New Term: Diabesity and Bariatric Surgery
I read this article in the Toronto Star June 22 section of Weekend Life. I found it very interesting and learned a few things too. Hope you do too!
Scientists are unravelling the mystery of why weight-loss surgery such as gastric bypass is so effective at dropping pounds and reversing Type 2 diabetes.
The hope is that researchers will be able to create new treatments that mimic the results of surgery without patients having to go under the knife.
No surgery, no stapling and no shrinking of the stomach. Instead, patients struggling with obesity and Type 2 diabetes could pop a pill, get an injection or undergo a far less invasive procedure.
Cutting-edge research presented Monday at a Toronto symposium called Frontiers in Diabetes Research offered hints of novel therapies that could one day revolutionize the treatment of diabetes, a growing global epidemic. The Samuel Lunenfeld Research Institute of Mount Sinai Hospital, a world leader in diabetes research, invited top experts from the United States to share their latest, as yet unpublished, research.
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“Diabetes represents the most pressing and impactful disease of the new millennium,” says renowned diabetes expert Dr. Bernard Zinman, a clinician-scientist at Mount Sinai, who helped organize the event.
By 2025, there will be 500 million people with diabetes in the world, he says. That’s up from the current 347 million people living with the disease, according to the World Health Organization.
“The HIV-AIDS epidemic is nothing compared to the diabetes and obesity epidemic that’s coming,” Zinman told the Star. “It’s a true tsunami of a major health problem.”
In an effort to curb the epidemic of obesity and diabetes, referred to as diabesity, a growing number of people are turning to gastric bypass surgery. But there’s hope that in the future patients won’t have to resort to such invasive methods.
That’s the goal of Dr. Randy Seeley, a professor of medicine at the University of Cincinnati and director of the Cincinnati Diabetes Obesity Center, who shared his latest research at the symposium.
He’s an expert on food intake and obesity and is studying the molecular changes that occur during bariatric surgery, which refers to various types of weight-loss surgeries.
Studies show that bariatric surgery is even more effective than diabetes medications and lifestyle changes at reducing and reversing Type 2 diabetes. Within days of having had surgery, even before pounds are shed, there’s a dramatic improvement in glucose levels.
However, surgery is permanent, costly, invasive and given the rising obesity rates, it’s hard to keep up with demand.
“Even if we thought surgery was the most appropriate solution for people with obesity and diabetes, there are not enough surgeons and not enough surgery tables to deal with the epidemic, either in Canada or the U.S.,” Seeley told the Star in an interview before the symposium.
In Ontario, for instance, obesity rates are at a record high, with statistics showing 18 per cent of adults are obese and 33 per cent are overweight. According to the Ministry of Health, bariatric surgeries are on the rise.
The number of procedures has jumped by more than 550 per cent since 2008-09, when there were 436 bariatric surgeries done in-province. In 2012-2013, there were 2,850 surgeries, which cost the province $53.2 million.
Scientists know bariatric surgery works, but they aren’t sure why. Seeley and his team of researchers painstakingly reproduce the procedures on obese mice and rats to better understand why surgery is so effective. They’re also testing less invasive surgical methods and other new treatments that mimic the effects of bariatric surgery, which would benefit more patients.
“Surgery probably changes 100 different variables, but there are 10 of those that are really important,” said Seeley. “So how do we devise a procedure that will only hit those 10 and not the 90 that are irrelevant? That’s exactly what we’re trying to do.”
For years, experts assumed that weight-loss surgery worked so well because it reduced the size of the stomach and bypassed part of the intestine to limit calorie absorption. But that’s not the case, Seeley said.
“The problem with those mechanical explanations is that they’re wrong,” he said. The surgery works because it changes the nature of communication, or signalling, between the gut and the brain, pancreas and liver.
After surgery, hormones in the gut signal the pancreas to secrete more insulin and reduce the amount of glucose made by the liver, Seeley explained.
On Monday, Seeley revealed that a key part of that communication involves bile acids, which break down fat and play a role in fat absorption, but also act as hormones. Identifying the significance of bile acids as being responsible for inducing many of the benefits of surgery, is “a real step forward,” he said.
His team genetically engineered the animals so that they wouldn’t have the key protein responsible for bile acids’ hormonal action. Then, they performed surgery. The result was that there was no weight loss and no improvement in glucose levels. This suggests the reason surgery works has less to do with mechanical changes to the digestive system, than it does with signalling from hormones in the gut.
Seeley hopes his findings will help fellow scientists with their research. And he says he, too, will be poring over the many notes taken at the symposium during the presentations of colleagues.
Some of the other speakers included Dr. Philipp Scherer of the University of Texas Southwestern Medical Center, who studies what makes fat good or bad; Dr. Joel Elmquist of the same university whose resear*****ludes what makes us eat and the pathways to the brain that control appetite; and Dr. Bruce Spiegelman of the Harvard Medical School and the Dana-Farber Cancer Institute who’s an expert on converting white fat to brown fat, which burns more calories, to create heat.
“It’s incredibly important to find a way to lower health-care costs in the long run and help people lead longer and more healthy lives,” said Seeley. “And that’s what this is all about at the end of the day.”
SIDEBAR/SIDEBAR/SIDEBAR
Diabetes is a chronic, sometimes fatal disease, in which the pancreas either doesn’t produce enough insulin or the body is incapable of using the insulin it makes.
Insulin regulates glucose, or sugar, in the blood. Without it, glucose, which comes from foods such as bread, rice and pasta, builds up instead of being used for energy.
High blood sugar levels can damage organs, blood vessels and nerves and is a major risk factor for blindness, kidney failure, non-traumatic amputation, heart disease and stroke.
There are three main types of diabetes, but 90 per cent of diabetics have Type 2, which used to be called adult-onset diabetes. It often affects people in their 60s and 70s.
Physical activity, proper nutrition and a healthy weight are key to preventing and managing diabetes, but increasingly sedentary lifestyles, poor diets and rising obesity rates means Type 2 is now occurring in people as young as teenagers, says Dr. Bernard Zinman, a diabetes expert at Mount Sinai Hospital in Toronto.
No one is immune to diabetes, and if you’re 40 or older you should get tested every three years, according to the Canadian Diabetes Association. But certain individuals are at greater risk, including those who tend to pack on the pounds around their midriff, and people of aboriginal, Hispanic, Asian, South Asian and African descent.
Diabetes is a classic disease where there’s an interaction between genetic susceptibility and environmental factors, says Zinman and Canada’s native population exemplifies this point.
For centuries, they were lean hunters and gatherers, whose major nutritional problem was starvation during winter months. Now, many lead inactive lifestyles, eat high-calorie foods and live on reserves, where rates of obesity, diabetes and heart disease are rising rapidly. Currently, aboriginal people are up to five times more likely than the general population to develop Type 2 diabetes.
According to the diabetes association, three million Canadians have diabetes and six million have prediabetes. Diabetes contributes to the death of about 41,500 Canadians each year.
Not only is diabetes a devastating disease, it’s also costly. Medical costs for diabetics are up to three times higher than they are for nondiabetics. Estimates show that by 2020, diabetes will cost the Canadian heath-care system about $16.9 billion each year, according to the diabetes association.
Isabel Teotonio
