HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Wednesday, January 23, 2008

Diabetes and Surgery

The New York Times reports today on a new study showing that "Weight-loss surgery works much better than standard medical therapy as a treatment for Type 2 diabetes in obese people, the first study to compare the two approaches has found."  The story continues and states,

The study, of 60 patients, showed that 73 percent of those who had surgery had complete remissions of diabetes, meaning all signs of the disease went away. By contrast, the remission rate was only 13 percent in those given conventional treatment, which included intensive counseling on diet and exercise for weight loss, and, when needed, diabetes medicines like insulin, metformin and other drugs.

In the study, the surgery worked better because patients who had it lost much more weight than the medically treated group did — 20.7 percent versus 1.7 percent of their body weight, on average. Type 2 diabetes is usually brought on by obesity, and patients can often lessen the severity of the disease, or even get rid of it entirely, by losing about 10 percent of their body weight. Though many people can lose that much weight, few can keep it off without surgery. (Type 1 diabetes, a much less common form of the disease, involves the immune system and is not linked to obesity.)

Zuzu at Feministe responds by looking behind the articles and getting the bottom of the report on diabetes and weight loss surgery - it doesn't appear to be quite the easy fix to diabetes that the New York Times and Associated Press reports present.  Zuzu writes,

Patients who have lap band surgery can, once they heal, go on to eat a fairly wide variety of foods in small amounts. As for gastric bypass patients? (AP):

Gastric bypass is even more effective against diabetes, achieving remission in a matter of days or a month, said Dr. David Cummings, who wrote an accompanying editorial in the journal but was not involved in the study.

Yeah. And yet somehow the AP article, like the Times article, mentions this without also mentioning what gastric-bypass patients face after surgery. From the Mayo Clinic:

You won’t be allowed to eat for one to three days after the surgery so that your stomach can heal. Then, you’ll follow a specific progression of your diet for about 12 weeks. The progression begins with liquids only, proceeds to pureed and soft foods, and finally to regular foods.

With your stomach pouch reduced to the size of a walnut, you’ll need to eat very small meals during the day. In the first six months after surgery, eating too much or too fast may cause vomiting or an intense pain under your breastbone. The amount you can eat gradually increases, but you won’t be able to return to your old eating habits.

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