We are in the midst of what has been described as a “Dia-besity Epidemic” in the United States. Today, 8% of all adults suffer from Adult Onset Diabetes or Type II Diabetes. It is projected that by the year 2030, more than 25% of all adults will have diabetes. There is a direct relationship between the development of diabetes and obesity as 90% of patients with diabetes have at least Class I obesity (>50 lbs overweight).
In 2007, the American Society of Bariatric Surgery (ASBS) changed its name to the American Society for Metabolic and Bariatric Surgery (ASMBS) in recognition of the significant improvement that our procedures provided for patients who suffered from diabetes in addition to their obesity. At the time, it was well known amongst Bariatric Surgeons that our patients would often be discharged home after their surgery no longer requiring any more diabetic medicine before they experienced any significant weight loss. It was clear that the “metabolic procedures” (ie. Sleeve Gastrectomy, Gastric Bypass, Duodenal Switch) somehow affected the ability of the pancreas to secrete more insulin by affecting the hormones controlling the Gastrointestinal system.
In 2014, both the American Diabetes Association and the American Association of Clinical Endocrinologist’s guidelines recommend that patients with a BMI > 35 who have diabetes consider pursuing bariatric surgery as part of their diabetes management. These recommendations are based upon the results of data published in the New England Journal of Surgery that demonstrate that surgery in addition to optimal medical management is superior to simple medical management alone.
At issue today, is the question of whether or not we should be offering metabolic surgery to patients who have a BMI 30-34 (ie. 50-75 lbs overweight). It has been argued that basing the decision to offer surgery based upon the amount of obesity one has rather than the diagnosis of diabetes is arbitrary and misguided. For patients who fit this profile and are interested in pursuing surgery to help control their diabetes, my practice offers the opportunity to participate in an IRB approved research protocol focused upon the Sleeve Gastrectomy procedure. Patients are offered either a multi-port technique or the “Spider” Sleeve Gastrectomy technique. These patients have to be committed to close follow-up afterwards to determine the extent of benefit provided by this treatment approach.
Prior to attending the informational seminar about weight loss surgery, I was unaware that gastric surgery could be done with a single incision. After learning that indeed it can be done if one meets certain size requirements, I was still ambivalent about having one or many incisions because I knew that for vanity reasons, I wouldn’t be showing off my scars either way. When Dr. Chiasson approached me with the option of doing the spider incision, I decided to go along with this method. After my surgery, I was very happy that I just had one incision instead of multiple. With just one incision that needed to heal, I felt that my recovery time was easier and shorter compared to others who had many incisions that needed to heal. I would recommend this approach to anyone who is considering it. Megan R.