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Like Peas & Carrots: How Type 2 Diabetes and Obesity Often Go Hand-In-Hand

Many of us saw the Tom Hanks film Forrest Gump, and can recall vividly how Forrest described his relationship with his long time girlfriend, and eventual bride Jenny. He used to say that “me and Jenny, we go together like peas and carrots”. What better way to describe how two seemingly disconnected things can be so perfectly paired?

As it turns out, the idea of two seemingly disconnected things perfectly going together can be applied to medicine. Indeed, many of us know that obesity and diabetes may be considered the peas and carrots of primary care. Certainly the prevalence of these diseases in primary care are about as common as peas and carrots, and these two diseases frequently dance in the same body of many of our patients.

Once a person is burdened with the disease of obesity, type 2 diabetes mellitus (T2DM) is frequently tagging along. Even if T2DM is not overtly present, its eventual appearance can be reliably predicted based upon the findings of a prediabetic state such as metabolic syndrome, impaired fasting glucose or impaired glucose tolerance. Unfortunately, once a person has prediabetes or T2DM their life expectancy is reduced by as much as seven years, and the amount of money they will spend on healthcare goes up. Patients turn to their healthcare providers in search of treatment options, but medical treatments alone often result in disappointing results. For those who are able to lose weight, we are reminded of the powerful grip obesity has on a person as we watch our patients slip back to the weight at which they started. All too often, we are reminded of the fact that medical treatments for obesity usually offer a temporary solution since over 90% of patients are unable to maintain long term weight loss.

But all is not lost.

As it turns out, an operation may be the most effective way to not only help them achieve a healthier weight, but also to achieve freedom from the need to take antidiabetic medications. Since the landmark article in 1995 by Dr. Pories at East Carolina University, news has slowly made its way into the literature that the best treatment for an obese person suffering from T2DM is bariatric surgery. For the morbidly obese person, bariatric surgery has been proven to improve overall survival, reduce overall healthcare expenditures and reliably cause diabetes to either no longer require treatment, or at least markedly improve glycemic control.

At the Winchester Medical Bariatric Program, we are committed to helping people achieve a healthier weight. Obesity is a complicated disease, and its effective treatment must be implemented through a multidisciplinary, coordinated approach. We offer medical and surgical treatment options for weight loss. Medical options include calorie restriction, short term medication use or liquid meal replacement with Optifast® products. Surgical treatments include laparoscopic gastric bypass, and the newly approved laparoscopic sleeve gastrectomy. Over 99% of our operative procedures are done laparoscopically, and patients typically spend one or two nights in the hospital after surgery.

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  1. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339-352.
  2. Buchwald H, Avidor Y, Brauwald E, et al. Bariatric surgery: A systematic review and meta-analysis. JAMA. 2004;292:1724-1737.
  3. Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;Sep 240(3):416-423; discussion 423-424.
  4. Cremieux P-Y, Buchwald H, Shikora SA, Ghosh A, Yang HE, Buessing M. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008; 14(9):589-596.