Reviewed by Michael Dansinger on July 13, 2014
Kenneth Fujioka, MD, director, Nutrition and Metabolic Research Center, Scripps Clinic.
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When you’re doing treatment, you have three options and you have diet and exercise,
which will give you about 5% to 10% weight loss.
You have diet, exercise, and medications which can push it from 10% to almost 15% weight loss
in the right hands and then you have bariatric surgery which is more like 25% to 30% weight loss.
So if somebody is 300 pounds, they need to lose 100 pounds that may be their best option.
And again, especially if they have a problem related to their weight, in other words, diabetes, that’s the big one.
These folks may have the best option. We also know that as you get heavier into these higher ranges,
what we call “seriously overweight” or 100 pounds overweight or two times normal weight,
they have more metabolic changes that are trying to drive their weight up.
And unfortunately, this is just picking the wrong parents.
It’s your genetics. Unfortunately, their genetics are to be heavier.
Because you can take someone who’s destined to be thin and over feed them,
they never get overweight. Well, they’ll gain maybe 20 pounds, that’s it.
But somebody who gets real heavy, they have a lot metabolic issues.
So now, bariatric surgery becomes a real viable option because it actually--
not only do patients eat less after bariatric surgery,
but in turns out that two of the bariatric procedures; the sleeve and the bypass,
actually adjust some of the hormones that we’ve talked about earlier that are trying to drive your weight back.
When you’re looking at the -- seriously overweight patient with diabetes,
bariatric surgery clearly has the best track record of getting you out of diabetes,
and either prediabetes or even to normal blood sugar state.
It doesn’t mean all patients with diabetes are going to get miraculously cured by it.
But it means a very high percentage; 70%, 80% are going to have much better blood sugars
to a point that where they’re going to come off most or many of their diabetic medications