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More and more doctors recommend weight loss surgery for their patients who are seriously overweight, and for patients who have trouble controlling diabetes. A non-surgical approach, however, can work just as well.

Many American doctors have a very positive opinion of gastric bypass and lap band surgery, especially for their diabetic patients.

Doctors recommend these stomach-reducing procedures to their patients who suffer morbid obesity, usually needing to lose 100 pounds (45 kilos) or more, especially those who have not been able to get their blood sugar levels under control after trying for a year. Gastric bypass is also sometimes recommended as a treatment for moderately overweight diabetics who are unable to control their blood sugars with exercise, diet, medication, and insulin.

Less Expensive, No More Dangerous Than Other Options

Promoters of the procedure tout the $15,000 to $25,000 procedure as a nearly immediate "cure" for type 2 diabetes, and recommend it for women who have polycystic ovarian diseases and for people of both sexes who have joint problems aggravated by weight and cardiovascular disease.

The cost of the procedure may sound high, but it is usually covered by insurance for people who are morbidly obese (who have a BMI over 40), and it is no more expensive than a typical year's medical expenses for many people who have uncontrolled diabetes.

Surgeons usually perform gastric bypass through "keyhole" surgery. They make a very small incision and use special instruments to transform the stomach into a tiny pouch which they reconnect to the small intestine. (Sleeve gastrectomy, another common procedure, results in a less drastic reduction in the size of the stomach.) Complications occur in about 1 percent of cases, but the overall risk of hospitalization and death is no higher for patients who get this kind of bypass than for those who do not.

Does Gastric Bypass Deliver What It Promises?

As a treatment for diabetes, gastric bypass is considerably less than 100 percent effective. In a clinical trial reported in 2014, 38 percent of type 2 diabetics receiving the procedure in one group and 25 percent of type 2 diabetics receiving the procedure in another group went into "full remission" from diabetes.  

At the beginning of the study, 90 percent of patients needed insulin, but three years later, only 50 percent continued to need to take daily insulin injections. And diabetics receiving the procedure lost, on average, 23 percent of their body weight and kept if off.

Diabetics who took medications were on average able to get their HbA1C levels (a measurement of long-term blood sugar control) down to a still unacceptably high 8.4 percent, while diabetics who got weight loss surgery were able to get their levels down to a still-high but acceptable 6.7 to 7.0 percent. 

A New Stomach, A New Life

What doctors usually don't tell their gastric bypass surgery patients is that a new stomach may require a new life. Husbands and wives of newly thinner spouses may be threatened by their newfound positive attitudes and attractiveness.

Food no longer plays the same role in life after a gastric bypass. It's no longer possible to drown your sorrows in a carton of Haagen-Dasz ice cream or celebrate a holiday with hot dogs and roasted Marshmallows. Holiday meals have to be rethought, and gatherings with family and friends can no longer center around food — or the person who gets the bypass must be able to deal with being left out.

There has to be a better way. At least one doctor thinks there is.
Continue reading after recommendations

  • Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, Nguyen NT, Li Z, Mojica WA, Hilton L, Rhodes S, Morton SC, Shekelle PG.Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005 Apr 5
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