Diabetes and Weight-Loss Surgery: The 4 Types of Procedures, Pros, and Cons
Weight-Loss Surgery Risks
Generally, these surgeries are laparoscopic procedures that are performed with small surgical tools inserted through small incisions. They are done while the patient is done under general anesthesia and usually have low complication rates.
A small percentage of patients who undergo LAGB procedures do not have changes in their hunger and do not experience long-term weight loss. All weight-loss surgeries may require revisions, and complication risk increases if patients do not follow their eating plan. The most common complications are dumping syndrome (which occurs when food passes to quickly from the stomach to the small intestine causing cramps and gastrointestinal distress), nutritional deficiencies, loss of bone density, and abdominal pain.
Surgeries may cause bleeding, infections, or blood clots in the legs. General anesthesia may cause breathing problems or other negative reactions in some patients. Surgeries may cause leaks that need to be corrected, and the band in LAGB procedures may slip. In all procedures, if patients do not eat right, they may regain weight.
Because diabetes can cause wounds to heal more slowly, those with diabetes considering weight-loss surgery may be at increased risk of complications, but at the same time people with type 2 may stand to gain the most from weight-loss surgery. Patients considering weight-loss surgery should discuss all the pros and cons, including all possible complications, with their doctor.
The American Diabetes Association’s 2018 Standards of Medical Care recommend weight-loss surgery for people with a body mass index (BMI) of 40 or higher (37.5 for Asian Americans) regardless of blood sugar level, and for people with a BMI between 35 and 39 (32.5 and 37.4 for Asian Americans) where blood sugar is high. In some cases, people with a lower BMI may be eligible if medications fail to properly control blood sugar.
Potential candidates should remember that their appetite may return six months to two years after surgery, and they will need to adopt healthy eating to avoid regaining weight. Also, dramatic weight loss often occurs immediately after surgery but tapers off in later months, and patients may not lose as much weight as they had hoped. Surgery should be delayed until substance abuse, depression, and mental health have all been adequately addressed.
Weight-loss surgery is a big decision, and if successful can lead to dramatic, long-term weight loss, improved type 2 diabetes control, and improved quality of life. It’s certainly not the right choice for everyone, but it should also not be considered the easy way out or even “cheating” considering the many factors that lead to obesity and the serious health consequences of the condition.