommend bariatric surgery to patients "who are obese and are having trouble either controlling their diabetes or losing weight."
He said results like those from the Utah Obesity Study, which he is not involved in, have led to conjecture that gastric bypass could become a treatment for diabetes, regardless of whether the patient is obese.
Still, he said, before seeking surgery, patients must first try to lose weight by changing their diet and exercising. "There are always unintended consequences."
Adams and his colleagues have been tracking severely obese patients since 2001. Previously published studies have shown other promising health results post-surgery, evaluating patients after two years of follow up:
• Two 2011 studies showed they had larger reductions in body mass index, waist circumference, systolic blood pressure, resting heart rate, cholesterol and insulin resistance compared to obese Utahns who didn't have surgery. They also showed improvements in heart rate recovery after exercise. The results, according to one study, support the use of surgery to prevent cardiovascular complications in the severely obese.
• A 2010 study found that compared with obese Utahns who hadn't had surgery, 80 percent no longer had diabetes, 50 percent no longer had high cholesterol and 40 percent didn't have hypertension.
In addition, a 2009 study suggested the surgery can lower patients' cancer risk. Over a 24-year period, the incidence of mainly obesity-related cancers (such as pancreatic, kidney and postmenopausal breast cancer) was reduced, as was cancer mortality.
According to Rocky Mountain Associated Physicians, which offers gastric bypass and whose surgeons are part of the study team, surgery costs more than $19,000 for self-pay patients.
That office says some insurance companies cover the surgery if it's recommended by their doctor, or if the patient is morbidly obese or obese and has conditions such as diabetes or sleep apnea, has completed a psychological evaluation, has consulted with a nutritionist, has completed a diet history and tried a medically supervised weight-loss program before surgery.
Diabetes in Utah
Diabetes exacts a higher toll in Utah than the rest of the country: It is the state's sixth leading cause of death but the seventh in the U.S. Almost 7 percent of Utah adults, or more than 120,000, had diabetes in 2009. And another 45,000 are thought to have diabetes but not know it.
Source: Utah Department of Health