The enormous health benefits of gastric bypass operations kick in before you even drop the pounds
Before her gastric bypass surgery two years ago, Mary Ellen Sweeney weighed in at 344 pounds and suffered from type 2 diabetes. Her blood sugar levels were so out of control that sweet desserts were forbidden. But now, as she sits in a restaurant at the Jersey shore, she orders a slice of raspberry Linzer torte that’s served on a streak of chocolate sauce, with whipped cream on the side. She can indulge because three days after she had a gastric bypass operation, a remarkable thing happened: Her diabetes disappeared.
Sweeney left the JFK Medical Center in Edison, New Jersey, with normal blood sugar levels. It was almost as if a switch had been flipped and the worst complication of her obesity had been turned off—even though she was still more than 150 pounds overweight. “I had hoped that after the surgery, the diabetes would resolve over time, but this was entirely unexpected. It was a beautiful gift,” says the Highlands, New Jersey, writer and tropical fish expert.
Sweeney’s story is striking but not unusual: About half of patients whose stomachs are shrunk by the adjustable (and removable) gastric band experience diabetes remission; fully 80 percent of those whose stomachs are reduced by the much more common Roux-en-Y gastric bypass surgery undergo reversal of the disease. This transformation often happens within days after surgery, well before patients have lost significant amounts of weight.
With the obesity epidemic making diabetes much more prevalent, a possible cure couldn’t have come at a better time. The condition, which causes huge (and damaging) fluctuations in blood sugar levels because of the body’s inability to produce or utilize insulin, disproportionately affects people who are obese as well as those who are physically inactive. (Still, an estimated 10 to 20 percent of people with type 2 are not obese, including some of normal weight.)
Diabetes is a leading cause of death in America, where it affects one in 10 adults, including nine million women. For the vast majority of them, the disease is diagnosed after age 40. Type 2 dramatically increases the risk of heart disease for women at this age and contributes to complications such as stroke and damage to the eyes, kidneys and nerves. There’s no cure for the ailment. This form of diabetes is, at best, treated and managed, and even patients who are vigilant have a hard time keeping their blood sugar levels in check. So if bariatric surgery eliminates diabetes, should more patients be having it?
Right now almost a quarter million Americans undergo bariatric surgery for weight loss each year, and eight out of 10 are women—but the surgery is recommended only for people who are morbidly obese, defined as having a body mass index of at least 40, or a BMI of 35 if you have an additional condition such as type 2 diabetes or hypertension. (Obesity technically starts at 30; you’re overweight if your BMI is 25 to 29.9.) In other words, prime surgical candidates are those who are so obese, their lives are in danger.
Still, some surgeons offer the operations to a limited number of patients who are not that heavy if their diabetes is severe. And some doctors argue that more diabetics—including those who are somewhat overweight rather than obese—could benefit from the surgery. “We cannot just sit here staring at the evidence,” says Francesco Rubino, MD, chief of gastrointestinal metabolic surgery at New York–Presbyterian/Weill Cornell Medical Center in New York City and one of the most vocal and enthusiastic proponents of what he calls diabetes surgery. “The benefits go beyond better blood sugar levels,” Rubino adds. “The patients also improve their cholesterol, hypertension and triglycerides—all the factors that are real killers when clustered together. That’s why the potential for surgery is so huge, and that’s why it makes so much sense to do it on some people who are not obese.”
But what Rubino considers obvious, some experts consider controversial. Medicine is an art that requires a delicate balance of risks and benefits, and gastric bypass surgery is a grueling procedure that carries major risks. Patients can die during surgery or develop serious complications, and the recovery is long and painful. Post-op, patients have to radically cut down on their food intake to accommodate the new tininess of their stomachs. The dramatic rerouting of the intestines and shrinking of the stomach may cause persistent long-term problems, such as malnutrition and bone loss, and some patients suffer severe depression. In addition, little is known about how diabetics who are only slightly overweight will respond to the surgery.