Resolution of Comorbidities
On this week’s episode of Bariatric Friday, Kemal Erkan and Dr. Isaias Irgau sit down to talk about the comorbidities associated with morbid obesity. Comorbidities refer to medical conditions that occur simultaneously with being overweight, so it may be easier to think of them as complications of obesity. Obesity-related comorbidities include type 2 diabetes, dyslipidemia, hypertension, cardiovascular disease, obstructive sleep apnea, and non-alcoholic fatty liver disease. Bariatric surgery can actually help resolve many of these conditions, which makes it an extremely powerful tool to improve one’s overall health.
Surgery doesn’t just induce weight loss through making the stomach smaller, it also impacts the metabolism itself. Patients may see improvements in their glucose levels just days after surgery, even before they even start losing weight. Why is this? Dr. Irgau explains that surgery changes the hormones that regulate metabolism. He describes it as “injecting yourself with your own Wegovy.” Your body naturally produces GLP-1, and surgery makes it much more available. There is better sensitivity of insulin, and better distribution of sugar from liver cells.
In terms of type 2 diabetes, those with a shorter history of type 2 diabetes have a higher chance of completely reversing the condition after surgery. Those who are not already on insulin for their diabetes have a higher chance of reversal. However, everyone will experience improvements after surgery. Some things to look out for after surgery are diabetes medication adjustments to avoid hypoglycemia, as the body has now gone through significant metabolic changes. Surgeons will actually recommend lowering doses of insulin or avoid taking it completely after surgery, based on their blood sugar readings.
Fatty liver disease is another major and dangerous comorbidity associated with obesity, because it leads to dysfunction of the liver. These changes can look identical to the damage seen in someone who drinks excessive alcohol. Excess accumulation of fat around the liver can lead to cirrhosis of the liver, and then liver cancer. Non-alcoholic fatty liver disease is a major reason why many people in the US may need a liver transplant. With the intervention of bariatric surgery, liver dysfunction can be reversed completely before it turns into cirrhosis.
Comorbidities do have the potential to come back, but that is primarily due to lack of adherence with lifestyle changes. If there is significant weight regain after surgery, that can also lead to a recurrence of associated comorbidities. Behaviors such as grazing can cause increased calorie intake and result in weight regain. Low activity levels, mental health struggles, and loss of follow-up can also all be factors in weight regain. However, with accountability and responsibility, as well as collaboration between patient and surgeon, this does not have to be the case.