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    Weight Loss Surgery Gives Hope to Diabetes Patients

    Abe Lee holds up a picture of he and his wife Suzette before his successful sleeve gastrectomy - a weight loss surgery offering new hope to patients.

    Forty-year-old Abe Lee of San Francisco was quickly running out of options. For 15 years, he had had Type 2 diabetes, weighed 265 pounds, and was in poor health. No matter how much dieting or exercise he did, he couldn’t get his weight down. The insulin he was taking only made him gain. To make matters worse, his body was growing more insulin-resistant, and he needed increasingly higher doses.

    At the same time, Marcia Whitaker, 62, grieved her husband’s early death from brain cancer, and started getting worried about her own mortality. She had a litany of health problems—sleep apnea, high cholesterol, and high blood pressure—and was at risk for developing diabetes. At her heaviest, the 5’3” Union City resident weighed 250 pounds. She tried everything to keep her weight down, including an all-liquid diet, working out, and getting a personal trainer, but nothing worked. “I couldn’t climb a set of stairs without getting winded,” she recalls. “My husband died at the age of 63, and I didn’t want to have any condition that would take me off this earth early.”

    Hope for a Cure
    Abe and Marcia were starting to feel hopeless until they met with Gregg Jossart, M.D., director of bariatric surgery at California Pacific Medical Center, and his multidisciplinary team of doctors, dieticians and nurses.

    Initially, weight loss surgery seemed extreme, but under the caring guidance of Dr. Jossart, they soon realized that it could possibly cure them of their medical conditions. Many patients who undergo the surgery are happy to overcome their metabolic issues. “Dr. Jossart made the extra effort to get to know me and my wife and explain how the surgery could help me,” says Abe. “It wasn’t about losing weight for my appearance. My goal was to address my diabetes. If I could get rid of my excess weight, my natural insulin would work better.”

    From Stomach to Sleeve
    Although Dr. Jossart offers several types of bariatric surgery, he recommended sleeve gastrectomy for both Abe and Marcia. In this procedure, surgeons restrict food intake by removing part of the stomach and leave a narrow pouch, or sleeve. Other types of surgery include lap-band surgery, in which doctors place a silicone band around the stomach, and gastric bypass and duodenal switch surgeries, which require both stomach restriction and rerouting of the small intestine.

    Dr. Jossart prefers the sleeve gastrectomy for most cases. “The stomach that’s left behind is more natural. It doesn’t have the problems of a foreign body like the lap band, which can create blockages,” he explains. “And there’s no intestinal bypass, which can cause complications like bloating and diarrhea. Sleeve gastrectomy also gives patients a better quality of life since they can eat a greater variety of food.”

    Team Commitment
    Sleeve gastrectomy surgery takes only one to two hours, and patients leave the hospital after just one overnight stay. The lifestyle change requires a lifetime commitment to healthy eating. Dr. Jossart’s team of doctors, dieticians and nurses meets with patients for years following surgery and organizes monthly group meetings to help them stay on track. “It’s great because you can share with people who have been through the same thing,” says Marcia. “Dr. Jossart is incredibly informative, empathetic and empowering, and his staff really got to know me and gave me the tools I needed to succeed.” “The staff were excited and passionate about my progress,” Abe agrees. “They were 100 percent with me.”

    One Year and 100 Pounds Later
    It’s been just over a year since Marcia and Abe had their surgeries. Marcia has dropped nearly 80 pounds, now weighs 140, and went from a size 24 to a size 8. She can climb stairs without any problems and walks 25 miles a week. “I sometimes still think of myself as someone with weight problems, but when I look in the mirror, I realize that I’m not that person anymore,” she muses. “I have friends who haven’t seen me for a year who literally stand next to me and don’t recognize me.”

    After bariatrics surgery, Abe's portions are a fraction of what he ate before (in foreground).
    After surgery, Abe was back at his software design job within five days. And in less than a year, he lost 100 pounds – from clothing size XXL to a small. Before surgery, he didn't go outside often, he now works out an hour and a half every day and takes long walks with his wife. Abe says, “Imagine you had to wear a 100-pound backpack all your life and then took it off. My knees don’t hurt as much; I can walk faster; and I have a lot more energy.”

    But none of that compares to what happened to Abe’s diabetes, which all but disappeared. “The day after surgery my blood sugar had already dropped to a normal range without insulin,” Abe marvels. “It was like a switch turned on, and it never went up again. I went from having an insulin pump to taking no medicine.”

    Marcia also stopped taking her medications the day after surgery and no longer needs her sleep apnea machine. “It’s a whole new me,” she beams. “My children are amazed, and they’re happy that I’ll be around longer for my grandkids. CPMC's bariatric surgery team saved my life.”



    Sutter Health offers free bariatric surgery seminars and physician consults in San Francisco, Marin and Sonoma counties. Patients can sign up to determine eligibility and find the best treatment for their specific needs at the following websites:

    Options for Weight Loss Surgery

    Gastric Sleeve

    • Average excess weight loss: 70 - 90%
    • Restricts food intake & decreases amount of food used
    • Second most common bariatric procedure in the U.S.
    • Emerging as most common procedure due to positive safety and outcomes.

    Gastric Band
    • Average excess weight loss: 40%
    • Decreases food intake
    • Reversible surgery
    • Third most common bariatric procedure in the U.S.
    • Least invasive, but some device-related problems can occur

    Gastric Bypass
    • Average excess weight loss: 70 - 90 %
    • Restricts food intake and reroutes food
    • Reversible surgery
    • Most common bariatric procedure

    Outcomes
    • Type 2 Diabetes Improvement - 85.4%
    • Hypertension Improvement - 78.5%
    • High Cholesterol Reduction - 70%
    • Sleep Apnea Elimination - 85.7%

    Bariatric Surgery Candidates
    • BMI > 3 5 with diabetes, sleep apnea, high blood pressure or heart disease
    • BMI > 40 if the above medical conditions do not exist

    Sources
    1. "Changes in the Makeup of Bariatric Surgery: A National Increase in Use of Laparoscopic Sleeve Gastrectomy" Journal of the American College of Surgeons. Feb 2013 1013; 216(2): 252-257.
    2. Henry Buchwald, MD, PhD; Yoav Avidor, MD; Eugene Braunwald, MD; Michael D. Jensen, MD; Walter Pories, MD; Kyle Fahrbach, PhD; Karen Schoelles, MD. "Bariatric Surgery: A Systematic Review and Meta-analysis." JAMA. 2004;292(14):1724-1737.
    3. "New Evidence Prompts Update to Metabolic and Bariatric Surgery Clinical Guidelines." American Society for Metabolic & Bariatric Surgery. (2013). http://www.asmbs.org.
    4. Weight-control Information Network, National Institute of Diabetes and Digestive and Kidney Diseases, http://win.niddk.nih.gov/