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Canwest News Service
Diabetes doesn't have to be a life sentence. In fact, there is a way to get rid of it once and for all. But freedom from the disease doesn't come cheap; you're going to have to work for it. D r. Christopher Cobourn holds in his hands a potential cure for type 2 diabetes. it doesn't look like much–a coil of silicone tubing, more or less–but the Allergan Lap-Band® System can actually send the disease into remission. Gastric banding has been a viable surgical weight-loss option in Canada for over a decade, but it was only recently that Health Canada approved the Lap-Band®, the device used by Cobourn at his Mississauga-Ont. clinic, Surgical Weight Loss Centre (SWLC; obesitysurgery.ca),as a treatment option for type 2 diabetes. this endorsement comes as a result of a study published in The Journal of the American Medical Association in 2008, which found that 73 percent of Lap-Band® recipients with an initial body mass index (BMi) of more than 35 experienced remission of their type 2 diabetes within two years of the procedure. Although the Lap-Band®'s approval by Health Canada does not represent any change in funding (unlike gastric bypass, which is covered by provincial healthcare programs, gastric banding is not an insured service in Canada), it is still exciting news for obese Canadians with type 2 diabetes. "People think that once you have diabetes, you always have diabetes," says Cobourn, who has performed more than 1,500 Lap-Band® operations himself. "those of us in the surgical world have known for a long time that significant weight loss puts [type 2] diabetes into remission."
The procedure is quite non-invasive: the surgeon enters the abdomen through a series of punctures and creates a tunnel around the upper part of the stomach to accommodate the Lap-Band®. the inflatable band is sutured in place, creating a small pouch in the upper part of the stomach with the remainder of the organ below. At SWLC, the largest Lap-Band® clinic in Canada, the procedure takes under an hour, and the patient typically returns home the same day.
The Lap-Band® stimulates weight loss through portion control. As food fills the pouch created by the band, the stretch receptors in the upper-stomach wall send a message to the brain, which the brain interprets as if the entire stomach was full. As a result, the patient achieves a feeling of satiety with a smaller portion of food. the sensation of fullness is maintained as the food passes across the restricted opening to the lower part of the stomach at a slower, controlled rate. Unlike some surgical obesity treatments (e. g. gastric bypass), there is no change to the digestion process or reduction in nutrient absorption.
The Lap-Band® can and should be adjusted periodically to ensure proper function. the band itself is connected by tubing to a small port, which is placed underneath the skin and fat of the abdomen during surgery, making it easily accessible post-op. "if food is crossing that narrow part of the stomach too fast and patients are getting hungry again quickly," says Cobourn, "we can inject a little saline into the port, which inflates the band, tightening it up so it slows down the transit of food and reestablishes that feeling of satiety."
Although standard risks of surgery under general anaesthesia still apply, on the whole, the Lap-Band® procedure is much safer than gastric bypass. But in order for it to work, it requires two things that are not mandated by bypass: ongoing medical support and patient compliance. " if they don't choose to change the way they eat [eating smaller portions, eating slowly, chewing well] or are unable to come back [for band adjustments], they won't get the success they hope for," says Cobourn. "the advantage of gastric bypass from the patient's point of view is that they're pretty well guaranteed to lose weight. they really don't have to be as committed as they do with the Lap-Band®, nor does it require the intensive long-term follow-up."
Most of Cobourn's Lap-Band® patients have worked hard to lose weight through lifestyle changes but haven't been able to achieve lasting results. "Our patients come to us and say 'i'm tired of losing weight and gaining it all back again.'And we say,'if you're willing to commit to this program and change the way you eat, then the Lap-Band® will work for you.'"
"One of the advantages of having patients be financially involved in their healthcare," says Cobourn (the Lap-Band® program at SWLC costs $16,000), "is that they are committed. if patients get the surgery at no cost [to themselves], the results aren't as good. if they run into problems, there's a risk of them saying,'Oh, just take this thing out and do a bypass.'"
The important thing for people with type 2 diabetes to remember is the value of the sustained weight loss offered by surgery–be it Lap-Band® or gastric bypass. "that's the message that needs to get out there," says Cobourn, "to give people the knowledge that type 2 diabetes can be put into remission with surgery. if you need to do it with a gastric bypass, that's fine; if you do it with a Lap-Band®, that's fine, too." it doesn't matter how you take the weight off, what matters is that you take it off for good.
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LAP-BAND® IN BRIEF
What?
A laparoscopic surgical procedure for the treatment of obesity.
How?
An adjustable silicone band placed around the upper part of the stomach limits the amount of food that can be consumed at one time.
Who?
Severely obese people (35+ BMi) or obese people with weight-related health issues (e. g. diabetes).
How much?
Approximately $16,000.
Where?
Private surgical weight-loss centres.
TIPS TO PREVENT TYPE 2 DIABETES
The National diabetes education program's "Small Steps, Big Rewards" campaign offers this advice in its brochure "Your Game plan to prevent type 2 diabetes,"which you can see at www.ndep.nih.gov: – Set a weight-loss goal – Aim to lose 5-10 per cent of your current weight. For a 250-pound person, that would mean a loss of 12.5 to 25 pounds. – Weigh yourself at least once a week, and track your progress. – Eat healthy foods – Reduce portion sizes. Use smaller dinner plates to make less food look like more. – Eat slowly-ittakesabout20minutes for your stomach to tell your brain that it's full. – Move more – Start with a five-minute walk or other fun activity, and add minutes until you're up to at least 30 minutes of moderate-intensity activity at least five days a week. – Walk the dog. park a distance from the store. dance around the room while watching tV or cleaning the house.
