A weighty decision

While weight-loss surgery may not be for everyone, it has helped Stuart Reich shed nearly 100 pounds and allowed him to better control his diabetes.

Stuart Reich testifies to the benefits of surgical weight loss—he’s kept off 90 pounds and his diabetes is better controlled after his laparoscopic band surgery four years ago. Here’s what Stuart tells people with diabetes who are considering weight-loss surgery: “Get all the information you can, talk to your doctors, and make your own decision. It’s not something another person can decide for you.” For him, there’s no doubt that it was the right decision.

Stuart developed type 2 diabetes at age 17 and has been using insulin for 36 years. “Weight has been a problem for me,” he admits, even though he followed diet and exercise recommendations as well as he could. Stuart’s endocrinologist prescribed weight-loss medications, but they were unsuccessful.

As a physician assistant with his own practice in Suffern, N.Y., Stuart is better informed than many people about diabetes. “I thought about surgery for a long time. I did a lot of research and talked to doctors. Then, one day, I was running across a street—to a doctor’s office!—and the driver of a car called me a ‘fat ’ because I wasn’t moving fast enough. That helped me make up my mind.”

Stuart’s wife was against his decision, especially when his first operation was stopped because a blood vessel burst where the band would be placed. The doctor stopped the bleeding—and the operation. When Stuart woke up, the doctor explained what had happened. Stuart’s response? That he’d have surgery after he recovered. And, a few weeks later, “on a Tuesday or a Wednesday—I can’t remember now—I had the surgery, and I was in my office the following Monday.” Stuart’s only side effect was temporary—a more rapid than normal heartbeat—but it was gone before he left the hospital.

After the surgery
As Stuart put it, “surgery is one tool” to control diabetes. A recent study has shown that weight-loss surgery is better than standard treatment for people with type 2 diabetes. Some people with diabetes in this study experienced remission with surgery, while others have better glucose control. Stuart has found that his glucose is more normal, and he has fewer swings in glucose levels. He still takes insulin, but only 4 to 10 units a day; he tests his blood glucose four times a day. His A1C is 6.4%.

Just because Stuart’s lost 90 pounds doesn’t mean the weight stays off easily. He’s had the band tightened three times (because he was gaining weight) and says, “that’s not often for four years.” He still counts carbs, watches calories, and continues to see his nutritionist.

How would Stuart describe his postsurgical life? “I feel better; I feel good about myself.” Weight-loss surgery isn’t for everyone, he says, but it’s been good for him—and his diabetes.

Types of bariatric surgery

These surgeries aid weight loss. Surgeons use two methods: open or laparoscopic. In open surgery, an 8- to 10-inch cut is made in the middle of the abdomen. In a laparoscopic procedure, several 1?2- to 2-inch cuts are made to let instruments and cameras into the cavity.

Adjustable gastric banding
The width of the opening into the stomach from the esophagus is reduced by an adjustable band. The surgeon can shrink or enlarge the size of the band through a port (or opening) in the wall of the abdomen just under the skin.

Gastric bypass(Roux-en-Y gastric bypass)
The stomach is reduced to an egg-sized pouch. This pouch is reconnected to a tube of intestine that bypasses 2 feet of intestines.