Bariatric Surgery, Diabetes and Cancer
Diabetes, cancer, and weight loss go hand in hand. The majority of obese patients with type 2 diabetes that undergo bariatric surgery see a near-immediate reversal of their diabetes after surgery. They have another chance at life. Studies also show that bariatric surgery reduces the risk of developing certain weight-related cancers.
Type 2 diabetes and bariatric surgery
Type 2 diabetes is closely linked to obesity. According to the American Diabetes Association, nearly 90 percent of people diagnosed with diabetes are overweight or obese (American Diabetes Association 2006). One theory is that an excess amount of abdominal fat contributes to the body's response to insulin, meaning that weight gain contributes to developing type 2 diabetes. Heart disease, blindness, nerve, and kidney damage are complications associated with type 2 diabetes.
Bariatric surgery may be used for patients who have type 2 diabetes, but are not necessarily obese. Diabetic symptoms can improve disease symptoms, reduce the risk of death, and often cause remission of type 2 diabetes. Obesity is a major factor for developing diabetes; however, not all diabetics are qualified for bariatric surgery.
Studies of bariatric surgery and diabetes
A 2007 study published in the New England Journal of Medicine found that morbidly obese patients with diabetes who underwent bariatric surgery had a 92% decrease in long-term mortality (Adams et al 2007).
A recent study, published in the Journal of the American Medical Association (JAMA) shows that 73% of patients who had gastric banding surgery combined with post-surgery therapy achieved remission from their diabetes and lost 21% of their body weight (Dixon 2008). JAMA published another study in 2004 that followed more than 22,000 patients who had gastric banding, gastric bypass, biliopancreatic diversion bypass (BPD), duodenal switch, or gastroplasty. In these patients, 86% showed an improvement in their type 2 diabetic condition, and 76.8% resolved their type 2 diabetes completely (Buchwald et al 2004).
There are theories about how bariatric surgery actually cures diabetes. Some believe it's because of the stimulation of a glucagon-like substance called peptide 1 that increases insulin level when food travels directly into the lower intestine after bariatric surgery such as gastric bypass. Also, the rerouting of the digestive tract decreases the production of hormones, such as ghrelin, that trigger hunger. This decrease in hormone production suppresses the craving for sugar and other foods.
Is bariatric surgery cost effective for diabetics and cancer patients?
Each patient's experience is different. Some patients may save money with bariatric surgery while others may not. Health risks, probable future medical expenses due to obesity, and ongoing medical treatments for obesity-related illness must be considered and measured when comparing the cost of bariatric surgery to continuing on a path without surgery.
Bariatric surgery usually costs an average of $17,000 to $25,000. Bariatric surgery for diabetic patients may cut the costs of those patients who continue using non-surgical medical treatments for their diabetes, estimated at about $30,000. The cost of weight loss surgery is usually less than the cost of diabetic treatments in a patient's lifetime. Bariatric surgery is also believed to be cost effective in the area of cancer treatment, saving many patients from the pain and expense of weight-related cancers.
Cancer and bariatric surgery
There is a link between weight reduction through bariatric surgery and cancer prevention. Obesity is one of the many causes of certain cancers, but if the obesity is reversed, so is the likelihood of those cancers. A recent report estimated that in the United States, 14% of deaths from cancer in men, and 20% of cancer deaths in women are due to being overweight or obese.
Types of cancer associated with obesity
The following types of cancers are more prevalent in obese patients. Some of these cancers are four times more common in obese individuals than non-obese individuals.
- Breast cancer
- Uterine cancer
- Colon cancer
- Kidney cancer
- Esophageal cancer
Researchers of several studies funded by the National Cancer Institute are still investigating the relationship between obesity and cancer, including breast, colorectal, endometrial, esophageal, ovarian, and prostate cancers (National Cancer Institute 2004).
Is surgery the answer?
Only after consulting with a bariatric surgeon, dietician, and psychologist will you know if bariatric surgery is right for you. Bariatric surgery is a life choice requiring life-long changes in behavior, eating habits, and lifestyle. Not everyone is a candidate for bariatric surgery, but if you and your health professionals determine that bariatric surgery is the right choice for you, you can begin your journey to a healthier lifestyle, reducing your risk of diabetes, cancer, and other weight-related diseases.
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Adams, T., R. Gress, S. Smith, R. Halverson, S. Simper, W. Rosamond, M. LaMonte, A. Stroup, and S. Hunt. 2007. Long-Term Mortality after Gastric Bypass Surgery. New England Journal of Medicine. August 23. 357:753-761. http://content.nejm.org/cgi/content/full/357/8/753 (accessed July 17, 2009).
American Diabetes Association. 2006. New US Diabetes Rate Up 90 Percent in Past Decade. Diabetes Forecast: The Healthy Living Magazine. http://forecast.diabetes.org/news/new-us-diabetes-rate-90-percent-past-decade (accessed July 10, 2009).
Buchwald, H., Y. Avidor, E. Braunwald, M. Jensen, W. Pories, K. Fahrbach, and K. Schoelles. 2004. Bariatric Surgery: A Systematic Review and Meta-analysis. Journal of the American Medical Association. October 13. 292(14):1724-1737. http://jama.ama-assn.org/cgi/content/full/292/14/1724 (accessed July 17, 2009).
Dixon, J. 2008. Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes. Journal of the American Medical Association. 299(3):316-323.
National Cancer Institute (US). 2004. Obesity and Cancer: Questions and Answers. March 16. http://www.cancer.gov/cancertopics/factsheet/risk/obesity (accessed July 10, 2009).
Pallarito, K. Weight-Loss Surgery Weighed as Diabetes Rx. 2008. HealthDay News. September 12. Consumer Health Complete. EBSCOhost. University of Houston-Downtown. (accessed July 10, 2009.)
Reinberg, S. Bariatric Surgery Cuts Cancer Risk for Women. 2009. HealthDay News. June 24. Consumer Health Complete. EBSCOhost. Universtiy of Houston-Downton. (accessed July 10, 2009.)