When should bariatric surgery be used in the treatment for type 2 diabetes?
Bariatric Surgeon, Dr. Kelly Francis, MD, focuses on the benefits of gastric bypass surgery for the treatment and reversal of type 2 diabetes and other co-morbidities.
Selected Podcast
The Role of Gastric Bypass in the Treatment of Type 2 Diabetes
Featured Speaker:
Organization: Orange Coast Memorial Medical Center
Dr. Francis' Bio
Dr. Kelly Francis, MD
Dr. Francis received her medical degree from Tulane School of medicine in New Orleans in 1994 and completed her internship and residency at Charity Hospital in New Orleans. She is certified by the American Board of Surgery, a fellow of the American College of Surgeons, and a fellow of the American Society for Metabolic and Bariatric Surgery and American Medical Association. Dr. Francis enjoys spending time with her family, traveling and bike riding.Organization: Orange Coast Memorial Medical Center
Dr. Francis' Bio
Transcription:
The Role of Gastric Bypass in the Treatment of Type 2 Diabetes
Deborah Howell (Host): Hi there. Welcome to the show. You’re listening to Weekly Dose of Wellness. It’s brought to you by MemorialCare Health System. I’m Deborah Howell. Today’s guest is Dr. Kelly Francis. Dr. Francis received her medical degree from Tulane School of Medicine in New Orleans. She is certified by the American Board of Surgery as a Fellow of the American Society for Metabolic and Bariatric Surgery and is a bariatric surgeon at the MemorialCare Center for Obesity at Orange Coast Memorial Medical Center. That’s a mouthful. Welcome, Dr. Francis.
The Role of Gastric Bypass in the Treatment of Type 2 Diabetes
Deborah Howell (Host): Hi there. Welcome to the show. You’re listening to Weekly Dose of Wellness. It’s brought to you by MemorialCare Health System. I’m Deborah Howell. Today’s guest is Dr. Kelly Francis. Dr. Francis received her medical degree from Tulane School of Medicine in New Orleans. She is certified by the American Board of Surgery as a Fellow of the American Society for Metabolic and Bariatric Surgery and is a bariatric surgeon at the MemorialCare Center for Obesity at Orange Coast Memorial Medical Center. That’s a mouthful. Welcome, Dr. Francis.
Dr. Kelly Francis (Guest): Thank you very much.
Deborah: A very full career you have.
Dr. Francis: It’s quite busy.
Deborah: Today we’re going to take just a few minutes of your busy day, and we’re going to talk about the role of gastric bypass in the treatment of type 2 diabetes and other comorbidities. Let’s start from the very beginning, if that’s all right with you.
Dr. Francis: Sure.
Deborah: What is obesity?
Dr. Francis: Obesity in general is a metabolic condition in which excess body fat has accumulated to such an extent that patients develop severe medical problems as a result of this excess fat, which decreases their life expectancy due to the increase in health problems.
Deborah: I never knew that. I just thought obesity meant grossly overweight. I didn’t know it was attached to medical conditions affected by that.
Dr. Francis: There’s actually a number which was assigned by the World Health Organization which is based on a calculation of the height-weight ratio. So an obese individual actually has a BMI or body mass index greater than 30. In general, a healthy BMI would be between 19 and 25. As you can see, as someone reaches a BMI of 25, they’re considered overweight.
Deborah: Interesting. Why does type 2 diabetes occur in obese patients?
Dr. Francis: Type 2 diabetes occurs in general because these patients, because of their obesity, which is a result of consuming a high-fat diet, high-calorie diet, and in essence they have a sedentary lifestyle, so what happens is their body is unable to metabolize this excess glucose or blood sugar that is in their system.
Deborah: It’s all down to metabolism, isn’t it?
Dr. Francis: It is. And behavior, lifestyle. It’s basically multifactorial.
Deborah: Okay. Once we’re there, what are the surgical procedures that are available to treat diabetes in obese patients?
Dr. Francis: Well, there are several surgical procedures that are available to treat obesity. Having said that, only two procedures in general, which involve bypassing a portion of the intestine, are available to treat diabetes. The simplest of all surgical procedures is the lap band procedure, which has been well publicized and so forth. However, it does not help treat diabetes other than with the patient losing weight. The bypass procedures that I’m referring to such as gastric bypass, which is considered the gold standard of all surgical procedures, because there’s a segment of intestine that is bypassed, this is what helps contribute to the reversal and remission of diabetes.
Deborah: So you’re taking out a part of the intestine. Is that what you’re saying?
Dr. Francis: The gastric bypass procedure in essence involves two steps, one in which the stomach is made into a small pouch. So we decrease the size of the stomach. We also bring a portion of the small intestine up to that pouch in order to drain it. In doing that, it bypasses a segment of small intestine as well as the remainder of the stomach in which the pouch was taken from.
Deborah: I see. So the common misconception is that you’re cutting out a part of the intestine. That’s not what you’re doing at all. You’re bringing it up to the stomach.
Dr. Francis: We bring it up to the pouch that’s made. It’s the portion of intestine that is bypassed which is what is believed to help or what is one of the main contributors of reversal of diabetes.
Deborah: Okay. Now, is it true that some patients see immediate reversal in their diabetes after gastric bypass and even before they’ve lost much weight?
Dr. Francis: That is very true. Again, it’s well documented that patients will lose weight. That doesn’t happen immediately after surgery. The diabetes portion, which is still not clearly understood, it appears to be a complex interaction between the intestine, the fat cells, the brain, and the immune system. What we are seeing that these patients who have had gastric bypass surgery often are not resumed on any of their medication in the hospital. They often go home on no medications and have glucose control before they’ve lost the pounds.
Deborah: Incredible. Are there other comorbidities besides diabetes that having weight loss surgery can help eliminate?
Dr. Francis: Absolutely. There are many comorbidities or medical problems that are a result of obesity and excess weight. Diabetes is the most important, because as we are seeing, our world is becoming overfed, not undernourished. Therefore, obesity as well as diabetes is becoming an epidemic that is seriously a concern. There are other medical problems as well. Diabetes also contributes to heart disease, which can cause coronary artery disease and fatal heart disease. We see skin problems that resolve. We see respiratory problems or breathing problems. Often, obese patients have difficulty breathing. Some of these patients even have unintelligible apnea which they, quite frankly, just stop breathing at night. So we see this resolved as well. We see that the hypertension or high blood pressure and the cardiovascular benefits of weight loss. We see many patients who have fertility issues resolved as well. As a female bariatric surgeon, I’ve sent a lot of female patients from gynecologists who want to have kids and they can’t because their hormone balance is off. Once they’ve lost that weight, their estrogen cycles normalize, and these patients can now have children. We also see a decrease in cancer. It’s well publicized that obese patients have an increase in cancer, breast cancer, prostate cancer, so we see a decrease in cancer as well. There are many, many benefits to weight loss and weight loss surgery.
Deborah: Everything’s connected in there.
Dr. Francis: It is.
Deborah: What steps would you recommend to someone who’s interested in a weight loss procedure to help with the treatment of their type 2 diabetes?
Dr. Francis: First and foremost, they have to be committed to wanting to do it. That’s hard to do. That’s why conventional methods of diabetes treatment today, such as medical management, behavior management and exercise, aren’t successful, because patients can’t commit and stick to a program. So the patient has to be committed, first and foremost. By that, they need to be educated. They need to understand what the surgery is and how the surgery works and how to use the surgery properly in order to modify their own behavior and so forth. They also should seek out a center of excellence, which is a program such as at Orange Coast Memorial where the physicians have all been doing gastric bypass for many years. I myself have been doing it for 12 years. So there’s a lot of experience there. We can deal with the patient as well as any potential complication. They need to be evaluated medically by their own physician to make sure that all of those problems that we talked about that result from excess weight are as controlled to the best of their ability before they undergo a surgical procedure.
Deborah: But there’s still no reason not to. There would be no reason to fear going into it. What’s your success rate?
Dr. Francis: Absolutely not. The fear is the decrease in life expectancy as a result of obesity and diabetes. Diabetes and obesity are now one of the most common preventable causes of death. That should be the fear. The risk of surgery is much less than the risk of staying obese with diabetes.
Deborah: Well said, Dr. Francis. It’s been really enlightening, inspiring too. I would say consult with your own doctor first, and then go to the experts.
Dr. Francis: Excellent.
Deborah: Thank you so much to have spent some time with us. Did you have any final thought there?
Dr. Francis: I’m sorry, one more time?
Deborah: I just wanted to thank you once again for being on the program.
Dr. Francis: Thank you very much for giving me the opportunity to hopefully enlighten some potential patients.
Deborah: Absolutely, a lot of hope for patients in this time of the year, and of course, in this time in life in general, because we are in a great medical age.
Dr. Francis: We are, definitely. Deborah: I’m Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Be happy, be well.
Deborah: A very full career you have.
Dr. Francis: It’s quite busy.
Deborah: Today we’re going to take just a few minutes of your busy day, and we’re going to talk about the role of gastric bypass in the treatment of type 2 diabetes and other comorbidities. Let’s start from the very beginning, if that’s all right with you.
Dr. Francis: Sure.
Deborah: What is obesity?
Dr. Francis: Obesity in general is a metabolic condition in which excess body fat has accumulated to such an extent that patients develop severe medical problems as a result of this excess fat, which decreases their life expectancy due to the increase in health problems.
Deborah: I never knew that. I just thought obesity meant grossly overweight. I didn’t know it was attached to medical conditions affected by that.
Dr. Francis: There’s actually a number which was assigned by the World Health Organization which is based on a calculation of the height-weight ratio. So an obese individual actually has a BMI or body mass index greater than 30. In general, a healthy BMI would be between 19 and 25. As you can see, as someone reaches a BMI of 25, they’re considered overweight.
Deborah: Interesting. Why does type 2 diabetes occur in obese patients?
Dr. Francis: Type 2 diabetes occurs in general because these patients, because of their obesity, which is a result of consuming a high-fat diet, high-calorie diet, and in essence they have a sedentary lifestyle, so what happens is their body is unable to metabolize this excess glucose or blood sugar that is in their system.
Deborah: It’s all down to metabolism, isn’t it?
Dr. Francis: It is. And behavior, lifestyle. It’s basically multifactorial.
Deborah: Okay. Once we’re there, what are the surgical procedures that are available to treat diabetes in obese patients?
Dr. Francis: Well, there are several surgical procedures that are available to treat obesity. Having said that, only two procedures in general, which involve bypassing a portion of the intestine, are available to treat diabetes. The simplest of all surgical procedures is the lap band procedure, which has been well publicized and so forth. However, it does not help treat diabetes other than with the patient losing weight. The bypass procedures that I’m referring to such as gastric bypass, which is considered the gold standard of all surgical procedures, because there’s a segment of intestine that is bypassed, this is what helps contribute to the reversal and remission of diabetes.
Deborah: So you’re taking out a part of the intestine. Is that what you’re saying?
Dr. Francis: The gastric bypass procedure in essence involves two steps, one in which the stomach is made into a small pouch. So we decrease the size of the stomach. We also bring a portion of the small intestine up to that pouch in order to drain it. In doing that, it bypasses a segment of small intestine as well as the remainder of the stomach in which the pouch was taken from.
Deborah: I see. So the common misconception is that you’re cutting out a part of the intestine. That’s not what you’re doing at all. You’re bringing it up to the stomach.
Dr. Francis: We bring it up to the pouch that’s made. It’s the portion of intestine that is bypassed which is what is believed to help or what is one of the main contributors of reversal of diabetes.
Deborah: Okay. Now, is it true that some patients see immediate reversal in their diabetes after gastric bypass and even before they’ve lost much weight?
Dr. Francis: That is very true. Again, it’s well documented that patients will lose weight. That doesn’t happen immediately after surgery. The diabetes portion, which is still not clearly understood, it appears to be a complex interaction between the intestine, the fat cells, the brain, and the immune system. What we are seeing that these patients who have had gastric bypass surgery often are not resumed on any of their medication in the hospital. They often go home on no medications and have glucose control before they’ve lost the pounds.
Deborah: Incredible. Are there other comorbidities besides diabetes that having weight loss surgery can help eliminate?
Dr. Francis: Absolutely. There are many comorbidities or medical problems that are a result of obesity and excess weight. Diabetes is the most important, because as we are seeing, our world is becoming overfed, not undernourished. Therefore, obesity as well as diabetes is becoming an epidemic that is seriously a concern. There are other medical problems as well. Diabetes also contributes to heart disease, which can cause coronary artery disease and fatal heart disease. We see skin problems that resolve. We see respiratory problems or breathing problems. Often, obese patients have difficulty breathing. Some of these patients even have unintelligible apnea which they, quite frankly, just stop breathing at night. So we see this resolved as well. We see that the hypertension or high blood pressure and the cardiovascular benefits of weight loss. We see many patients who have fertility issues resolved as well. As a female bariatric surgeon, I’ve sent a lot of female patients from gynecologists who want to have kids and they can’t because their hormone balance is off. Once they’ve lost that weight, their estrogen cycles normalize, and these patients can now have children. We also see a decrease in cancer. It’s well publicized that obese patients have an increase in cancer, breast cancer, prostate cancer, so we see a decrease in cancer as well. There are many, many benefits to weight loss and weight loss surgery.
Deborah: Everything’s connected in there.
Dr. Francis: It is.
Deborah: What steps would you recommend to someone who’s interested in a weight loss procedure to help with the treatment of their type 2 diabetes?
Dr. Francis: First and foremost, they have to be committed to wanting to do it. That’s hard to do. That’s why conventional methods of diabetes treatment today, such as medical management, behavior management and exercise, aren’t successful, because patients can’t commit and stick to a program. So the patient has to be committed, first and foremost. By that, they need to be educated. They need to understand what the surgery is and how the surgery works and how to use the surgery properly in order to modify their own behavior and so forth. They also should seek out a center of excellence, which is a program such as at Orange Coast Memorial where the physicians have all been doing gastric bypass for many years. I myself have been doing it for 12 years. So there’s a lot of experience there. We can deal with the patient as well as any potential complication. They need to be evaluated medically by their own physician to make sure that all of those problems that we talked about that result from excess weight are as controlled to the best of their ability before they undergo a surgical procedure.
Deborah: But there’s still no reason not to. There would be no reason to fear going into it. What’s your success rate?
Dr. Francis: Absolutely not. The fear is the decrease in life expectancy as a result of obesity and diabetes. Diabetes and obesity are now one of the most common preventable causes of death. That should be the fear. The risk of surgery is much less than the risk of staying obese with diabetes.
Deborah: Well said, Dr. Francis. It’s been really enlightening, inspiring too. I would say consult with your own doctor first, and then go to the experts.
Dr. Francis: Excellent.
Deborah: Thank you so much to have spent some time with us. Did you have any final thought there?
Dr. Francis: I’m sorry, one more time?
Deborah: I just wanted to thank you once again for being on the program.
Dr. Francis: Thank you very much for giving me the opportunity to hopefully enlighten some potential patients.
Deborah: Absolutely, a lot of hope for patients in this time of the year, and of course, in this time in life in general, because we are in a great medical age.
Dr. Francis: We are, definitely. Deborah: I’m Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Be happy, be well.