Obesity rates keep increasing in the United States of America. As of 2013, 2/3 of the US population was overweight and 1/3 of the US population was obese. More specifically, 36% of those living in U.S., or about 78million people in the U.S., are estimated to be obese with a Body Mass Index (BMI) >30kg/m2. As of 2013, all states in the U.S. had greater than 20% obesity prevalence and alarmingly, Mississippi and West Virginia had a prevalence rates of obesity 35% or greater.
Obesity brings with it many health complications. For example, patients with a BMI between 30-35 have a decreased life expectancy of 2-4 years. Patients with a BMI >40 have decreased life expectancy of 8 years. Alarmingly, a BMI >35 is equivalent to a 70% risk of developing DM2. Obesity is noted to have increased rates of multiple sclerosis, hypertension, gout, infertility, osteoarthritis, sleep apnea, and many cancers including breast cancer, kidney cancer, and pancreatic cancer. Therefore, it is imperative that healthcare professionals help their patients achieve a healthier BMI.
In addition to healthier lifestyle changes, patients may qualify for either weight loss surgery or weight loss medications. Patients should be recommended for these therapeutic options under the following conditions:
Indications for weight loss medication:
BMI >30 or
BMI >27 with obesity related comorbidities (DM, HTN, HLD, OSA, NASH, GERD, Asthma, urinary incontinence, debilitating arthritis, pseudotumor cerebrii)
Indications for bariatric surgery:
BMI >40 with no comorbidities or
BMI 35-39.9 with one or more obesity related comorbidity (DM, HTN, HLD, OSA, NASH, GERD, Asthma, urinary incontinence, debilitating arthritis, pseudotumor cerebrii)
The great thing is that even small amounts of weight loss can amount to significant improvements in obesity related comorbidities. For example, aach average 1-kg (2.2-pound) weight loss is associated with a 3-4 month survival increase.
Weight loss of 5-10% of initial body weight can:
- improve glucose control
- reduce blood pressure
- improve cholesterol levels
Bariatric Surgery is one method to assist patients in losing weight and in improving their diabetes. It has been found that after 6 years of having bariatric surgery, patients lose 27% of their initial body weight. In comparison, patients using only lifestyle modification in 6 years lose 0.2% of their initial body weight. Forty two percent of people who underwent bariatric surgery were cured of their high blood pressure in the 6 years post operatively. In addition, 6 years after bariatric surgery, 62% of patients had diabetes remission. When looking at specific kinds of bariatric surgery, 42% of those undergoing gastric bypass and 37% of those undergoing sleeve gastrectomy achieved a HgA1C level of 6% or less after 1 year of treatment. Among patients with pre-diabetes, bariatric surgery reduced the risk of progression to diabetes by 87%.
Although the process of undergoing through Bariatric surgery may seem expensive, the costs are actually fully recovered after 30 months in patients that had diabetes prior to undergoing weight loss surgery. These costs are recovered in the fact that patients who had diabetes before surgery, oftentimes are able to get off many of their medications after having a significant weight loss. For example, insulin use drops by 43% only 3 months after surgery. The use of non-insulin medications for diabetes also drops by almost 50% 3 months after weight loss surgery. In the first three month period after bariatric surgery, the average monthly cost of diabetes medications and supplies for surgery patients is $33 compared to $123 for patients who do not have weight loss surgery. Patients undergoing weight loss surgery are able to save about $120 a month on medications associated with diabetes, high blood pressure, high cholesterol, acid reflux, and depression as soon as 6 months after surgery. Seeing how 10% of US healthcare costs are spent treating complications of obesity, it makes financial sense to have patients undergo weight loss surgery and decrease their risk of obesity related comorbidities.
Obesity is a chronic condition that needs multiple approaches to tackle it. Nutrition, exercise, and healthier living are crucial to improving a person’s health and wellbeing. However, sometimes patients need some medical support to help them achieve their goals. It’s encouraging to know that bariatric surgery is one of the available treatments that can significantly decrease obesity, diabetes, high blood pressure, high cholesterol, and obesity related cancers.
If you need further assistance in managing your diabetes, contact Dr. Miriam Padilla at 801-508-3140. If you are interested in finding more out about bariatric surgery, contact Dr. Beck at 801-964-3855.
Adams, Ted; et all. Health Benefits of Gastric Bypass Surgery After 6 Years. JAMA. 2012; 308 (11):1122-1131.
Carlsson, Lena; et all. Bariatric Surgery and Prevention of Type 2 Diabetes in Swedish Obese subjects. The New England Journal of Medicine. 367;8. August 23, 2012. Pages 695-703.
Klein, S; et all. Economic Impact of the Clinical Benefits of Bariatric Surgery in Diabetes Patients with BMI> 35. Obesity (Silver Spring). 2011 March; 19 (3): 581-587.
American Diabetes Association Clinical Practice Recommendations. Standards of medical care for patients with DM. January 2016 vol. 39 (Supplement 1) S1-S112.