Surgery best option for dangerous ‘diabesity’By Charles E. Buban
Philippine Daily Inquirer
Diabetes and being way over your ideal weight are inseparably linked. Consider these unwelcome statistics: 70 percent of those suffering from type 2 diabetes are overweight while 30 percent of those who are overweight suffer from type 2 diabetes.
“Unfortunately, there exists a fine line between diabetes and obesity. These two conditions share such an intimate relationship that it’s often difficult to distinguish which one precedes the other,” observes Dr. Hildegardes Dineros of the Cardinal Bariatric and Metabolic Institute.
In fact, Dineros relates that many doctors worldwide now group these two distinct diseases together into a unique, brand-new epidemic called “diabesity.”
Serious health crisis
“It’s not just a play of words,” assures Dineros who also co-hosts a health radio show at Radyo Inquirer (Radyo Clinic-ko). “Diabesity is a serious health crisis considering that if you are overweight—much worse if you are already obese—your sugar levels may already be off the charts; blood pressure already high; arteries already showing signs of narrowing; kidney function not so good; and if you are a male, the condition may already be causing impotence (erectile dysfunction).”
Dineros shares that diabesity may already be soaring in the Philippines considering one out of four Filipinos are now overweight while one out of 20 Filipinos are already classified as obese.
“We need to help these individuals because type 2 diabetes (with this type of diabetes the body produces some insulin just not enough to meet all of the body’s requirements) develops so slowly that by the time the symptoms are too evident, the condition might already be difficult to manage,” Dineros says.
He also warns that for a Filipino to be regarded as overweight, that person doesn’t have to have a BMI between 25 and 29.9 (a BMI is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in meters).
“You don’t have to be tens of kilos above your ideal weight. As long as you already suffer from high blood pressure, high blood sugar, mobility problems, sleep apnea (condition wherein breathing stops or gets very shallow during sleep), complain of numbness, tingling feeling or pain in the lower legs or feet (because of nerve damage as well as poor blood flow, reduced self-confidence, I believe you are ready for some intervention,” Dineros explains.
Obesity and weight gain can create a vicious and depressing cycle that can be extremely discouraging, Dineros says, adding that the more these people eat, the harder it is for them to feel full.
And the more weight one gains, the harder it is to exercise.
According to Dineros, this cycle is not the root cause of obesity, but can make getting healthy seem impossible once the person has been going down the path of unhealthy habits for years. “The reasons for the imbalance between calorie intake and consumption vary by individual. It could be because of age, gender, genes, psychological makeup, environmental factors or combinations of a number of these factors,” Dineros enumerates.
For these reasons, Dineros often recommends weight loss surgery, which is an important decision to make when the patient is already suffering from obesity and want to live a healthier, more comfortable life.
Not magic bullet
“Weight loss surgery is not a magic bullet. However, it is an option when dieting and exercising have failed and your obesity and its accompanying complications are affecting your health and quality of life,” Dineros explains. He performs the United States FDA-approved LAP Band Adjustable Gastric Banding System (Allergan) at the Cardinal Santos Medical Center (Wilson Street, San Juan) as well as in the two St. Luke’s Medical Centers (Quezon City and Global City, Taguig).
A LAP-Band is a silicone belt or collar that goes around the upper part of the stomach. “After this restrictive, reversible surgery, the functioning part of your stomach will be less than 5 percent—roughly the size of a golf ball—and only able to hold an ounce of food. As a result, your appetite will decrease, and you will eat less, feel full sooner and gradually lose weight (around a pound a week),” Dineros says.
On average, the LAP Band produces a loss of about 40 percent of excess weight in the first year and 55 percent of excess weight in the second year.
Dineros also explained that the procedure is much simpler nowadays considering that not only is the surgery performed in less than an hour but that only one small incision (no longer three or four laparoscopic incisions) is required. “It’s less complicated to perform and less prone to complications”.
However, Dineros clarified that the procedure is just one part of the whole process. “Understanding the root causes of obesity are extremely important if you are considering this procedure as a way to get back to a healthy weight. This is why, together with a dietician and other specialists, I discuss with my patient why compliance to now eat in moderation as well as choosing the right food to eat is crucial,” he said.
Probably the best result that Dineros learned from hundred of his patients is the fact that they no longer need the 16 or 17 medicines they have to take every day to deal with diabesity.
In fact, a new study published by the New England Journal of Medicine found that most bariatric surgery patients were able to discontinue all diabetes medications and maintain disease remission. None of those randomly assigned to receive standard medical treatment for diabetes was able to stop medication.
“While bariatric surgery was previously conceived as a treatment for weight loss, it is now clear that surgery is an excellent approach for the treatment of diabetes and metabolic disease,” he observed.
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