Many South Africans have the misconception that metabolic surgery is done purely to achieve weight loss for cosmetic reasons.
“In fact, metabolic surgery shows a high degree of success in assisting to resolve the medical conditions associated with obesity including impaired glucose tolerance; metabolic syndrome and type 2 diabetes,” says Dr Gert du Toit, surgeon, Durban Metabolic Surgery Centre, Netcare St Augustine’s Hospital.
According to the International Diabetes Federation (IDF), approximately 1.8 million South Africans were living with diabetes in 2017, and globally there are 425 million people living with the disease.1
“This highlights the magnitude of the global health challenge posed by the deadly combination of obesity and diabetes. There is a strong correlation between the rise in obesity and the explosion in type 2 diabetes and other lifestyle-related chronic health conditions,” notes Dr du Toit.
He says that other health conditions often associated with obesity include ischaemic heart disease; sleep apnoea; certain kinds of cancers; osteoarthritis and mobility problems.
“Where patients are treated and properly supported pre- and post-operatively by a multidisciplinary team of medical practitioners, metabolic surgery presents a safe and viable treatment option for obese individuals,” adds Dr du Toit.
“If undertaken at a metabolic centre that is accredited by the South African Society for Surgery, Obesity and Metabolism [SASSO], the surgical approach not only achieves outstanding weight loss results, but also a high degree of success in resolving conditions associated with obesity including metabolic syndrome, impaired glucose tolerance, as well as type II diabetes.”
The American Diabetes Association (ADA) states: “Many people who undergo metabolic surgery experience major improvements in glycaemia, and a reduction in cardiovascular risk factors, making it a highly effective treatment for type 2 diabetes and an effective means of diabetes prevention.”2
Dr du Toit concurs, noting that early surgical intervention shows outstanding potential in preventing the obese patient from proceeding from impaired glucose tolerance (pre-diabetes) to full-blown type 2 diabetes, and that it furthermore improves outcomes.
A recent study published in the Biomedical Journal of Science and Technology Research3 points out that metabolic surgery in type 2 diabetes patients’ results in:
- Better glycaemic control;
- Reduction in medication use;
- Reduction in cardiovascular disease risk;
- Reduction in heart attack, stroke, cancers and in overall mortality rates; and
- Improved weight loss and quality of life.
The randomised, controlled STAMPEDE trial, published in the New England Journal of Medicine (NEJM), compared medical and surgical therapy and the results thereof,reported similar findings.4,5
Dr du Toit says that metabolic surgery often achieves a complete remission in diabetes, but this depends on factors such as how long the patient has had the disease. “The best outcomes are achieved in patients who have not had diabetes for more than five years, so early diagnosis is important.”
Recognising the advantages of early intervention, Discovery Medical Scheme, revised its funding requirements for metabolic surgery for 2018, reducing the patient Body Mass Index (BMI) requirement from 35 to 30.
“This is a significant development and recognition of the important preventative role metabolic surgery can play, particularly with regard to pre-diabetes and type 2 diabetes, which can cause irreversible damage to blood vessels and organs.
“This decision, which was made following negotiations with endocrinologist Professor Tess van der Merwe, SASSO chair and director of the Centres of Excellence for Metabolic Medicine and Surgery of South Africa, highlights that metabolic surgery treatment makes economic sense for many patients, and we expect other medical schemes will follow in covering metabolic procedures in future,” says Dr du Toit.
Before the decision is taken to recommend metabolic surgery, SASSO-accredited facilities insist that the prospective patient undergo a thorough physiological and psychological evaluation to ascertain their suitability for the treatment.
“As there can be numerous highly complex physiological and psychological causes of obesity, and each person has a completely different constitution and metabolic makeup, every case is different and not everyone can have, or will respond well, to the treatment,” says Dr du Toit.
“In the majority of cases, where patients are treated and properly supported before and after surgery by a multidisciplinary team and the surgery is safe for the patient, life-changing results are achieved. It should be understood that metabolic surgery is not a quick-fix solution for obesity, however. It requires a long-term commitment to a proper post-surgery diet and an on-going follow-up programme, ” asserts Dr Du Toit.
Over and above the laparoscopic surgeons, the multidisciplinary teams at SASSO centres include highly experienced endocrinologists, physicians, dieticians, psychiatrists and/or psychologists, and biokineticists.
“Such a team is able to take a comprehensive and holistic approach to weight loss, and determine the most practical solutions for each individual patient. The three main types of metabolic surgery offered at SASSO-accredited facilities in South Africa are all minimally invasive and are undertaken laparoscopically through small incisions in the skin.
“A high degree of disease resolution and very low complication rates are achieved at dedicated multi-disciplinary metabolic surgical centres. For those who qualify for this treatment, metabolic surgery is a tried and proven option,” concludes Dr Du Toit.
Issued by: Martina Nicholson Associates (MNA) on behalf of Netcare St Augustine’s Hospital
Contact: Martina Nicholson, Graeme Swinney, Meggan Saville and Estene Lotriet-Vorster
Telephone: (011) 469 3016
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