Robin Williams Adams| Your Health correspondent
How weight-loss surgery helps control chronic conditions like diabetes and hypertension is a complex subject.
Having a vastly smaller stomach obviously makes overeating undesirable and uncomfortable. The surgery also affects metabolism:how the body turns food into energy.
Researchers spent a great deal of time debating what was metabolic surgery and what was bariatric surgery, sometimes to the frustration of doctors who see them as intertwined.
Actually, we use them interchangeably, said Dr. Sanjiv Gray, bariatric surgeon with Lakeland Regional Healths Institute for Metabolic and Bariatric Surgery and Medicine.
Its not just about weight loss for us. Its about improving the patients life.
The two most common bariatric surgery procedures sleeve gastrectomy and gastric bypass affect the bodys metabolism by adjusting the circulating levels of different hormones.
The surgery affects the metabolic rate, which is ultimately how you lose the weight, said Dr. Shiva Seetahal, bariatric surgeon at AdventHealth Heart of Florida Hospital in Northeast Polk.
After a large portion of the stomach gets removed from the digestive process, peoples appetite is curbed. They feel more satisfied.
Other metabolic changes can be seen immediately after surgery, such as some patients who previously needed insulin not needing it the morning after surgery.
Thats what led us to say, Something else is going on outside of weight loss, said Dr. C.R. Hall, Gessler Clinic bariatric surgeon and director of the bariatric program at Winter Haven Hospital.
Gray shared a study published in October that found both bypass and sleeve resulted in significant decreases in diabetics average level of blood sugar (HbA1C). This study involved predominantly in Hispanic and Black patients.
Part of the puzzle appears to center on the bodys internal battle between hormones leptin and ghrelin.
Leptin triggers the brain to want to consume less food. Ghrelin, known as the hunger hormone, stimulates appetite.
Other hormones and peptides also regulate bodys willingness to store fat. Trials to tease out all these different hormones and their effects are ongoing, Hall said.
These also affect non-surgical treatments for weight loss.
Some older diabetes medicines can lead to weight gain, but newer ones have been found to help people lose weight.
Victoza, Saxenda and Ozempic are among those getting a lot of attention, said Dr. Lilliam Chiques-Colon, a Watson Clinic internal medicine doctor who specializes in obesity treatment.
Shes one of several doctors affiliated with the LRH Institute.
These medicines are synthetic versions of a hormone called glucagon-like peptide (GLP-1) that stimulates receptors in the brain, increasing the feeling of being full.
Victoza and Saxenda contain liraglutide, a class of drugs called GLP-1 agonists.
Victoza has Food and Drug Administration approval for use in improving blood sugar levels in adults with type-2 diabetes.Saxenda is approved for long-term weight loss (along with better diet and exercise.)
Ozempic (a semiglutide) is approved for blood sugar control in type 2 diabetes and to lower risk of major events like heart attacks. The FDA is reviewing whether to approve it for weight loss too.
Chiques-Colon does suggest some of her patients change to newer medications to help them lose weight.
I look like a hero and all I did was change their medicine, she said.
Robin Williams Adams can be reached at robinwadams99@yahoo.com
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Metabolic aspects of weight-loss surgery scrutinized - The Ledger
