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    Bariatric Banding and Diabetes

    March 11th, 2008

    by Nick Jacobs

    How do you stop a speeding freight train? Type 2 diabetes is one of the most poignant ailments of the 21st Century. According to the American Diabetes Society website: If present trends continue, one in three Americans, and 1 in 2 minorities, born in 2000 will develop diabetes in their lifetime. That prediction alone could lead to our children having shorter life spans than their parents. In 2005 1.5 million new cases of diabetes were diagnosed in people age 20 years or older.

    Diabetes is the fifth-deadliest disease in the United States. Since 1987 the death rate due to diabetes has increased by 45 percent, while the death rates due to heart disease, stroke, and cancer have declined.

    Sedentary lifestyles and inappropriate diets are at least two of the primary culprits contributing to this situation. It is no secret that diabetes is a disease that can destroy your body in numerous ways including:

    * High Blood Pressure
    * Blindness
    * Kidney Disease
    * Nervous System Damage
    * Amputations
    * Dental Disease
    * Pregnancy Complications
    * Sexual Dysfunction
    * Others

    What is the answer? Maybe the answer is to employ the Ad Council? White bread is bad. Broccoli is great. If all else fails, however, there may be one last emergency rip cord to pull for the auxiliary chute.

    A few weeks ago, Parade Magazine featured an article that reported the findings of a study from Melbourne, Australia confirming what many of us have known definitively for a number of years now. Type 2 diabetes can, through weight loss attributed to bariatric banding surgery, be reversed.

    Bariatric banding surgery involves the careful placing and then inflation of a small silicone type band around the top of the stomach. How is the surgery done? A miniature camera is inserted through a small incision and transmits images back to a video monitor. The band is then inserted through very small incisions that, post surgery, can simply be covered with band aids.

    This procedure limits the amount of food a patient eats and thus begins the weight reduction process. That is what contributes to the reversal of diabetes. The study found that, “after two years, 73% of those treated surgically went into remission from diabetes. That was in comparison to the other 15% who underwent the conventional therapy of diet and exercise. The surgically treated patients lose over 20% of their weight during that amount of time. The researchers did observe that the magic number leading toward reversal seemed to have been a weight loss of about 10%.

    Of course the reversal itself is directly attributable to weight loss, and is only recommended and paid for by most insurance companies after everything else has been tried.

    The pitfalls of the various solutions available including any surgical procedure must be fully understood, but bariatric banding surgery is: 1.) Less risky than traditional gastric bypass surgery 2.) It is minimally invasive, and 3.)Finally, it is reversible. Although this procedure as compared to the complete bypass procedure may result in a little slower weight loss, it is, according to the study, very effective.

    Regardless of the type of procedure chosen, the patient must make a commitment for several months to attempt to reduce the weight through conventional diet and exercise, and in a quality, comprehensive program, numerous professionals including: a physician, dietitians, exercise physiologists, a psychologist and nurses are provided to give the patient the support needed to enable them to stay on the program.

    Post surgery, that same team of professionals must be available to monitor you so as to ensure that your progress is appropriate, that appropriate nutrients are consumed, and that no complications are permitted to go unchecked.

    If the train won’t stop, maybe banding is the solution.

    Comments:

    Comment from: Onehealthpro [Visitor] · http://www.Onehealthpro.typepad.com
    I fear solutions like this one as it suggests no one need be accountable. And I don't just mean those of us who need to reduce our weight. The food industry continues to profit from selling items that knowledgeable people know they should not be eating. Schools cannot find the funding to support physical education. Medical professionals can't find the time to establish quality educational and support systems for patients. Restaurants have no accountability for identifying nutritional information on menus.
    Onehealthpro
    Permalink 03/11/08 @ 08:27
    Comment from: Dweb911 [Visitor] · http://danovation.blogspot.com
    I agree with onehealthpro. The banding solution does not mesh with the prevention focus that we need to move to in order to sustain a healthy health care system in this country. So its another wait till it gets bad and then fix it. Its more of the same for the medical community. Just fix it. So who will be paying for it. With millions of uninsured will Banding be a emergent procedure so everyone must get it. Agreed.... We need more accountability!
    Permalink 03/11/08 @ 12:02
    Comment from: Tom [Visitor] · http://lastmilemktg.net
    Who can disagree with following a sensible diet and getting regular exercise as the best "treatment"? Now back to reality. A banding procedure will be selected by many patients and their physicians - some patients will have private insurance/some won't. I thought Nick's post clearly balanced the potential benefits of the banding procedure with lifestyle changes.

    My business question to Nick (and other hospital CEOs)-is banding generally a profitable procedure for the hospital? Can you shed some light on what procedures provide positive pay mix results where profits or margin can be used to support procedures that are not profitable and/or cover costs that are not paid by patients or insurance? Also, are certain procedures more likely to result in patient loyalty to the healthcare provider if/when the need arises for procedures in the future?

    I'm asking these questions to try and get a balanced view of the economics of procedures & pay mix as compared to legitimate debate over whether certain procedures are driven by lack of investment in prevention.
    Permalink 03/11/08 @ 14:36
    Comment from: Lavinia Weissman [Visitor] · http://www.workecology.com
    There are many issues that surround obesity that are more than dietary. There are less costly and evasive methods to support people to recover from obesity at any age and hence reduce the risk of diabetes.

    There is also a rise in childhood (juvenile diabetes). Recently I interviewed a mother of a six year old and she turned to me and said, if we keep calling it Juvenile Diabetes, we are going to make people think it is not a life long disease and it disappears. My daughter will have this as an adult. What was pleasant about this interview is that the 6 year old, named Katie who I walked along side for more than an hour was more responsible than many adults I know for her illness. She can even distinguish for her mom, when she is just plain healthy tired versus having a bad reaction of some kind. Katie told me she has to "teach" alot of people about her disease alot..because most people don't understand it.

    But Tony, your entry here really reminds me how the "hospital way" is not always the best way and ecourages economics that for profit where patients become an extension of a method and mechanic rather than being taught about a future where they can live well and be well even with an ailment.

    I am now in Utah and learning about a number of interventions and programs for obesity. There are those people who want to learn to be well and those people who want a fix for a disease. It is very interesting from the natural, community based treatment and hospital view.
    Permalink 03/12/08 @ 19:31
    Comment from: glenner [Visitor] · http://www.bariatric-beds.com
    A few weeks ago, Parade Magazine featured an article that reported the findings of a study from Melbourne, Australia confirming what many of us have known definitively for a number of years now. Type 2 diabetes can, through weight loss attributed to bariatric banding surgery, be reversed.
    Permalink 09/28/08 @ 22:44

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