Adjustable Gastric Banding and Diabetes

Diane Helms has spent most of her life struggling with her weight.  She’s tried just about every diet you can name and, despite them all, has watched the pounds pile on year after year. 

Diane has been morbidly obese, a term used for someone 50 to 100 percent or 100 pounds above her ideal body weight, for the past thirty-five years. She’s dealt with a host of health issues:  high blood pressure, blocked arteries, and heart problems. Then, three years ago, she was diagnosed with diabetes. 

“I was devastated,” Diane recalls.  “I’d been lucky all those years and not had it.  I always had a fear of getting diabetes because my friend in high school had it, and I knew how hard it was to manage.”

A self-described “country cook” all her life, Diane bought some books and studied ways to manage her diabetes.  “I had to learn to cook differently, season differently, use more vegetables and fruits, and, worst of all, limit my carbohydrates.” Nevertheless, she couldn’t seem to lose weight, and her doctors warned her repeatedly that her health was getting worse.

Finally, the doctor who’d been treating her diabetes surprised Diane with a suggestion.  “Miss Helms,” she remembers him saying, “You need to have lap band surgery because you’re not going to lose this weight on your own.”  

Unfamiliar with the procedure and a little apprehensive about the concept, she dismissed the idea until her oldest son, Tony, encouraged her to have the surgery. “You have it,” she replied. Tony, who was also overweight, decided to go ahead and have the procedure, thinking that it might encourage Diane to do the same.   

After Tony had the adjustable gastric banding surgery and began losing weight, Diane decided that it might also work for her.  She went to a seminar at a local hospital that offered the procedure.  Then she went to two more before finding a bariatric practice that she liked and that would also take her insurance.  Although some insurance companies require a lengthy series of steps before approving the procedure, due to Diane’s health issues and thanks to letters written by her physicians, her paperwork proceeded more quickly than most.

Although banding has been around since the early nineties in the United States, it has grown in popularity in recent years.  The minimally invasive laparoscopic surgery takes about 30 to 45 minutes and is done on an outpatient basis.  Small incisions are made in the skin, and an adjustable ring, the gastric band, is inserted like a belt around the upper part of the stomach to create a small pouch. 

Dr. John Oldham, Jr., MD, FASMBS, who performed Diane’s procedure, explains how it works.  “Basically, we’re just creating a small stomach. We’re making their functional stomach a lot smaller, about the size of an egg, so they can feel fuller much quicker with small portions.” 

In addition to the adjustable ring, doctors implant a small access port that connects to the ring to tubing.  During routine office visits after the procedure, saline can be added through the port to tighten the ring and increase the restriction.  The restriction is what signals people to stop eating if they tend to eat too much at meal time. Karen Barnett, Bariatric Coordinator with the Baptist East Hospital Bariatric Center in Louisville, Kentucky, explains, “It’s a tool that helps trigger a sense of fullness, reminding you ‘I’m full, I’m full, I can’t take another bite.’  It helps you move on.”

It works for people like Diane, who says that in the past, she never truly knew when she was full.  “It’s totally changed the way I eat because I used to eat really, really fast and just gobble my food down, not even thinking about what I was eating. ”  

Unlike most diets, the gastric band doesn’t restrict her from eating certain foods. “I’m a carbohydrate addict, for one thing, and I think it’s hard for a carbohydrate addict not to have carbohydrates.  So all those times I tried the South Beach, Atkins, and the others, I wasn’t getting carbohydrates, so I could never stay on the diet for very long.  With the gastric band, if I want a carbohydrate, I have a carbohydrate, but I may only have eight or ten bites of it.”

Adjustable gastric banding has proven to be very successful for people with a host of weight-related health issues, including diabetes. Dr. Oldham says that there is “a whole list of problems” that are cured or greatly improved as the weight loss occurs, including diabetes, high blood pressure, and sleep apnea. 

Diane Helms after her adjustable gastric banding surgery

Less than three months after her surgery, Diane went back to the doctor to have her diabetes checked.  She’d lost nearly 20 pounds and made some big changes.  “It was more her attitude than anything else,” remembers Nurse Practitioner Mary Ann DeMuro, who has helped treat Diane for her diabetes since Diane was diagnosed. According to DeMuro, the difference was that now Diane “had hope.”  

DeMuro says that both Diane’s diabetes and her blood pressure improved after the procedure.  “Her A1c had come down.  It was 7.6%, and it came down to 7.0%.  Now, this is with no change in medication.  And then her blood pressure improved: It was 159 over 88, and that came down to 130 over 80.”  

DeMuro adds that if Diane continues to lose weight, her quality of life will only get better. “The prognosis is very good. She can continue taking less medicine. She is more active, and you can see the difference-she has a little more pep in her step.  She’s walking better-her whole outlook is better.”    

Medical experts say that although some might consider surgeries such as adjustable gastric banding and gastric bypass a last resort, it’s sometimes the only thing that works for people who are severely overweight. “Most people who are morbidly obese cannot keep the weight off,” says Dr. Oldham.  “It’s a vicious cycle, and that’s been proven time after time. There are rare exceptions, like Jared the Subway guy and people on ‘The Biggest Loser,’ but time will tell when you don’t have time to exercise two straight hours every day and you have to go to work and do your normal job.”  

Dr. Oldham adds that statistics show that morbidly obese patients die 10 to 15 years earlier than normal weight patients, which means that taking the weight off can be a matter of life and death.

Case studies done on adjustable gastric banding have shown it to be an effective therapy for type 2 diabetes.  In fact, a controlled trial conducted at the University Obesity Research Center in Australia between December 2002 and December 2006 found that patients who had adjustable gastric banding surgery not only saw their condition improve, but were also more likely to achieve remission of their type 2 compared with those using more conventional approaches. (Results printed in the January 2008 issue of the Journal of the American Medical Association found of the 60 patients enrolled, 73 percent achieved remission in the surgical group, compared to 13  percent in the conventional group.)

Dr. Oldham notes that although any surgical procedure carries some risk, the risks associated with banding are minimal.  They include the normal risk involved with general anesthesia, as well as the possibility that the band can slip out of position or the stomach can slip up underneath the band. (He says that it’s about a 3 percent chance nationally, but a less than one percent chance in his practice.) The band can also get infected, but that’s very rare, occurring less than one percent of the time.

Diane says she knew that at this point in her life, she wouldn’t be able to lose the weight on her own. “I’m 57 years old, and I was on diet pills when I was ten, so you tell me.  Nobody wanted to lose it more than I did, but after a while you get to where you don’t believe you can lose it…”

She calls her adjustable gastric banding procedure a miracle. It has given her new hope and new dreams.  “I see a future including family vacations, a cruise, looking decent in jeans with a belt, normal shoes, maybe even heels and a red convertible.”  She looks up and asks, “That’s not too much for an old lady, is it?” and starts to laugh. 

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