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The diet you should try before scheduling weight-loss surgery
Bariatric surgery is increasingly recommended for weight loss and treatment of diabetes, but two doctors say no one should schedule surgery before trying this kind of diet. - photo by Jennifer Graham
Obese Americans are increasingly turning to bariatric surgery help them lose weight and manage diabetes. But two doctors are urging people considering the surgery to try a low-carb diet before choosing that path.

Writing in The New York Times, Sarah Halberg and Osama Hamdy said low-carb diets, once considered a fad, have withstood the scrutiny of more than 40 clinical trials and have been shown to help overweight and obese patients lose weight and lower their blood glucose levels without the risks and costs of surgery.

Bariatic surgery, Halberg and Hamdy wrote, "costs $11,500 to $26,000, which many insurance plans wont pay and which doesnt include the costs of office visits for maintenance or post-operative complications. And up to 17 percent of patients will have complications, which can include nutrient deficiencies, infections and intestinal blockages."

The word "bariatric" comes from bari, which means weight, or pressure, in Greek. There are a handful of different procedures, most of which involve manipulating the stomach or intestines to cause a person to eat or absorb less food. They include the sleeve gastrectomy, in which 80 percent of the stomach is removed, and the gastric band, which cinches the stomach, allowing less food to enter.

In their commentary in the Times' Sunday Review, the doctors wrote skeptically about a new "obesity device" approved by the Food and Drug Administration, noting that others have called AspireAssist "medically sanctioned bulimia."

In the treatment, a tube is inserted in the patient's stomach, which the patient manually drains 20 to 30 minutes after eating. According to the FDA, about 30 percent of the calories consumed are removed.

In one clinical trial, patients using AspireAssist lost an average of 12 percent of their body weight, compared to a control group that received "lifestyle therapy" and lost an average of 3.6 percent of their weight.

The AspireAssist patients, however, suffered side effects that included "occasional indigestion, nausea, vomiting, constipation and diarrhea," according to the FDA.

The company's website says some patients experience "significant pain" for two to three days after the tube is installed.

The doctors writing in The New York Times both run obesity clinics where they have had success treating patients with Type 2 diabetes by sharply reducing their intake of carbohydrates. One, a woman in her 60s, had treated her diabetes with drugs for 12 years, but was able to stop using them after a year on a low-carb diet. She also lost 25 pounds, the doctors wrote.

But their advice was challenged, first by the Times' longtime health writer Gina Kolata who noted the difficulty of maintaining low-carb diets, then by an article in The New Yorker that said 75 percent of people who have bariatic surgery sustain weight loss for five years or longer.

Diets of any kind are so hard to stick with that even when all the food is provided to a dieter, compliance is poor, Dr. Kevin D. Hall, of the National Institute of Diabetes and Digestive and Kidney Diseases, told Kolata.

Moreover, like bariatic surgery, sustained low-carb diets also have risks. One study found that people who ate lots of animal protein had four times the risk of dying of cancer than people who ate the lowest amounts. (The risk was reduced when people consumed most of their protein from plant sources, Forbes magazine reported.)

But for the obese, the greatest risk of all is doing nothing about their weight.

Excess weight is associated with 13 kinds of cancer, including breast, pancreatic, liver, colorectal and ovarian, as well as heart attack and stroke. Americans' poor eating habits have recently replaced smoking as the most likely cause of disability in old age.

With about three-quarters of Americans overweight or obese, and the average American woman now weighing about the same as the average American man in the 1960s, for many people, draining their dinner out of a tube and into the toilet may seems preferable to being obese for the rest of their lives.

About 200,000 people have bariatric surgery in the U.S. each year, a number that has been stable for a few years. The surgery is covered by Medicaid in 48 states, Rivka Galchen wrote for The New Yorker. But only about 1 percent of people who qualify for the surgery get it.

That could be changing, since the American Diabetes Association earlier this year joined 45 health organizations around the world in endorsing bariatric surgery over drugs as the go-to treatment for Type 2 diabetes, even for some patients who are not severely obese. It was, according to Scientific American, possibly "the most radical change in the treatment of Type 2 diabetes for almost a century."

Type 1 diabetes often begins in childhood and cannot be prevented. Type 2 diabetes, which is associated with lifestyle and genetics, typically begins in middle age. Ninety percent of people with diabetes worldwide have Type 2, and its incidence has quadrupled since 1980, vaulting from 108 million to 422 million.

Under new treatment guidelines, published in June in the journal Diabetes Care, millions of those people would be eligible for surgery, according to London's Daily Mail.

Anyone with Type 2 diabetes and a body mass index of 40 or more should be offered surgery regardless of their blood sugar levels. People with a BMI of 30 or more which is at the margins of being considered obese should be offered surgery if their glucose levels are still unstabled despite taking drugs, The Daily Mail reported.
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