Test Your Knowledge Answer #481

• An individualized weight reduction program consisting of medical nutrition therapy as developed by a registered dietitian is most likely to achieve a sustained weight loss and improved glycemic control.
• Bariatric surgery guidelines indicate that the criteria for selection in patients with diabetes are a body mass index of 40 or of 35 to 39.9, the presence of severe diabetes, and repeated failure at medically supervised weight loss.

Weight reduction improves insulin sensitivity and glycemic control. However, weight loss in patients with diabetes who use insulin is a challenge for both the patient and the health-care provider. Research has shown that as little as a 7% change in total weight can effect a change in diabetes control and cardiovascular health. Meal plan modification should involve a registered dietitian and include meal-to-meal consistency of carbohydrate content and the elimination of snacks as part of an individualized plan. An assessment by a dietitian with a comprehensive review of medical management and treatment goals is necessary to select an approach that is likely to succeed and includes exercise. If the goals have not been reached in 6 months, reassessment of the patient's eligibility for bariatric surgery is appropriate. Bariatric surgery has been shown to be effective in preventing and managing Type 2 diabetes for those patients who are obese and meet the criteria below.                     

• Patients who are severely obese (body mass index of 40 or more) or who have a body mass index of 35 to 39.9 with serious medical conditions (e.g., high blood cholesterol and triglycerides, hypertension, sleep apnea, Type 2 diabetes, and other serious cardiopulmonary disorders);
• Patients who have tried other weight-loss methods, such as changes in eating and behavior, increased physical activity, and/or drug therapy, and remain severely obese;
• Patients who are unable to physically perform routine daily activities (work-related and family functions) and have a seriously impaired quality of life because of the severity of their obesity;
• Patients who understand the procedure, risks of surgery, and effects after surgery; and
• Patients who are motivated to commit to lifelong behavioral changes that include well-balanced eating and the physical-activity habits needed to achieve the best results.

1. Bariatric surgery: American Society for Bariatric Surgery Guidelines. Available at: www.lapsurgery.com/BARIATRIC%20SURGERY/ASBS.htm. Accessed 3 October 2006.
2. Joslin Diabetes Center & Joslin Clinic. Clinical nutrition guidelines for overweight and obese adults with type 2 diabetes, prediabetes or at high risk for developing type 2 diabetes: 9/30/05. Available at: www.joslin.org/Files/Nutrition_ClinGuide.pdf. Accessed 3 October 2006.