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Weight Loss Surgery and Type 2 Diabetes

Obesity, in itself, is a major medical risk. But obesity with type 2 diabetes significantly raises the risk of heart attack, stroke, and other major medical problems associated with diabetes. Increasingly, weight loss surgery is being used as a tool to manage type 2 diabetes. That's because controlling diabetes and managing the related health risks is directly related to losing weight.

Bariatric Surgery and Diabetes

Weight loss surgery is called bariatric surgery. Bariatric surgery has been shown to improve type 2 diabetes for most obese people with diabetes. One potential benefit of bariatric surgery is that it can help some people with diabetes normalize their blood sugar levels without needing diabetes medications. Because diabetes can damage the heart, kidneys, nerves, and eyes, the relatively drastic measure of weight loss surgery may be justified as a way to improve health.

Weight loss surgery works in two basic ways: by restricting the amount of food the stomach can hold, and by decreasing the absorption of food in the stomach and small intestine. There are two types of weight loss surgery commonly used: gastric banding and gastric bypass.

Both types of weight loss surgery ultimately result in a drastic reduction in stomach size. The stomach shrinks from the size of a football to a little pouch about the size of a golf ball above the band or bypass. This helps people eat less and feel full faster with smaller meals. A normal stomach can hold about a quart of food, whereas the small pouch created after weight loss surgery holds only about a half-cup of food.

Adjustable Gastric Banding

The newest technique in weight loss surgery is gastric banding. Banding restricts how much food the stomach can hold, and it does it with minimal change in the way food is absorbed.

Because of the way the procedure is performed, this surgery is known as laparoscopic adjustable gastric banding (LAGB) or gastric banding. There are two types of gastric banding available -- Lap-Band and the Realize band.

LAGB works primarily as a "restrictive" weight loss surgery. An adjustable band placed around the upper stomach creates a small pouch in the upper stomach. Periodic adjustments are made through an adjusting port that's sewn under the skin in the abdomen. To adjust the banding balloon, a bariatric surgeon adds saline fluid to tighten it or takes fluid out to make it looser. The band controls how quickly food can pass through the small stomach pouch and how quickly patients feel full.

Banding is a less risky, less invasive weight loss surgery than gastric bypass. And banding also is often reversible.

Gastric Bypass

The more invasive bariatric surgery -- gastric bypass -- is both a "restrictive" and "malabsorptive" weight loss surgery. It restricts stomach volume and decreases calorie absorption. This procedure, also known as the Roux-en-Y gastric bypass, surgically reduces the size of the stomach. It also bypasses the top of the small intestine. This decreases the calories and nutrients that can be absorbed after eating.

During the procedure, the surgeon divides the stomach to create a small stomach pouch. The surgeon then divides the small intestine and sutures one end to the pouch. The other end of the small intestine is sutured back to itself, creating the "Y" of the Roux-en-Y. The result of the bypass of part of the stomach and small intestine is malabsorption -- or faulty absorption -- of some food and nutrients. The diet after surgery focuses on supplementing specific nutrients that are lost -- protein, vitamin B12, iron, and calcium.

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