Position statements - 15 December 2011

Managing Diabetes Through Weight Loss Surgery

Diabetes Australia has identified a need to present advice on the use of weight loss surgery, or bariatric surgery, as a method of managing diabetes. The position statement was developed by a group of multidisciplinary experts as a result of increased popularity and success of the procedures and the continual rise in Australians living with diabetes. Bariatric surgery refers to the variety of surgical weight loss procedures available including reducing the size of the stomach to restrict the amount of food that a person can consume.

Diabetes Australia Chief Executive Officer Lewis Kaplan explains the purpose of the document. “This position statement is for people living with diabetes. It complements other statements which have been prepared for medical professionals” he said. Advice from Diabetes Australia highlights that weight loss through healthy diet, exercise and lifestyle change is an effective, safe and economical means to help prevent type 2 diabetes and improve control in established diabetes. However there are instances where lifestyle interventions and medical treatments are not successful and bariatric surgery may be considered.

Diabetes Australia advises that bariatric surgery is a viable weight loss treatment option for people with type 2 diabetes with a Body Mass Index (BMI) over 35, where lifestyle interventions and medical treatments for obesity or diabetes have not been successful. People who do not already have diabetes but are risk of developing the condition should only consider surgery if they are very obese (BMI over 40 or over 35 with an obesity-related medical condition).

“While bariatric surgery should always be considered as a last resort, more people have reached that position than ever before, so surgery is increasingly being viewed as a viable option - although not without dangers. A key issue is access for those most in need of the surgery, as public funding is much lower than demand” said Kaplan.

The risks, benefits, appropriateness of surgery and type of procedure must be assessed for each individual. Considerations include a person’s weight, medical history, social environment, lifestyle, expectations and readiness to change their eating and exercise habits. The success of bariatric surgery varies and carries some risk of complications. Access to an experienced, multidisciplinary care team and ongoing follow-up is vital for success and to minimise complications.

Sean Kelly is a person living with type 2 diabetes who has experienced positive lifestyle changes since bariatric surgery, after living at an unhealthy weight for most of his life. “I lived to eat from the moment I woke up in the morning until I went to sleep at night. Now I have virtually no interest in food at all. This is admittedly a loss, but it has saved my life” Kelly said. Kelly has lost 55kg since surgery, has said goodbye to insulin injections and his blood pressure is normal.

An estimated 1.7 million Australians have diabetes with an additional 275 Australians developing the condition every day. There are also an estimated 2 million Australians at risk of developing type 2 diabetes with 25% of Australians considered obese.

Diabetes Australia is the peak consumer body representing people affected by diabetes and those at risk.
Lyn Curtis on 0411 019 929 or lcurtis@diabetesvic.org.au

Case Study - Cheryl

Cheryl was first diagnosed with type 2 diabetes when she was 40 years old and has now lived with the condition for 18 years. Diabetes was a major setback for Cheryl and at first she found adapting her exercise habits and diet an enormous challenge. “Diet was definitely a challenge and having to understand what sugar content was actually in the food I ate” she said. Cheryl had experienced difficulties with her weight since her early twenties, however due to the insulin medication administered to control her diabetes; she gained a great deal more weight and found herself needing additional medication to control her blood pressure, cholesterol and thyroid.

After feeling as though her frustrations were outweighing her breakthroughs, Cheryl researched bariatric surgery and after seeking expert advice and consulting with a dietician, she decided it was the right decision for her to make. Bariatric surgery has been a very positive experience for Cheryl and it has made a significant improvement on the management of her weight and diabetes. “It has been absolutely the best thing I have ever done in my life. It was as though everything just fell into place” she said. Her confidence has grown immensely and she is proud of the way she looks and feels. Medically she has stopped taking most of the medication, her arthritis has improved, she feels healthier and has lost a significant amount of weight. “I now feel like doing things and being involved in activities” she said. “I want to share my experience with others and hopefully encourage them”.

Cheryl acknowledges that there is still work for her to do, however her attitude has changed for the better and she now walks as much as possible and watches what she eat. “I find I am not eating as much as I used to and not eating just for the sake of eating” she said. Her advice to others in the management of diabetes is “be aware of what you put in your mouth and walk, even if you start slowly and work your way to longer walks. Every little bit helps”

Case Study – Sean Kelly

Sean was diagnosed with type 2 diabetes four years ago, however was warned a decade prior that he was “at risk” of developing the condition. Sean had been at an unhealthy weight for as long as he can remember, and despite being aware of the life changing implications of type 2 diabetes, he didn’t take serious notice of the warning signs.

For Sean, he has seen the effects of diabetes first hand. He remembers his great uncle Kenny as an “amazing, decent and beautiful man” transformed into “a man who went totally blind, lost all feeling in his lower legs and had amputations”. Sean recalls a severe loss when his uncle “withered away physically and eventually died from diabetes type 2 related complications”. Sean’s father also passed away at the age of 56 due to cardiovascular disease.

Sean has made multiple efforts at weight loss over the years through dieting, joining a gym, appointing a personal trainer and consulting a psychiatrist. His perseverance has led to some major successes including losing over 30kg through a weight loss program when he was 14 years old and giving up alcohol completely after an adult lifetime of drinking.

Despite this, nothing compares to the breakthroughs he has experienced since opting for a type of bariatric surgery called Roux-en-Y or Gastric Bypass, where the stomach is reduced significantly to leave only a “small pouch”. At first he was a little fearful of the procedure but his optimism outweighed his concerns and while he experienced some surgical complications due to his high BMI, Sean accredits the surgery to saving his life.

Through the ongoing support of his partner, diabetes educator, psychiatrists, dietician and G.P; Sean has lost 55kg since surgery, has said goodbye to insulin injections and his blood pressure is normal. He feels significantly better and has never before received so many compliments about his appearance. Another change Sean has experienced is what he calls the loss of his food libido. “I lived to eat from the moment I woke up until I went to sleep at night. Now I have virtually no interest in food at all. This is admittedly a loss, but it has saved my life” he said.

Sean recommends bariatric surgery to others in a similar position to him but urges them to do lots of research and be prepared for complications. “For about 48 hours after the surgery I felt pretty - actually very bad. But would I take the surgery again? You bet I would! No question” he said.