Diabetes and “Radical” Solutions
I am occasionally struck by the comments from medical physicians or from people in the health care community who comment that some of what I do to help people lose weight and solve their diabetes is so “radical”. Usually when they say this they are referring to Roux-N-Y-Gastric Bypass surgery, which does involve a fairly permanent rerouting of the stomach and upper intestinal system. Even though the procedure is done with a laparoscopy, or minimally invasive technique, and usually involves a one hour surgery and overnight hospital stay, I certainly agree that it is a major decision to undergo the procedure and not something to be taken lightly.
I am ,however, troubled by the real lack of understanding of the nature of the diseases of both obesity and diabetes among those making this kind of comment. I have even had, for example, people in my office who were considering weight loss surgery and brought along their skeptical spouse or significant other to talk with me. Here I would be, speaking with a person who has tried for decades to lose weight and is now seriously overweight struggling with insulin shots, umpteen medications, severe pain in the spine and weight bearing joints, high blood pressure, breathing difficulties and yet the spouse or significant other would be very discouraging, saying things like, “the surgery is too radical”. I wonder just what solution would be appropriate given the “radical” nature of the disease that is leading to such diminished quality of life for the person in such a dramatic shortening of life span with early onset of these devastating diseases. What we seek in medicine and all health interventions is proportionality wherever possible. This means that we prefer that the treatments, or intervention, be proportional to the seriousness of the disease. For example, radical brain surgery would only be considered appropriate if the disease being treated was a life threatening brain tumor. We would not recommend craniotomy surgery and its attendant risks and recovery time for a less severe brain condition, like say, headaches.
So, is weight loss surgery a proportional treatment for this disease? I would argue that it is quite acceptable in terms of this concept of being proportional, especially when compared to so many other kinds of treatments across the spectrum of so many other diseases. And especially as weight loss surgery has moved increasingly to the minimally invasive and even to the outpatient realm, it has become far less radical than the disease it treats and in many cases cures.