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Does Operation for Obesity Cure Diabetes?
CBS News - (April 2008)

It's pretty well known to doctors that the most successful treatment for obesity is surgery, especially the gastric bypass operation. But here's something the medical world is just realizing: that the gastric bypass operation has other even more dramatic effects. It can force type 2 diabetes into almost instant remission and it appears to reduce the risk of cancer.

Watch the full "60 Minutes" news clip called "The Bypass Effect" below:

Surgeons have been performing bariatric, or weight loss operations since the 1950s, but they're much safer than they used to be. They're typically done laparoscopically now, where doctors use tiny surgical tools and video cameras instead of making big, deep incisions.

Despite the increase in obesity, only a small number of people have had the gastric bypass operation.

Correspondent Lesley Stahl met some people who were once morbidly obese.

There was Tony Sideman, who underwent surgery in April 2007 and has lost 140 pounds; there was Janet Rovak, who lost 90 pounds in the eight months since her surgery; and there was Travis Goodbou, who lost 260 pounds in the seven months since he underwent the operation.

Dr. Neil Hutcher from Richmond, Va. has performed more than 3,000 bypass surgeries. Asked how many people gain the weight back, Dr. Hutcher tells Stahl, "You know I think when you’re dealing with an incurable disease that kills many people, if you have an 85 to 90 percent success rate, that’s pretty darn good."

"Is that what you have?" Stahl asks.

"Yeah," Hutcher says.

There's no diet, no exercise regimen, and no pill with a success rate like that. These patients lose a ton of weight and keep it off.

Here's how Hutcher does the surgery: first, he sections off a small pouch of the upper part of the stomach, which is then attached to a lower part of the small intestine, bypassing most of the stomach, so that there's not a lot of room for food.

It used to be that roughly one in 100 people died from this operation. Hutcher says it's now about one in 1,000, which makes it less deadly than most major surgeries.

"It's less than gall bladder surgery. It's about one-tenth of cardiac surgery," he explains.

It's safer because of new surgical techniques which have also made it more effective. For instance, they can make the stomach pouch smaller than they used to.

"Even if I wanted to eat a whole cheesecake, my stomach is very tiny. It holds four ounces max, stretched to the max. And that's not even one piece of cheesecake," a female patient explained.

A big reason the operation works is because it seems to suppress appetite. "If you listen to your patients, they come back and they say, 'Doctor, you put the fire out,'" Hutcher says.

"When you see a sign for fast food or…she's already shaking her head at me," Stahl asked a patient.

"Don't want it," the female patient replied. "I used to crave sweets all the time. I couldn't go past the gift shop at work without getting a candy bar. Now I go past it and I never give it a thought."

Paul Delios of Saugus, Mass. has lost 90 pounds. He owns a doughnut shop with his siblings, but he's able to resist the cravings. "Before I'd have cravings for everything. Now I really don't," he told Stahl.

For most patients the cravings really do disappear. One theory is that's because the operation suppresses the levels of a stomach hormone called "grelin" that activates the sensation of hunger.

Yet most people who have this operation do not get skinny. Dr. David Cummings, an expert on appetite at the University of Washington, says as a rule these patients end up just one third lighter.

"Most people with severe obesity who undergo gastric bypass do not become fully normal, in terms of body weight. They go from severely obese to mildly obese, or from obese to overweight. But nevertheless it’s an enormous change," Dr. Cummings explains.

And not just in terms of weight loss. Dr. Hutcher says the operation itself can take type 2 diabetes - which has ballooned in this country - and throw it into complete remission.

The group of patients Stahl met say they all had diabetes before the operation; post-surgery, none have diabetes.

That means they no longer need sugar-control medication, like insulin injections.

One patient, Vicki, told Stahl she went from having eight or nine insulin shots a day to none, and that she's diabetes free - "cured" as she put it.

"Would you use the term 'cure diabetes?'" Stahl asks Dr. Hutcher.

"I think my patients are cured," he says.

"Cured?" Stahl asks.

"Well, they go home on no medication," he says. "And I've followed them now for 10 and 15 years, and see no evidence of recurrence. So, it's pretty darn close."

Studies confirm that about 80 percent of diabetics go into complete remission following the operation. Obesity is considered one of the major causes of type 2 diabetes, but here's something odd: when you have the gastric bypass operation, your diabetes goes away long before you lose the weight.

For Travis, the man who lost 260 pounds in seven months, it took "about a week and a half" before he was rid of diabetes and off all his medication.

Another male patient named Bill said it took him four days. "I went into the hospital on Friday, came home on Monday and dumped my pills," he told Stahl.

This spontaneous remission puzzled Italian surgeon Francesco Rubino, now at New York Presbyterian Weill Cornell Medical Center. "We wanted to know what is making diabetes remit. We thought it could have been something to do with the small bowel," Dr. Rubino says.

So he began performing the bypass on diabetic rats, and realized that when he disconnected the top of the small intestine, an area called the duodenum, the diabetes disappeared. Then, he reversed the operation.

When he reattached it, the diabetes came back.

This was a pivotal discovery. By merely blocking food from traveling through the duodenum, Rubino sent diabetes into remission, proving the effect was independent from weight loss. This meant diabetes could essentially be removed with a scalpel.

Dr. Rubino says this operation has been performed on humans.

60 Minutes joined him in Sao Paulo, Brazil, where clinical trials have begun on diabetics who are not obese, to determine if the "diabetes surgery" is safe and effective.

As of now, if you have diabetes and are not obese you can't have the bypass surgery. Under guidelines written by the National Institutes of Health 17 years ago in 1991, only the severely or morbidly obese are eligible for any bariatric operation. If you're just mildly obese, you can't get it.

"And a lot has changed since 1991," Dr. Hutcher remarks. "I would like to see them change their guidelines, especially for the diabetics. I think we have clear cut evidence that we can do terrific things for diabetes."

The NIH told 60 Minutes there's no plan to revise the guidelines, but they are currently studying the benefits and risks of bypass surgery.

Several existing studies point to one risk. "I've seen some studies that say that suicide rates go up among patients who have this operation. Now why would that be?" Stahl asks Dr. Hutcher.

"We're not sure," he says. "A lot of our patients are very depressed. When you lose weight, there's a period of euphoria and then there's a period of realization that maybe my depression wasn't related to pounds."

But in the meantime, the positive side effects continue to accumulate, like for sleep apnea disorder.

"Sleep apnea is one of the silent killers. That's where, at night, you literally suffocate. You stop breathing," Hutcher says.

Of the patients Stahl met, about half had had sleep apnea; after the surgery, none of them did.

That's because of the weight loss. Dr. Bruce Miller, a family doctor from Hopewell Va., has lost 120 pounds in three months.

"I've seen all my other problems improve as well," he says. "I don't take any blood pressure pills anymore. I don't take any cholesterol pills anymore as well as my diabetic medicine. I'm off all medicine."

In addition to the operation reducing hypertension and coronary artery disease, there appears to be an affect on cancer as well.

"Does being fat give you cancer?" Stahl asks Dr. Eugenia Calle, an epidemiologist at the American Cancer Society.

"Being overweight or obese increases the likelihood that you'll get several different types of cancer," Calle says.

Dr. Calle has been studying the link between cancer and obesity.

Asked what kinds of cancer, Calle gives Stahl a long list: "Breast cancer, colon cancer, endometrial cancer, kidney cancer, cancer of the esophagus, pancreatic cancer, liver cancer."

"I should have said what cancers don't, aren't affected by obesity," Stahl remarks.

"There are very few that aren't affected, yes," Calle says.

"Have you been able to calculate how many people die every year of obesity-related cancers?" Stahl asks.

"We have. And our estimate is that about 100,000 individuals in the U.S…,every year die of cancer, because of their weight," Calle says.

"So if you lose weight, you're fending off cancer?" Stahl asks.

"Well, that is and has been, up until now, sort of the piece of evidence that hasn't been in place. People don’t really lose weight in this country," Calle says. "They lose it and they gain it back."

But now researchers are studying people who've had bypass surgery, because they tend to keep the weight off. "And in those populations, very interestingly, the cancer, overall cancer risk, is greatly reduced, cut in half," Calle explains.

The number of people having weight loss operations grows every year. But it's still a small number compared to the millions who are eligible for the surgery and the many more who could benefit.

"So, what percent of the people who are eligible for this operation, actually eligible, get it?" Stahl asks.

"Actually, less than one per cent," Dr. Hutcher says.

"And how many had the operation this year," Stahl asks.

"About 200,000. So it's one percent," he says.

The bypass operation costs an average of $25,000 and insurance companies don't always cover it; and despite the gains in safety, most doctors still consider the operation an option of last resort. That is no longer the case for Dr. Miller’s patients.

"I look at 'em now and I'm handing out my surgeon's card right when I see 'em. I'm not waiting for the last resort now," Dr. Miller says, who lost 120 pounds after the surgery.

"Do you think most doctors are where you are?" Stahl asks.

"Probably not," he says. "They haven’t walked the walk."

"If you're used to a lifestyle of eating, you know, eating makes you comfortable. You're sad, you're mad, whatever the case may be: you eat," Travis Goodbou told Stahl.

Goodbou is just 26 years old. Heavy his hold life, he got the operation in July to change his weight. It ended up changing his health, and the way he lives his life. "For me I think I was addicted to food. I loved to eat, I loved to cook; I loved everything about food. Now, I love movin'. I'm kind of addicted to life out there. You don't catch me home," he says.

Copyright 2008, CBS Broadcasting Inc. All Rights Reserved.

 

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