Bariatric Surgery is a Turning Point in The Treatment of Diabetes Dr. Pradeep Chowbey
With murmurs of turnaround in Indian economy, the turnaround in the health of the ‘driver’ of the economy i.e. Finance Minister, Arun Jately, may also be in the offing. Mr. Jately (61) underwent gastric bypass surgery (most common bariatric surgery) in Max hospital on 2nd September. He has been suffering from diabetes for close two decades and has already undergone a bypass about a decade ago.
Dr. Pradeep Chowbey, chief of bariatric surgery in the hospital, who operated upon Mr. Jately, said that there would be a dramatic improvement in his health condition. Hot on the heels of operating on the most valuable patient ever, Dr.Chowbey, the doyen of bariatric surgery, talked to MediToAll Editor – in- Chief Dhananjay extensively about tectonic shift that this surgery has brought about in the management of a number of life style disorders, especially diabetes. Excerpts from Interview: em>What prognosis can you offer about the effects of Bariatric surgery on Arun Jately, the finance minister? Will diabetes disappear in his case too?
PC– Arun Jately should have come under the knife for this surgery much earlier. Early diabetic birds with certain serious indications get the windfall of benefits from this surgery but even those who come late improve substantially. I would not say diabetes would disappear in Arun Jately but the improvement would be dramatic for sure. His diabetes had escalated and there was swelling in his legs.
Damages already done in his kidney cannot be reversed but the surgery certainly will stem further damage. There would be considerable reduction in the dose of insulin or other medicines. His weight reduction, which is 117 kg now, will add value to his persona. You can fancy him dapper in pant and shirt or suit. His energy level will increase and his stamina for work would be getting a certain boost, which in turn will come handy in his efforts to shore up the economy.
Can we say Bariatric surgery is a turning point in the treatment of diabetes?
PC– Yes of course, bariatric surgery has turned out to be a life saving surgery. Indeed, a turning point in the management of diabetes. What originally was a weight reducing procedure emerged as a magic tool for managing diabetes. This disease is now almost a surgical condition. In diabetes with certain indications, it is now almost the first line of treatment. The procedure has certainly begun a new age in diabetes management. At least we can say that bariatric surgery has established itself as a very effective option in coping with diabetes. There is enough clinical evidence of people who underwent bariatric surgery about 20 years ago and weight and diabetes have not returned to them as yet.
Earlier, diabetes management meant dietary changes, medication and routine exercise and ultimately insulin. But now surgery is an additional weapon to cope with this lifestyle disorder.
Cure is a tempting word for diabetics. Because of this, Bariatric surgery has become a craze of sorts. Every diabetic today wants to undergo this surgery. What is your take on this?
PC- Undoubtedly bariatric surgery has come as boon for diabetics but all diabetics do not derive benefit from this. It is mere hope selling that whosoever undergoes this procedure will overcome diabetics. Let me clarify at the very outset, a diabetic patient having BMI (measurement tool of obesity) below 30 would get no relief from this surgery. I turn away such patients wanting to come under my knife.
Mark my words: There are indications as these which only decide candidates for bariatric. Only diabetics having 25-30 kg upward of normal weight, being type- 2, with uncontrolled sugar ( meaning HBA1C reading being more than 7 point) using insulin, having complication like kidney failure or abnormal increase in creatinine level, should elect this procedure. This surgery is not for normal diabetics whose sugar can be controlled by medicines alone. It is only for diabetics having BMI at 30 or upward of it.
There is strong and enough evidence that for patients with uncontrolled diabetes bariatric surgery is the best option- the earlier the better. If surgery is done within 10 years of onset of diabetes, patients get maximum results. The speed with which weight reduces after bariatric surgery is thrilling and overwhelming. Reduction of 8kg a month! How it happens and what is the extent of weight reduction?
PC– Yes, about 8 kg a month if reduction is reinforced by walk. But if the patient is having knee problems and cannot walk after the surgery, he will have to content with reduction of about 6 kg a month. The extent of reduction is till the patient is left with about 10 percent more weight than his normal.
The speed is really overwhelming. 8 kg in one month! No amount of exercise or other strict weight reduction regimen or diet control plan is known to precipitate such speedy reduction. After bariatric surgery, it so hastens because fat no more remains in reserve, it starts getting used and is exhausted speedily. The process of storage of fat in the body stops because no additional absorption of fat happens any more. It is only utilized, not replenished.
How does bariatric surgery help in the treatment of fatty liver? What are other collateral benefits?
PC- Bariatric surgery has 360 ramifications in terms of benefit. As diabetes endangers every vital organ of the body, bariatric benefits are immense. Damages to these organs due to diabetes immediately stop. But I would stress one benefit especially. It is regarding liver. Fatty liver is another non alcoholic cause of cirrhosis. As post bariatric every part of the body starts losing fat, liver also starts off loading fat. I would say bariatric surgery also is very effective in saving liver from degenerating into cirrhosis. After this surgery, cholesterol level also dips considerably, thus helps in keeping heart healthy.
There was a time when slimming centres like VLCC were a craze for fitness freaks. Now bariatric surgery is the overpowering buzz. Have bariatric surgery made slimming centres irrelevant?
PC- It is not at all so. Slimming centres like VLCC are still needed. Obese people must go to these slimming centres after bariatric surgery for getting their body toned. They are not antitheses to bariatric surgery but complementary. They very much cater to the need of weight loss of those overweight persons whose BMI is less than 30. We are not impinging on their territory at all.
Does bariatric surgery improve love life too?
PC- Greatly, I would say. Since confidence of a person gets a huge boost after bariatric surgery, love life gets a good kick start too. If even one of the couple is obese, their love life is adversely affected. It also helps in solving infertility problem.
Editor – in- Chief