A New Direction for Weight Loss Care

by Christine Bishundat
Med Ed Committee

Diabetes prevalence is among the highest for chronic disease in Americans. Obesity has a direct role in the foundation of diabetes. It is especially difficult to treat obesity when the steps taken to decrease weight loss relies on patient compliance to lifestyle changes. For severely obese patients, bypass surgery and bariatric surgery have yielded promising results for the long-term treatment of this disease. Through these techniques, interesting findings for weight loss have been uncovered.

Type 2 diabetes is a chain of processes. According to Nicholas Stylopoulos, HMS assistant professor of pediatrics at Boston Children’s Hospital, weight loss treatment usually focuses on the hormone step or fat and muscle section of the chain. Targeting the location of a different pathway in the metabolic system, such as the small intestine, brings us directly to the process that defines obesity.

As bariatric surgery has been around for a few decades, the effects of rapid weight loss have been observed, but only now have researchers begun to take a closer look at what goes on in the small intestine. This type of surgery has revealed that the transporter GLUT-1 appears and its mechanism helps to decrease the presence of glucose in the small intestine. As glucose contributes heavily to obesity, the reduced glucose environment created is highly efficient in weight loss.

Gastric bypass surgery removes a great quantity of gastrointestinal microbiota that effectively aid metabolism. Patients report being less hungry with help from an altered level of hormones that contribute to appetite. Changing the amount and type of gastrointestinal microbiota directly lowers metabolic weight and supports a rapid rate of weight loss. The processing of glucose by short-chained fatty acids in the small intestine accelerates, leading to the rapid rate of weight loss.

Thanks to these findings, it is becoming more apparent that one does not need to be severely obese to get the same benefits of bypass surgery or bariatric surgery. If an outpatient procedure for the small intestine can be developed, the diabetes treatment for primary care centers could become more effective and dramatically alter chronic care statistics.