Many of us saw the Tom Hanks film
Forrest Gump, and can recall vividly how Forrest described his relationship with his
long time girlfriend, and eventual bride Jenny. He used to say that “me
and Jenny, we go together like peas and carrots”. What better way
to describe how two seemingly disconnected things can be so perfectly paired?
As it turns out, the idea of two seemingly disconnected things perfectly
going together can be applied to medicine. Indeed, many of us know that
obesity and diabetes may be considered the peas and carrots of primary
care. Certainly the prevalence of these diseases in primary care are about
as common as peas and carrots, and these two diseases frequently dance
in the same body of many of our patients.
Once a person is burdened with the disease of obesity, type 2 diabetes
mellitus (T2DM) is frequently tagging along. Even if T2DM is not overtly
present, its eventual appearance can be reliably predicted based upon
the findings of a prediabetic state such as metabolic syndrome, impaired
fasting glucose or impaired glucose tolerance. Unfortunately, once a person
has prediabetes or T2DM their life expectancy is reduced by as much as
seven years, and the amount of money they will spend on healthcare goes
up. Patients turn to their healthcare providers in search of treatment
options, but medical treatments alone often result in disappointing results.
For those who are able to lose weight, we are reminded of the powerful
grip obesity has on a person as we watch our patients slip back to the
weight at which they started. All too often, we are reminded of the fact
that medical treatments for obesity usually offer a temporary solution
since over 90% of patients are unable to maintain long term weight loss.
But all is not lost.
As it turns out, an operation may be the most effective way to not only
help them achieve a healthier weight, but also to achieve freedom from
the need to take antidiabetic medications. Since the landmark article
in 1995 by Dr. Pories at East Carolina University,
news has slowly made its way into the literature that the best treatment
for an obese person suffering from T2DM is bariatric surgery. For the morbidly obese person, bariatric surgery has been proven to improve
overall survival, reduce overall healthcare expenditures and reliably
cause diabetes to either no longer require treatment, or at least markedly
improve glycemic control.
At the Winchester Medical Bariatric Program, we are committed to helping
people achieve a healthier weight. Obesity is a complicated disease, and
its effective treatment must be implemented through a multidisciplinary,
coordinated approach. We offer medical and surgical treatment options
for weight loss. Medical options include calorie restriction, short term
medication use or liquid meal replacement with Optifast® products.
Surgical treatments include laparoscopic gastric bypass, and the newly
approved laparoscopic sleeve gastrectomy. Over 99% of our operative procedures
are done laparoscopically, and patients typically spend one or two nights
in the hospital after surgery.
Feel free to visit
www.valleyhealthlink.com/bariatrics for more information.
Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it?
An operation proves to be the most effective therapy for adult-onset diabetes
Ann Surg. 1995;222:339-352.
Buchwald H, Avidor Y, Brauwald E, et al. Bariatric surgery: A systematic
review and meta-analysis.
Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term
mortality, morbidity, and health care use in morbidly obese patients.
Ann Surg. 2004;Sep 240(3):416-423; discussion 423-424.
- Cremieux P-Y, Buchwald H, Shikora SA, Ghosh A, Yang HE, Buessing M. A study
on the economic impact of bariatric surgery. Am J Manag Care. 2008; 14(9):589-596.