May-22-2012

Diabetes Surgery: Do Drastic Times Call for Drastic Measures?

(Guest post by Amy Walters, PhD, psychologist)

PowerPlay Obesity Management

Type 2 diabetes is truly becoming a national health crisis. The Centers for Disease Control estimate more than 20 million Americans live with this metabolic disease which carries serious health complications if not properly controlled.

Diabetes is  a serious problem, and recently published research details the outcome of a serious treatment: bariatric surgery. According to these studies, the weight-loss surgery was even more effective than medication in controlling patient symptoms. In fact, a significant number of patients experienced remission of their conditions (35-95 percent).

Is this the diabetes cure as so many news headlines have touted? Perhaps–but probably not.

Behavior change matters after weight loss surgery

According to the American Society for Metabolic and Bariatric Surgery most patients who undergo weight-loss surgery regain weight if they don’t change the lifestyle patterns (think diet and exercise) that caused their initial weight gain. Those same lifestyle patterns are contributing factors to the development and progression of Type 2 diabetes. The long-term effects of the surgery are not yet known; but without a change in lifestyle, patients who had surgery, lost weight, and  experienced remission of diabetes symptoms are at serious risk for recurrence.

Learning to follow a healthy diet and incorporate regular activity into daily life is important for everyone.  These lifestyle changes are important for patients with diabetes, whether or not they choose bariatric surgery as a treatment option. But making lifestyle changes can be challenging, especially when we try to do it alone.

Need for support in making changes

Although patients receive professional support for other aspects of diabetes treatment–medication, nutrition counseling, exercise training–behavioral change is typically an unsupported treatment mandate. Diabetes teams need to include a psychologist or other behavioral health professional to help patients reach their health behavior goals. With professional support, patients often report improvements in blood glucose levels (A1C), weight, activity level and mood.

Is there a time when surgery is the best treatment option?  Perhaps. Health care choices are very individual in nature and need to be made with careful consideration of all information. Future research may reveal more about the long-term effects of disease following surgery.

Patients are best served when they meet with their providers to discuss the potential risks and benefits of their treatment options and choose the approach that best meets their individual goals, lifestyle factors and health care needs. A psychologist can provide a source of support and objectivity to help patients explore their thoughts and feelings about health care options, as well as the possible social, emotional, mental, financial or behavioral consequences of their choices. In the end, a well-explored and -informed decision is the best health care decision.

Dr. Amy Walters is a practicing psychologist in Boise, Idaho, who focuses on helping children, teens and adults live well and manage the challenges of diabetes. You call follow her on Twitter @DiabetesPsych.

Photo by heacphotos (via Flickr)

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