Dr. Pradeep Chowbey, Chairman – Max Institute of Laparoscopic, Endoscopic, Bariatric & GI Surgery, Max Hospital Saket, New Delhi
While obesity remains, the major factor contributing to type II Diabetes Mellitus, is also an attributing factor to a plethora of co-morbidities like cardiovascular diseases (CVD) hypertension, Stroke, Infertility and certain type of cancers. Obesity not only affects the longevity of life but also drastically reduces the overall quality of life. It is estimated that globally more than 1 billion adults are overweight & at least 300 million are clinically obese.
Diabesity, a term coined to appropriately express Diabetes in association with obesity has a major prevalence among the Indian Population. It is estimated that around 60% of diabetics are obese, and for every ten kilogram of extra body weight, the lifespan reduces by three years. An obese person with a 50 kg of extra weight has already shortened his life by nearly 15 years. Commonly associated diseases like diabetes, heart problem, joint pains and risk of developing cancer may even shorten the lifespan of the person. That’s the reason we see young obese and not old obese. The simultaneous prevalence of diabetes and obesity in a person has boded doom, a dead end on the road to healthy and long-living.
However, in recent years advanced scientific developments have opened a new channel of life for people who are diabetic as well as obese (Diabesity) – Bariatric and Metabolic surgery. The surgery involves re-alignment of the stomach and intestines in a manner that the size of the stomach reduces, thereby reducing hunger. ‘Roux-en-Y Gastric Bypass’ and ‘Sleeve Gastrectomy’ are two popular bariatric procedures. These procedures are performed laparoscopic (key-hole surgery) giving the patients the benefits of quicker and safer recovery, significantly smaller scars, reduced pain and early return to routine activities.
There is a large body of research to show that medical costs of persons with diabetes and obesity are higher than people who are non-diabetic and not obese for the following key reasons- Obese and Diabetic people need to visit doctors more frequently, require long-term medication along with treatment of varied and often recurring complications caused by the interplay of diabetes and obesity.
In light of the escalating global diabetes crisis, the need of the hour is to identify surgical interventions that provide a long-term metabolic outcome. Hence the concept of ‘metabolic surgery’ is fast gaining ground. It is an attractive proposition for those who have been consigned to take pills for lifestyle diseases for the rest of their lives. With risk factors for virtually all serious diseases multiplied several times by the co-existence of obesity and diabetes, affected individuals suffer drastically shortened life spans. Not to overlook the deterioration in the quality of life of such patients.
Though the outcomes of metabolic surgeries are driven by the duration of diabetes, around 92% of the patients undergoing the procedure have shown resolution of diabetes, which is an overwhelming response. The medical fraternity has acknowledged laparoscopic surgery for obesity and diabetes (bariatric and metabolic surgery) as one of the most promising and breakthrough developments in the last decade which has delivered excellent patient outcomes.
In the given scenario of increasing morbidity and mortality due to Type II Diabetes Mellitus, bariatric intervention is emerging as a promising cure. With the help of the endoscopic (keyhole) technique, bariatric surgery can be performed with minimal invasion. The procedure involves 2 to 3 days of hospitalization and the patient can move around on the same day of the surgery. Recovery is fast and the patients lose 6 to 8 kgs on an average per month. It provides exceptional sustained weight loss and remission of type II diabetes in addition to related co-morbidities and quality of life improvements.