Bypass Ahead!

The expression “unintended consequences” usually applies to bad things that come from good intentions. For example, the noble goal of producing enough food for people to eat has created a worldwide epidemic of obesity.

But sometimes an unintended consequence is pleasantly surprising. For us type 2s, that would be the dramatic effects of gastric bypass on our disease. The procedure is used to help very obese people lose weight, either by inserting a band around the upper stomach (“sleeve gastrectomy”) or restructuring the digestive system (“gastric bypass surgery”) to make food bypass certain sections. Because patients can no longer digest as much food as before, the procedure often produces dramatic weight reductions. 

Many of the people who undergo gastric bypass are type 2 diabetics—which makes sense when you consider that obesity often precedes or accompanies the disease. A large percentage of those type 2s after the procedure experience the total remission of their diabetic symptoms. Their blood sugar levels drop to normal, non-diabetic levels, and their weight and blood pressure come down as well. Their insulin resistance decreases. Many no longer have to take medications to control their condition.

Scientists, being careful types, do not label these remissions as cures. The best they’ll say about them is that they are “long-term.”

OK, long term, as in being able to go months, possibly even years without a recurrence of type 2 symptoms.

Right now, gastric bypass is recommended only for people whose body mass index is 35 or greater (a person with a BMI of 30 or more is considered obese). Insurance companies set the bar at that level, too, seeing the procedure as almost an exotic, last-ditch intervention for morbidly obese patients.

But as gastric bypass has become more commonplace, and its effects on type 2 diabetes better documented, there’s a push by bariatric surgeons to lower the BMI threshold to 31. Yes, their push is partly motivated by a desire to perform more procedures—people who have spent years honing incredible skills like to get paid to use them. But they are also motivated by a genuine desire to spread a therapy that appears in many ways to be a sort of magic bullet.

However, gastric bypass as a common diabetes therapy is still a ways off, especially for type 2s who don’t qualify as obese. The hurdles that remain include the need for extensive documentation of just how long its beneficial effects last, and whether there might be complications that pop up long after the procedure is done.

Also, throw in insurers’ reluctance to cover the procedure until it becomes a demonstrably sure thing.

But if—and I don’t think this is all that big an if—gastric bypass comes down in price because it becomes more frequent (especially sleeve gastrectomy, an outpatient procedure that involves inserting a band down the esophagus while the patient is in twilight sleep), look for a great argument to be made in its favor: Which would an insurer prefer to pay for: A one-time procedure that produces almost immediate good results, or years of test strips, meters, medications, check-ups, and, later on, surgeries for cardiovascular problems or amputation?

Keep your eyes on this topic. It’s one we’ll be visiting from time to time.