A Call to Allow More People to Undergo Bariatric Surgery

A surgeon who has been at the forefront of exploring bariatric surgery as a potentially curative treatment for type 2 diabetes is calling for it to be made accessible to more people.

Francesco A. Rubino, MD, is the chief of gastrointestinal metabolic surgery at Weill Cornell Medical College and head of the Diabetes Surgery Center at New York Presbyterian/Weill Cornell Medical College.

During a seminar at the recent 69th Scientific Sessions of the American Diabetes Association, he told attendees that the criteria for determining who can undergo the surgery should be changed to allow more overweight people to use it.

Currently, people with a body mass index (BMI) of 40 or more are eligible for the surgery. Rubino would like to see the surgery made available to overweight people with BMIs under 40.

The surgery takes two forms: gastric banding, in which the opening from the esophagus into the stomach is made smaller; and gastric bypass, in which the stomach itself is made smaller. In each case, the digestive system cannot accommodate as much food as before, leading to often drastic weight loss.

Patients who undergo the procedure also experience a cessation of hypertension and a lowering of their risk for cardiovascular disease, often to levels below those of normal weight people in their same age group. In the great majority of patients with type 2 diabetes, the surgery produces a remission of the disease, as well as a 92 percent reduction in the mortality risks specifically associated with it.

Dr. Rubino has previously theorized that based upon the dramatic remissions experienced by type 2s after bariatric surgery, diabetes may well be an operable intestinal disease created by as yet unknown malfunctions-perhaps even at the molecular level-in the small intestine. He has argued that the success of bariatric surgery in eliminating type 2 symptoms indicates that diabetes may not be an irreversible condition.

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