By: Radha McLean
For the first time in years, I bought something from the Misses Department, not the plus sizes!” exclaims Sue Felton, a woman of 43 who’s been battling obesity and type 2 diabetes for the past five years.
A Story of Success
Today, Sue, a housewife who lives in Pittsburgh, Pennsylvania, stands 63 pounds lighter than she did six months ago.
Since her diagnosis with type 2 diabetes in 1997, Sue had progressively and uncontrollably been putting on weight. She went from 230 to as high as 296 pounds, partly as a result of the oral medications she had to take to control her blood-glucose levels.
“No matter how little I ate and how much exercise I got, I would gain weight,” she says. “My doctor and I were able to get the diabetes well under control, but the weight gain was consistent. We went to educators and dietitians. They all said this was the side effect of the oral medications.”
Now the pounds are slowly but surely being shed—a miracle, it seems.
Miracles, however, have little to do with her consistent weight loss. Rather, the weight loss has everything to do with stomach stapling, a surgical procedure that limits the amount of food that can be put into the body by blocking off a part of the stomach.
By virtue of this procedure, Sue has gone from 291 to 228 pounds. She is able to control the amount of food she eats and maintain normal blood-glucose levels without having to take medications.
“I’m doing fantastic,” she reports.
An Unexpected Decision
Ironically, last year Sue would never have expected to encounter such good fortune. At the time, she was juggling a series of oral medications to treat her high blood-glucose levels and control her careening weight gain. After trying numerous combinations of oral diabetes drugs that included Glucophage (metformin) and Avandia (rosiglitazone), her doctor considered putting her on insulin therapy.
“But then he suggested another alternative,” she says.
Why not consider bariatric surgery? her doctor asked.
More commonly known as stomach stapling, the procedure is available as a “last resort” option for severely obese people to lose weight. People with a Body Mass Index (BMI) of 35 or higher, which translates to being at least 100 pounds overweight, are considered to be severely obese. (See the sidebar on page 42 for more information about BMI.)
According to the National Institute of Diabetes and Digestive and Kidney Diseases, the subsequent weight loss following bariatric surgery may result in better blood-glucose levels for people with diabetes, sometimes eliminating the need to take medications.
“I looked at him like he was crazy,” Sue remembers reacting to her doctor. “It seemed almost too good to be true.”
But Sue went ahead and read the Diabetes Health article discussing the pros and cons of the operation (“Stomach Stapling,” May 2001). Her doctor explained that other patients who had undergone the procedure had subsequently lost a significant amount of weight.
The Pros and Cons
Sue decided to acquiesce. But which type of stomach stapling procedure should she choose? There were the relatively simple “restrictive” operations, which simply blocked off part of the stomach, limiting food intake. Then there were the gastric bypass operations, which limited the size of the stomach and shortened the length of the small intestine, restricting intake and absorption of food.
Enid Balder, the woman profiled in the May 2001 Diabetes Health article, had the Roux-en-Y procedure, a type of gastric bypass surgery, and lost 165 pounds. True, the Roux-en-Y had a good track record—it has been shown to cause more and longer-term weight loss than the “restrictive” operations. But people who undergo a gastric bypass operation are subject to malnutrition and are dependent on vitamin supplements for the rest of their lives. Also, minor complications such as infections and dumping (sweating, dizziness and weakness) are common with gastric bypass surgery, and major complications such as blood clotting and even death are a possibility.
After careful consideration, Sue decided on the Vertical Banded Gastroplasty, a “restrictive” operation blocking off part of the stomach, which has a lower risk of malnutrition and complications and would limit her food intake less than the gastric bypass surgery.
The operation went smoothly, with no immediate complications.
When Sue left the hospital, however, she began experiencing abdominal pain. She rushed back to the hospital for treatment of a swollen stomach, which healed itself within 24 hours.
At last, she was home free. Within five days after undergoing the procedure, Sue was completely off her diabetes medications.
“But the experience hasn’t been painless,” she points out.
The stringent food regimen after the operation was challenging—no food for four days, followed by five days on a liquid diet, 10 days of pureed soup, and then four weeks of soft food, not including bread, meat, fruit and vegetables. Only after that could she, at last, eat solid meals.
Now Sue eats a variety of foods in small portions.
“I can eat what I want,” she says. “It’s all in the timing. I eat small portions—a balanced diet with a mix of protein and carbohydrates. I eat only a few ounces at a time.”
She’s also found that her diet is less restricted regarding her diabetes, but more restricted regarding quantity.
“I look at calories, not sugar levels,” she says. “I’m not thinking as much in terms of controlling my blood glucose. I think to myself, .What can I eat, period?'”
And by no means is Sue using the operation as an excuse to slack off from exercise; she’s still working out at the gym several times a week, just as she did before the operation.
Is Getting Insurance Coverage a Battle?
Getting her insurance carrier, Blue Cross/Blue Shield, to cover the cost of the operation was a piece of cake for Sue. They considered her high blood pressure, diabetes and severe obesity and then gave her the thumbs up.
“Major insurance companies approve it,” says Sue about the surgery. “People don’t know it’s an option.”
A Procedure Gone Unnoticed
Her positive experience has left Sue believing that the virtues of bariatric surgery have gone unnoticed by the obese diabetes community.
“People don’t realize that it helps people with diabetes,” she says.