#obsm: Diabetes and Bariatric Surgery

Diabetes and Bariatric Surgery

When bariatric surgeons first identified weight loss surgery as a cure for type 2 diabetes, many argued the claims were “too good to be true.” We now have evidence from prospective randomized clinical trials demonstrating significantly greater improvement and even resolution of type 2 diabetes with surgery compared to medical therapies. The realization that bariatric surgery treats not only obesity, but also type 2 diabetes and other metabolic conditions, was so significant that the American Society of Bariatric Surgery (ASBS) changed their name to the American Society of Metabolic and Bariatric surgery (ASMBS) in 2007.

Despite the medical evidence that obesity is a disease, many medical professionals and laypeople alike continue to harbor negative stereotypes and implicit bias that prevent patients with obesity from receiving evidence-based care for their disease. Recognizing that diabetes and other medical conditions are directly related to obesity has led to the understanding that bariatric surgery is not a cosmetic procedure; rather, it is medically indicated.

Evidence supporting bariatric surgery for patients with diabetes

Today we know that Type 2 diabetes resolves or is improved in the majority of patients who undergo bariatric surgery. There are hormonal changes that occur on the day of surgery, before any weight loss has occurred, that can immediately improve glycemic control. Thus, it seems the stomach does more than just signal hunger. It also modulates the balance between insulin and glucagon and their role in blood sugar control through a complex pathway that involves other hormones such as GLP-1, Ghrelin, and peptide YY. While the exact mechanism is not known, scientists suspect a hormonal pathway modified by bariatric surgery promotes resolution of diabetes independent of weight loss.

Bariatric surgeons and patients celebrate not only weight loss, but also the  resolution of obesity-associated medical problems after surgery. Measurement of blood sugar and laboratory testing of hemoglobin A1c and glucose tolerance testing provide evidence of some of these benefits. Multiple studies have confirmed these findings; two of these are described here:

1. The Swedish Obese Subject study followed more than 2000 severely obese patients electing to have bariatric surgery and compared them with well-matched controls at 2 and 10 years after surgery. These data established the effectiveness of bariatric surgery in prevention and remission of Type 2 diabetes. 
   
   
2. Another notable study, performed by Philip Schauer et al, is the STAMPEDE trial. Researchers randomized patients with uncontrolled Type 2 diabetes into one of two groups: intensive medical therapy alone or intensive medical therapy plus bariatric surgery. Those who had bariatric surgery were much more likely to experience resolution of diabetes than those who did not have surgery.

Based on data such as these, the American Diabetes Association now recommends consideration of bariatric surgery for patients with BMI<35 who have diabetes. However, insurance policies do not routinely cover bariatric surgery for these patients.

In our next #obsm chat, we look forward to discussing these and other facts about bariatric surgery and diabetes. While there is a lot of informations on this topic, there remains much more to learn. We will discuss scientific data on the efficacy of bariatric surgery for patients with diabetes as well as strategies to increase the number of patients with diabetes we can help. The chat will take place June 11 at 9 pm EST, and we will discuss the following topics:

1.  What are some of the misconceptions about #BariatricSurgery and diabetes?
2. What is the mechanism of improvement or resolution of diabetes after #BariatricSurgery?
3. Which surgical option affords the highest likelihood of resolution of diabetes? Why? What are the negative consequences? In what ways can we help more patients with diabetes get #BariatricSurgery? What are the barriers?
4. What is the best care for patients with diabetes whose BMI is between 30 and 35?
5. What other topics would you like to see discussed in the #obsm forum? What comments/feedback do you have about how the chats are run?  
   
   ~The #obsm chat leadership: Heather Logghe, MD, Neil Floch, MD, Amir Ghaferi, MD, MS, Babak Moein, MD, and Arghavan Salles, MD, PhD
   

What does the world need to know about #obesity and #bariatricsurgery?

We are excited to announce the co-sponsored American Society for Metabolic and Bariatric Surgery (ASMBS) and #obsm (obesity social media) Twitterstorm on June 8 at 5:30 - 5:45 pm Pacific Standard Time (12:30 - 12:45 am GMT). Twitterstorms have proven to be powerful tools for health professionals and advocates to disseminate accurate health information. Our Twitterstorm will answer the question: “What does the world need to know about #obesity and #bariatricsurgery?”

Attendees of the #ASMBSweekend will be joining each other live for a workshop on the #obsm community. Beyond the local event, global participation is strongly encouraged. Tweets should include the #ASMBSweekend and #obsm hashtags and be posted between 5:30 and 5:45 pm this Thursday, June 8. We recommend tweets be scheduled in advance with apps such as @TweetDeck or @buffer. Alternatively, tweets can be drafted ahead of time and then manually released during the Twitterstorm, or simply created in real time during the event.

Tweets can be easily followed and retweeted by searching Twitter for #ASMBSweekend or #obsm. The goal of the Twitterstorm is to increase global awareness of the treatment of obesity through bariatric surgery. We encourage continued conversation after the Twitterstorm using the #obsm hashtag. We look forward to your participation.

~The #obsm chat leadership: Heather Logghe, MD, Neil Floch, MD, Amir Ghaferi, MD, MS, Babak Moein, MD, and Arghavan Salles, MD, PhD

Adolescent #BariatricSurgery: What is known? What are the pros/cons?

As a medical anthropologist focused on bariatric surgery, I’m thrilled to have this opportunity to share my story with the #obsm community. My passion for understanding the challenges that adolescents with obesity experience is an extension of my compassion for those who face bullying. Adolescents with obesity are especially vulnerable to bullying. Even when able to escape explicit bullying, adolescents with obesity are more likely to be socially marginalized. Rather than the chronic disease we now understand it to be, society still treats obesity as a character defect. These inequities have far reaching consequences: children with obesity lag behind their normal-weight peers in educational attainment.

Bullying and stigmatization are just two of the challenges that teens with severe obesity face. Due to physical limitations and interpersonal consequences, they routinely miss out on activities and milestones their peers take for granted. Despite their young age, they report struggling for years to lose weight. They (or their parents) seek bariatric surgery because nothing else has worked. In their risk calculus, committing to an irreversible alteration of their bodies with unknown long-term outcomes is a justifiable risk to improve their health and the quality of their lives. But their request for life-altering surgery is controversial. There are many misconceptions—such as bariatric surgery being “too extreme,” “experimental,” and “driven by vanity.”

As a social scientist working in medicine and bioethics, I'm committed to bringing the voices and perspectives of adolescents who undergo bariatric surgery to health care providers and researchers. Teens’ accounts—of their decision-making, the challenges they encounter after surgery, and their creative approaches to managing these challenges—will help providers understand adolescents’ reasons for choosing bariatric surgery, while offering a clearer idea of what information and support they need to succeed. I’m excited to bring the topic of bariatric surgery to the #obsm chat, which connects the surgical community to internists, family medicine physicians, pediatricians, and specialists treating patients with obesity.

Please join us in our next chat on May 14 at 9 pm EST. We are excited to have guest moderator, Dr. Marc Michalsky join us. Dr. Michalsky is a Teen-LABS co-investigator who led the development of the ASMBS (American Society of Metabolic and Bariatric Surgery) best practice guidelines for adolescent bariatric surgery and the ACS (American College of Surgeons) national adolescent bariatric accreditation standards.

We will be discussing the following topics:

T1: What are the most common motivations for adolescents seeking #bariatricsurgery? Do these differ between parents and children?

T2: Who (if anyone) should have #bariatricsurgery before the age of 18? Who should not?

T3: What evidence exists on adolescent #bariatricsurgery? What research is needed?

T4: What barriers are faced by adolescents seeking #bariatricsurgery? What are the pros and cons of waiting until age 18?

T5: Are adolescents prepared for #bariatricsurgery and the requisite lifestyle changes? What information and support do they need?

Guest post written by Janet Childerhose, PhD. Janet is a medical anthropologist and Hecht-Levi postdoctoral fellow at the Johns Hopkins Berman Institute of Bioethics. Her research explores adolescents' experiences of bariatric surgery to treat severe obesity and the ethical questions this intervention raises.

The #obsm chat leadership:

Arghavan Salles, MD, PhD

Heather Logghe, MD

Amir Ghaferi, MD, MS

Neil Floch, MD

Babak Moeinolmolki, MD

Author's note: The original blog post has been edited to reflect the cancellation of Drs. Kimberley Steele and Thomas Inge. We regret that they are no longer able to join us.

#InspireSurgResearch: Connecting via Twitter to meet the needs of #SurgResearchers

By Dr. Angie Ingraham

"Passion is energy. Feel the power that comes from focusing on what excites you."

~Oprah Winfrey

Surgical research excites me. My pursuit of a career in academic surgery is inspired by a desire to better meet the needs of my patients, a love for lifelong learning, and inspiring and supportive mentors. Over the course of my career, the American College of Surgeons has fueled this passion through research opportunities, educational conferences, and access to world class mentorship. 

I am excited to share my passion for surgical research and the American College of Surgeons with like-minded residents and junior faculty as the Surgical Research Committee Liaison for the American College of Surgeons Resident and Associate Society (ACS-RAS). Initially, my top priority is connecting with residents, fellows, and junior faculty to better understand how the American College of Surgeons can support them in surgical research.
 

Photo Credit

The Surgical Research Committee (SRC) is a standing committee of the ACS that focuses on the progress of academic surgery and the funding, content, and direction of surgical research.

The SRC sponsors several educational programs including:

●      Clinical Trials Methods Course

●      Health Services Research Methods Course

●      Symposia (Panel Sessions and Lectures) at the annual Clinical Congress
●      Profile in Surgical Research

The SRC is seeking input from the Resident and Associate Society of the American College of Surgeons (RAS-ACS) membership on the following research related topics:

●      Research in general and how RAS-ACS sees the College helping in the research mission

●      Research courses that RAS would like the College to develop (or modifications to the existing courses)

●      RAS’s opinion regarding the Surgical Forum and other research presentations and panels during the annual Clinical Congress

The SRC wants to design and redesign research and educational programs to meet the needs of the RAS-ACS membership in addition to that of Fellows of the ACS. To do so, the SRC needs the input of residents, fellows, and junior faculty.

Given the ease of social media for public dialogue, I would like to engage in an ongoing #InspireSurgResearch Twitter dialogue. Please use the hashtag to share how the ACS can serve you better in promoting and sustaining academic surgical research. 

I look forward to connecting with you via Twitter!
#InspireSurgResearch

Dr. Angie Ingraham
@AngieIngrahamMD

ACS Surgical Research Committee Liaison

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