Bariatric Tourism

In patients with obesity

Obesity is the most common preventable cause of type 2 diabetes. Fat cells are resistant to the effect of insulin, the hormone produced in the pancreas that lowers sugar blood levels. At first, the pancreas starts producing more and more insulin to overcome cell resistance and decrease sugar blood levels. With time, this mechanism becomes insufficient and people become diabetic.

It is well known that weight loss and increased physical activity can prevent or delay onset of type 2 diabetes among adults at high risk. They can also reduce the incidence of diabetes-related complications, such as heart disease and chronic renal failure.

Many people with diabetes suffer from disabling conditions, such as visual impairment, foot ulcers, and irregular heartbeat, which make vigorous physical activity difficult and less feasible. Therefore, achieving a substantial amount of weight loss through dieting along is much harder.

Current therapies for type 2 diabetes, which include diet, exercise, oral antidiabetic drugs and insulin injections, do not cure the disease. However, it has been known for years that surgically induced weight loss can cure obesity-related diabetes. Regardless of the type of bariatric operation, the type 2 diabetes mellitus is cured (in over 80% of patients) or dramatically improved (in 20% of patients).

Since the birth of Bariatric Surgery back in the 1950’s, the Roux-en-Y gastric bypass surgery has been one of the most commonly performed weight loss operation in America. It consists of dividing the stomach, with reduces its volume capacity (creating restriction). The small bowel is rearranged so that nutrients are diverted into the mid portion of the intestine (creating malabsorption).

By inducing weight loss, many diseases are controlled or significantly improved, including type 2 diabetes, high blood pressure, sleep apnea, reflux disease, and many others. However, a remarkable finding was constantly reported by bariatric surgeons. Diabetes resolution occurred within days or weeks in patients undergoing Roux-en-Y gastric bypass surgery, well before significant weight loss was achieved. In fact, one out of three patients undergoing gastric bypass discontinued their medications to control their diabetes before being discharged from the hospital. It was therefore concluded that something other that weight loss contributed to the prompt resolution of the diabetes.

Surgically induced weight loss is recommended in patients with morbid obesity and diabetes. Due to changes in the digestion and absorption of carbohydrates, gastric bypass surgery may be even more effective than restrictive bariatric operations, such as the LapBand and the sleeve gastrectomy. However, LapBand and sleeve gastrectomy operations will also ameliorate or cure type 2 diabetes mellitus in a large percentage of patients.

Bariatric surgery has been known to cure type 2 diabetes in over 80% of patients. A recent study published in January 2008 in the Journal of American Medical Association (one of the most prestigious medical journals in the world) showed that patients undergoing LapBand surgery were 5.5 times more likely to get cured from diabetes than patients undergoing conventional medical therapy

This was the first study of its kind to compare diabetes in patients randomly assigned to either surgery or standard medical care. Scientists consider randomized studies to yield the highest quality type of evidence.

Furthermore, a study published in The New England Journal of Surgery compared almost 16,000 patients with morbid obesity; half of them underwent bariatric surgery and the other half followed conventional diets. After a 7-year follow-up period, the study showed that bariatric surgery decreased long-term mortality.

In other words, they reported a significant survival benefit in patients undergoing weigh-loss surgery, since less people died, particularly from diabetes, coronary artery disease, and cancer.

We have observed similar results in our patients here in Guatemala. Regardless of the type of bariatric operation (gastric bypass, gastric banding, or sleeve gastrectomy), in about 80% of patients the type 2 diabetes resolved; in the rest, the diabetes is significantly improved and it is better controlled with conventional medical therapy.