Until not very long ago, the simultaneous prevalence of diabetes and obesity in a person boded doom, a dead end on the road to healthy and long living. With risk factors for virtually all serious diseases multiplied several time 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.
Paradoxically co-existing with under nutrition, ‘Globesity’ is not a problem of the developed world alone but it is a problem shared by developing countries as well. Obesity is a complex condition with serious social and psychological dimensions affecting virtually all age groups. Sedentary lifestyle, unhealthy diet, uncontrolled portion sizes and reduced physical activity have led to obesity rates to rise three fold since 1980’s. Obesity increases the risk of developing type II diabetes mellitus, heart diseases, hypertension & stroke, infertility and certain types of cancer. 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.
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 traditional approach to treat TYPE 2 Diabetes is by oral medications and insulin therapy. Even though the medication approach towards this disease has advanced over the years, very few patients attain normal blood sugar levels leaving the patients susceptible to a majority of severe effects. Treatment should focus equally on remission of both diabetes and obesity and needs to be widely publicized. In the 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.
- 'Diabesity’; is the term that has been coined to appropriately express Diabetes in association with obesity, 60% of Type 2 Diabetics are obese.
- 82%- 92% operated (metabolic surgery) patients show resolution of diabetes which is an overwhelming outcome and may not need any medications for diabetes.
- The outcomes are also driven by the duration of diabetes, best results are seen if the duration is less than ten years, however at all stages the results are good and satisfactory.
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. With the help of endoscopic (keyhole) technique, bariatric surgery can be performed with minimal invasion. The procedure involves 2 to 3 days 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.
In the given scenario of increasing morbidity and mortality due to Type II Diabetes Mellitus, bariatric intervention is emerging as a promising cure. It provides exceptional sustained weight loss and remission of type II diabetes in addition to related co morbidities and quality of life improvements.
(Dr PK Chowbey is the Chairman of Minimal Access, Metabolic & Bariatric Surgery at the Max Super-Speciality Hospital, Saket, New Delhi.)
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