Current Interventions

Currently obesity and diabetes are being treated with surgery, pharmaceuticals, diet and behavior modification, or a combination. These approaches have achieved varying success and each has its own shortcomings.

Surgical Interventions

There are a number of procedures that fall under obesity surgery including Roux-en-Y gastric bypass (GBP) and Laparoscopic Adjustable Gastric Banding (LAGB). However, in the US, only about 1% of patients who are candidates for surgery actually have a procedure. Mortality risk is the major deterrent to broader use of the Roux-en-Y; although the estimated 1% rate is far lower than the perceived 10% mortality reported by patients and some physicians. While all surgeries carry some risks, certain factors put patients in a high risk category for these bariatric surgeries, according to a Duke University study:

  • A body mass index of greater than 50. On this scale, a measure of body fat based on a person's weight and height, a level of 30 and above is considered obese.
  • Male gender. Men are more likely than women to suffer from conditions such as hypertension, diabetes and metabolic disorders that can add to the risks of surgery.
  • Increased age. Patients over 45 are known to be at the highest risk for death after bariatric surgery.
  • Hypertension. Patients with hypertension, or high blood pressure, typically have heart disease or chronic inflammation of blood vessels that can add to the risks of surgery.
  • Pulmonary embolus risk. Patients who have had a pulmonary embolism, a blood clot in the lungs, or are at risk for developing an embolism are at elevated risk.

Pharmaceutical Intervention

Pharmacological methods of treating obesity have fallen short of expectations. The weight loss realized is far below that of surgery. And the side effects range from highly unpleasant to dangerous. There has been no “magic pill” and the pipeline from the pharmaceutical industry has not been robust. Although the treatment of diabetes has become increasingly sophisticated, with over a dozen pharmacological agents available to lower blood glucose, a multitude of ancillary supplies and equipment available, and a clear recognition by health care professionals and patients that diabetes is a serious disease, the normalization of blood glucose for any appreciable period of time is seldom achieved. 1

Diet and Behaviorial Modification

For morbidly obese patients, their excess weight prevents them from engaging in the exercise that will help them lose weight. For these patients, finding a way to help them lose weight so that they can begin healthy physical activities is essential. While diet modification is an important part of living with diabetes, this change in lifestyle behavior has been reported as a management domain with very low compliance among diabetics. 2 A method of controlling diabetes that is not dependent on patient compliance with drug regiment and diets would be an advantage.

 

 

1. Sherwin RS, et al. The prevention of delay of type 2 diabetes. Diabetes Care. 2003; Jan 26 Suppl:S62-9.
2. Yannakoulia M. Eating Behavior among Type 2 Diabetic Patients: A Poorly Recognized Aspect in a Poorly Controlled Disease. Review of Diabetic Studies. 2006 Spring;3(1):11-16.