People who seek medical help for weight management are used to hearing that results take time. Imagine the surprise of some patients with type 2 diabetes when their blood sugar improves meaningfully within days or weeks of bariatric surgery. It happens—and it’s a dramatic sign of the benefits bariatric surgery holds for many patients, said Dr. Fritz Jean-Pierre, a board-certified bariatric surgeon and national leader in minimally invasive and robotic techniques for the treatment of obesity and metabolic disorders. When changes in blood sugar following bariatric and metabolic surgery were first observed in the 1990s, the reason was a mystery. But today, medical experts know more about the hormones that regulate hunger and insulin production. They also know more about how bariatric surgery affects the same hormones.
Understanding type 2 diabetes: It starts with insulin resistance
Insulin is a hormone that regulates blood sugar. Insulin resistance happens when muscle, fat and liver cells fail to respond to insulin, causing the pancreas to overproduce the hormone. Eventually, blood sugar rises. Patients may develop prediabetes or type 2 diabetes. Another hormone that affects weight is GLP-1. It’s naturally produced in the gut after eating. GLP-1 helps regulate blood sugar by:- Stimulating insulin
- Suppressing glucagon, a hormone the pancreas produces that raises blood glucose levels
- Slowing digestion
Many recognize GLP-1 today because of the class of weight-management drugs such as Ozempic, Zepbound and Wegovy. These medications mimic and amplify the effects of the GLP-1 hormone.
How bariatric surgery affects hunger hormones and improves health
Several types of bariatric surgery are performed at Wellstar. While each procedure alters the digestive system differently, all appear to influence the hormones that regulate hunger and blood sugar. Hormones, such as GLP-1, that promote fullness and insulin sensitivity increase after surgery. The liver produces less excess glucose, and the body becomes more sensitive to insulin. Other hormones—like ghrelin, which signals the brain that the stomach is empty—decrease after surgery. “We've known since the early 2000s that after bariatric surgery, you have a boost in GLP-1 hormone production,” said Dr. Jean-Pierre. “Patients notice improvements in their blood sugars and that feeling of fullness.” As a result of hormonal changes triggered by surgery, patients who are not yet on insulin replacement therapy may enter diabetes remission relatively soon, according to Dr. Jean-Pierre. “The patient may have lost only 5 or 10 pounds yet their blood sugars have become normalized,” he said. “Their diabetes is completely controlled without medication after surgery. That’s the best-case scenario.” For other patients, improved blood sugar may take longer. Still, clinical trials show that bariatric surgery leads to diabetes remission in 33% to 90% of individuals at one year after bariatric and metabolic surgery.1 “These surgeries are not just changing or shrinking the patient’s stomach,” Dr. Jean-Pierre said. “We're changing their metabolisms in a way that will help improve a lot of related health conditions like high blood pressure, abnormal cholesterol and fatty liver disease.”Long-term health benefits of bariatric surgery
There are many health risks of type 2 diabetes and obesity. Those include high blood pressure, high cholesterol, sleep apnea and joint pain. Unmanaged diabetes can lead to damage to nerves, kidneys, eyes and heart. Stroke risk is also higher in people with diabetes. Physicians have more treatment options for obesity than ever, including surgery, medications and lifestyle changes. Wellstar Center of Best Health is a comprehensive weight management clinic with clinicians, dietitians, psychologists and exercise physiologists who work collaboratively with surgeons. Together, they learn about each patient’s situation and develop a personalized treatment plan with the best chance of success. Some patients may benefit from both surgery and medication. “Obesity is a chronic, relapsing, multi-variable disease process that we have to approach from different angles in order to best treat it,” said Dr. Jean-Pierre. “You must approach it comprehensively, including nutrition and exercise. Medication itself is not a magic bullet. Surgery is not a magic bullet.” Wellstar’s weight loss teams support patients throughout their healthcare journey. The goal is to see patients reach their goals and return for follow-up care in even better health. “It’s amazing when all of these treatment options fire in the right direction and we see the health improvements that come along with surgery,” such as:- Better diabetes control
- Lower blood pressure
- Less joint inflammation and pain
- End of the need to use a CPAP for sleep apnea
“Most surgeons fix something, then you don't see your patient again. With bariatric surgery, it's a very different relationship,” Dr. Jean-Pierre said. “We see our patients for a long period of time afterward. We get to share in their successes and see their accomplishments as they lose that weight.” Learn more about obesity medicine at Wellstar and make an appointment to see an obesity specialist at one of our locations.
1 Affinati, Alison H et al. “Bariatric Surgery in the Treatment of Type 2 Diabetes.” Current diabetes reports vol. 19,12 156. 4 Dec. 2019, doi:10.1007/s11892-019-1269-4
