To Band or Not to Band - that is the question?
By: L.A. Pacitto

As obesity and type 2 diabetes rates rise higher each year in the U.S., gastric surgery is becoming an increasingly common procedure.  New research on gastric surgery, , suggests that the procedure can reduce insulin resistance (a predictor of diabetes) and send type 2 diabetes into remission.
     Lap-band surgery, in which a stretchable band is placed around the stomach, restricting the amount of food the stomach can comfortably hold, has gained popularity as a safe and reversible “fix” compared to gastric bypass surgery (the current standard of care), which involves creating a small stomach pouch by stapling part of the stomach together then attaching a section of the small intestine to the pouch allowing food to bypass the duodenum and the first portion of the jejunum.
        In an interview with CBC News, Dr. John Hagan, a bariatric surgeon at Humber River Hospital in Etobicoke, Ontario, stated that approximately 75 per cent of obese patients who underwent the surgery, either gastric bypass or lap-banding, experienced reverses in their diabetes, often instantly.
    "The diabetic patients often leave hospital off all their diabetic medications even before they've had a chance to lose weight," he told CBC News.
     The experts don't fully understand how either type of surgery is able to reverse Type 2 diabetes so quickly and even before weight loss begins. Dr. David Lau, a Calgary-based endocrinologist, suggests that gastric surgery might trigger hormonal changes that affect insulin resistance. 
    Dr. Joan F. Carroll of the University of North Texas Health Science Center in Fort Worth, Texas conducted research that suggests that lap-band surgery doesn't reduce patients' sensitivity to insulin the way gastric bypass supposedly does.
    Dr. Carroll and her team have been following 37 lap-band patients for up to one year. Those followed for six months have lost 51 pounds, on average, while average weight loss for those who have been followed for a year is 75 pounds; and insulin resistance had fallen by 60 percent after six months. The strange part is, according to Carroll is there's no reason either procedure should directly affect insulin sensitivity.
     John Dixon, an obesity researcher at Monash University in Melbourne, Australia, conducted a study to determine if patients who undergo the less drastic gastric lap-band surgery compared to gastric bypass do as well with regard to insulin resistance. Researchers looked at 55 diabetes patients defined as obese, having a body-mass index (BMI) between 30 and 40. In layman's terms, a 5’11”man with a BMI of 40 would weigh approximately 287lbs. The patients were randomly assigned to either undergo gastric banding or to try to lose weight through diet and exercise.
     After two years, diabetes went into remission in 22 of the 30 lap-band surgery patients only in four out of 30 diet-and-exercise patients. Those who had surgery lost an average of 20.7 percent of their body weight, while the dieting group lost only 1.7 percent of their body weight. According to Dixon, the difference appeared to be due to the amount of weight that the patients lost rather than the specific approach they used, meaning that if  the diet-and-exercise patients lost as much weight as the surgical patients, their diabetes may have been as well-controlled. Dixon’s findings are published in the Jan. 23, 2008  issue of the Journal of the American Medical Association.

      So should diabetics rush to get lap-band operations? The cost could stop many of them. The procedure costs an average of $18,000 in the United States, Dixon said. By contrast, diet and exercise are free.