Rates of bariatric surgery have doubled since 2012

Weight-loss procedure often eliminates type II diabetes

By JUDY SIEGEL-ITZKOVICH
Doctors perform surgery [illustrative]. (photo credit: REUTERS)
Doctors perform surgery [illustrative].
(photo credit: REUTERS)
Stomach-shortening (bariatric) surgery has become a trend around the country, according to Dr. Ram Shapira, head of the bariatic surgery unit at the capital’s Shaare Zedek Medical Center.
There, the number of such operations has doubled since 2012.
Shapira, who has been at SZMC or 12 years, said that even though his hospital now performs 300 such operations a year (60 percent of them on women), people face a waiting time of eight months to have one.
“We have enough surgeons to do it, but not enough unoccupied operating rooms,” he explained.
The procedure was most recently made famous by formerly obese Education Minister Shai Piron, who had bariatric surgery in a different hospital less than a year ago and now has a svelte figure; even his face has changed dramatically.
Bariatric surgery significantly improves the quality of life, health and self-esteem.
A bonus in obese people (a body-mass index over 30) with type II diabetes is that almost all of them are cured of the metabolic disease as a result of the surgery, because it changes the hormone balance in the gastroenterological system and eliminates the insulin resistance involved in diabetes.
Even in diabetics who are not obese or even overweight (a body-mass index over 25), bariatric surgery has been shown to cure type II diabetes in about 70% to 80% of patients, said Shapira.
In addition, the surgery brings down blood pressure, “bad cholesterol” levels and sleep apnea (momentary halting in breathing during sleep, which is involved in heart attacks). It also reduces a person’s food bills.
The mechanism involved is like that of a radiator thermostat, with the surgery resetting the brain’s “hormonal thermostat” and making it think the person weighs about a third less.
The operation – which costs NIS 47,000 to NIS 50,000 – is not, however, covered by the basket of health services except for the obese or those who weigh less but whose blood sugar control with drugs, including insulin, diet and exercise, is unstable.
Since the cure of diabetes results in significant reduction in pill taking and medical tests, Shapira believes that over time, diabetics who are not obese will more easily be able to get state-subsidized bariatric surgery.
He noted that most obese and overweight people put on diets are unsuccessful in keeping weight off with willpower.
But the obese cannot continue to gorge themselves on fatty and sweet foods after the surgery.
After undergoing the sleeve gastrectomy or bypass surgery, which are the techniques used at SZMC and most other hospitals, they feel full after eating less food, said Shapira.
The patients are briefed on lifestyle changes and what they can eat after the surgery.
The SZMC team include a dietitian, nurse and psychologist who encourage patients to change their habits. There are support groups, and the hospital’s cardiology department has a prevention center with a gym for the use of patients.
In the sleeve technique, the surgeon cuts out three-quarters of the stomach and leaves a narrow and long structure sewn like the sleeve on a shirt.
The bypass technique causes the food to move directly to the small intestine, so the body absorbs less food and fewer calories.
Which one is used is determined during a consultation between the patient and the surgical team.
Complications from the surgery and being put under general anesthesia are rare today, said the surgeon, but they do occur, so one should not regard the operation as like going to the hairdresser or the dentist.