Examiner.com posted “Diabetes cure: new guidelines recommend bariatric surgery” by Kristin Eckland.
The latest updates to current clinical practice guidelines for bariatric surgery and diabetes management contains several important changes that are important to healthcare providers and consumers alike. These guidelines, published in the March 26 issue of Endocrinology Practice are the first revisions since 2008 and contain 74 recommendations for enacting and following evidence-based practices and treatments.
Big Changes in BMI criteria
One of the biggest changes reflects the 2011 recommendations of the International Diabetes Federation regarding the use of bariatric surgery to treat type II Diabetes in the moderately obese. This change involves a reduction in the minimum BMI criteria for surgery.
BMI or body mass index, is a scale using weight and height to determine overall body mass, and levels of obesity. It replaces previous measurement tools like ‘frame size’. While there are some limitations to BMI for classifications of obesity, the BMI scale remains one of the easiest tools for health care providers and consumers for determining healthy body weight.
The National Institute of Health (NIH) current classifications along the obesity spectrum include:
- Overweight (BMI 25-29)
- Obese I (BMI 30 – 34)
- Obese II (BMI 35-39)
- Morbid or Extreme obesity (BMI greater than 40).
The World Health Organization has similar classifications but eliminates some of the terminology, classifying obesity simply as I, II and III.
Physicians, nutritionists, insurance companies and surgical programs in the United States have typically relied on BMI criteria that limited the more effective bariatric surgery procedures to people with class III obesity (with BMIs of 40 or greater).
Earlier Intervention possible
However, a wealth of recently published data along with recommendations from multiple diabetes, endocrinology and surgical groups reduced the BMI requirement to address the large numbers of obese diabetes who fall short of morbid obesity. This is important since many obesity-related complications such as coronary artery disease, hypertension, diabetes, obstructive sleep apnea, orthopedic joint damage and non-alcoholic fatty liver disease occur in patients along the entire spectrum of obesity, not just in the extremely obese.
The main changes in the new guidelines are related to recommending bariatric surgery for patients with a lower BMI based on co-morbid health conditions. The committee supports recommending surgery to people with a BMI of 35 or greater with co-morbid conditions including hypertension, obstructive sleep apnea, diabetes and high cholesterol.
In an enlightened move, the authors of the guidelines also recommend considering bariatric surgery in people with a BMI as low as 30 who have diabetes or metabolic syndrome.
Surgical Cure for Diabetes
This move, to open up and expand eligibility criteria is critical since bariatric surgery is the only known cure for established diabetes. The normalization of blood glucose levels occurs within 24-72 hours after surgery and is independent of post-surgical weight loss. While surgery may not be 100 percent effective in permanent remission of diabetes, it is the most effective treatment to date, for an extremely destructive and costly disease.
This move has been heralded as potentially saving billions of dollars and millions of lives, in an era where obesity is one of the United States top health problems. Healthcare providers in Europe, Latin America and Asia have more rapidly adopted these recommendations due to skyrocketing rates of obesity and diabetes worldwide.
Changes in Guidelines means more insurance coverage for Bariatric procedures
With an increasing volume of scientific data demonstrating numerous health benefits and even remission of diseases such as diabetes and fatty liver disease; the use of surgery as part of an arsenal that includes nutritional and dietary modification, psychological counseling and daily exercise are universally recognized by major insurance companies. Expanding this criteria to promote health coverage of this procedure for more patients may actually result in cost-savings for insurers.
Guidelines for effective procedures based on scientific evidenceThese recommendations outline the specific procedures such as gastric bypass and sleeve gastrectomy for the effective treatment of obesity and obesity-related complications. This comes on the heels of multiple studies that debunked the use of “lap-band” and other such pseudo-surgical procedures for promoting weight loss. The “lap-band” in particular, has been heavily marketed and advertised in the United States as being a “fast and easy” method for weight loss.