Newspaper headlines this past week tout the benefits of using bariatric surgery to cure Type 2 diabetes -- even in people who are not morbidly obese. That’s old news to Drs. Kelvin Higa and Keith Boone, bariatric surgeons at Fresno Heart & Surgical Hospital, who’ve seen these results again and again in their patients and have been studying the effect for several years.
 

“Many people think that bariatric surgery is cosmetic, but that is not true,” said Dr. Boone.  “Losing weight helps with general looks, but we perform bariatric surgery to ‘cure’ or improve medical problems that are caused or made worse by obesity.  Diabetes is the number one reason for proceeding with bariatric surgery.  In our patients who have diabetes and have the Roux-en-Y Gastric Bypass, 85% leave the hospital right after surgery off of all of their diabetes medicines.  The diabetes and obesity epidemics are so interconnected that we now have a new word called ‘diabesity.'"
 

Dr. Boone continued, “In addition to diabetes, we see resolution or improvement in many other medical problems including hypertension, hyperlipidemia, sleep apnea, reflux disease (GERD), asthma, and arthritis of weight bearing joints.”  "Surgery is the most effective treatment for Type 2 diabetes and morbid obesity,” emphatically agreed Dr. Higa, who has participated in several international conferences on this subject.
 

The Associated Press reported this week that that New York-Presbyterian/Weill Cornell Medical Center has been conducting a study on this issue, doing gastric bypass surgery on patients with diabetes, who because they are not extremely overweight, wouldn’t normally qualify for the weight-loss procedure. One of the hospital’s patients, Christina Iaboni, turned to bariatric surgery after trying unsuccessfully to control her diabetes through daily shots of insulin and other medications. "I didn't care if I lost any weight. I just wanted the diabetes to go away," the 45-year-old Connecticut mother of two teenagers told the Associated Press. She’s 50 lbs lighter since her surgery last fall, she’s stopped taking all her diabetes medications and her blood sugar is almost normal, she reported.
 

Most insurance plans cover bariatric surgery as a last resort – only after diet and exercise plans have failed.  And then guidelines, which often follow federal Medicare regulations, say surgery candidates must be morbidly obese with a body mass index over 40, or a BMI over 35 plus a weight-related medical problem like diabetes, sleep apnea or high blood pressure. Generally those who are 100 lbs overweight are considered morbidly obese. These limits, set by the National Institutes of Health in 1991, may have to be changed in light of new evidence regarding bariatric surgery’s affect on diabetes.
 

“In addition to discussions on lowering the criteria to be eligible for bariatric surgery,” said Dr. Boone, “there are some new procedures in experimental phase for patients who are not overweight or obese, for the treatment of diabetes." The Associated Press reported that Dr. Philip Schauer of the Cleveland Clinic is among those pushing the BMI envelope. For a study, he's recruiting 150 overweight and obese diabetics with BMIs between 27 and 43. Some will have surgery and their progress will be compared to those who manage their diabetes with medicine. The goal is to see which group can achieve complete remission. "These procedures can cause long-term remission and restore someone to normal blood sugar levels without medication," Schauer said to the Associated Press.
 

More and more physicians are making the same assertions about a cure for diabetes. This past spring at the International Diabetes Surgery Task Force summit in Italy, attendees issued a consensus statement pronouncing bariatric surgery to be a “legitimate approach” for diabetes treatment. Fresno’s Dr. Higa, who participated in this summit, said research supports a much more positive position. “Even the best medical practices cannot match the results we obtain with surgery,” he said. “Many countries find it more cost effective to treat diabetes with surgery,” Dr Higa explained. “Take away all the emotional, pre-conceived ideas and prejudice regarding obesity and what you’re left with is a growing number of patients who do not have access to the most effective treatment for type 2 diabetes – surgery. This has been proven through randomized, controlled studies.”
 

Last year, 220,000 people had obesity surgery, which can cost between $14,000 and $26,000, according to the American Society for Metabolic and Bariatric Surgery. But diabetes treatment can also be expensive – costing an average of $11,711 a year for total health care for those with the disease, according to the American Diabetes Association. Even so the association said there's not enough evidence to generally recommend surgery for diabetics with a BMI lower than 35 outside of an experiment.
 

This story was reported by Erin Kennedy. She can be reached at ekennedy@communitymedical.org.