Q: I have type 2 diabetes and need to take three different medications to keep my blood sugar under control. I hate taking all these pills. I am very overweight and thinking about weight loss surgery. Are they all effective?

A: First, you'll need to find out if you are a candidate for the surgery. At the current time, guidelines set limits on who should have weight loss surgery. It can be considered for people with a body mass index (BMI) of 40 or more. Usually, this is at least 100 pounds overweight. The surgery also can be done if someone has a BMI of 35 or more and an obesity-related health problem, such as diabetes.

In addition to having a BMI of at least 35, you need to have completed a structured weight loss program.

Assuming you meet these criteria, you'll want to consider the risks of surgery. The surgery has become safer, but deaths and serious problems can occur.

Patients with a higher risk of serious complications during and right after surgery include those who:

-- Are extremely obese, with a body mass index of 55 or greater

-- Have a history of blood clots in the legs and / or lungs

-- Function poorly in everyday life. This group may be unable to walk even short distances or do daily activities without help.

Surgeons generally suggest one of three weight loss procedures:

-- Laparoscopic adjustable gastric banding. This is the simplest of the three procedures. It is done through small holes in the abdomen. The surgeon wraps an adjustable band around the upper stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach.

-- Open Roux-en-Y. The surgeon cuts into the abdomen and creates small pouch in the stomach. This bypasses the rest of the stomach. The pouch is hooked to a loop of small intestine beyond the first section of intestine.

-- Laparoscopic Roux-en-Y. There's no large surgical cut. Small holes are made in the abdomen. Cameras are used to guide the instruments. The technique is otherwise similar to the open Roux-en-Y.

Specialists in weight loss surgery debate which of these procedures is best. Roux-en-Y is probably more effective, however, it has greater short-term and long-term risks.

Howard LeWine, M.D. is a practicing internist at Brigham and Women's Hospital in Boston, Mass., and Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School.

 

Available at Amazon.com:

No More Digestive Problems

 

 

Copyright © 2010 Harvard Health. All rights reserved.