Rebecca Blair, a veterinarian from Rancho Cucamonga, Calif., got a dreaded diagnosis back in 2007: type 2 diabetes.
"I was on four different oral medications and injections, but my diabetes was very bad and nowhere near controlled," said Blair.
She ate healthy foods and did everything she could to lose weight, but wasn't successful at either dropping the pounds or bringing her blood sugar under control.
Blair said she watched a lot of health-related television programs and learned about overweight people who had a gastric bypass surgery that actually helped their diabetes in addition to helping them lose weight.
"That sparked my interest, and I did some more research," said Blair. After that, she was convinced she wanted to have a gastric bypass.
But the bariatric surgeon she saw, Dr. Theodore Khalili of Cedars-Sinai Medical Center in Los Angeles, dashed Blair's hopes.
"Her BMI [body mass index] was too low to do a gastric bypass, because we follow the guidelines set by the CDC [Centers for Disease Control and Prevention]," said Khalili. Those guidelines, he said, recommend against doing bariatric surgery on diabetics with a BMI less than 35. Blair's was only around 24.
Blair was undeterred.
"I did more research, then I tried to find a clinical trial, and then I decided to gain weight," she said.
Blair hoped to gain enough weight to qualify for a bypass -- and eventually she did. She gained about 85 pounds over a two-year period by eating a lot of fat.
"When she came back, she qualified for surgery," said Khalili, who by then had founded the Khalili Center for Bariatric Care in Beverly Hills. "She underwent the surgery, and is now down to one diabetes medication that she can probably discontinue soon."
But Khalili and other surgeons say that while gastric bypass seems to work wonders for diabetics by resolving their condition and helping them lose weight, they would never recommend that any patient deliberately gain weight in order to meet criteria for weight loss surgery.
"There are potential problems that revolve around some of the other comorbidities that can occur when you gain weight, such as hypertension and high cholesterol," said Dr. Ronald Clements, professor of surgery and director of the Center for Surgical Weight Loss at Vanderbilt University Medical Center. It can also cause complications if a person is already diabetic.
"I never tell patients to gain weight, but the reality is that some of them do," said Dr. Nestor De La Cruz-Munoz, associate professor of surgery and chief of bariatric surgery at the University of Miami's Miller School of Medicine.
They also stress that any surgery comes with potential complications of its own and should never be a rash decision.
While it's unethical to encourage bad behavior in order to get a good outcome, doctors recognize that situations like Blair's are difficult.
"The symptoms of diabetes may get resolved by losing weight, but she can never get rid of the condition," said Clements.
Gastric Bypass Very Effective at Resolving Diabetes
Blair started getting relief from her diabetes within a couple of weeks of her surgery, which was back in September. Doctors say it can often get better even faster than that. Diabetes can resolve entirely or be brought under better control.
"A gastric bypass can induce changes in gastrointestinal hormones because as a result of the surgery, the hormones get redirected through the gastrointestinal tract," said Clements.
"The hormonal effects cause diabetics to go into remission, though the mechanism of that is unknown," said De La Cruz-Munoz.
Because of the hormonal effects and the weight loss, for many obese diabetics, a gastric bypass offers double benefits.
Gastric bands can also help diabetics because they lead to significant weight loss, but there's no hormonal effect.
"The band only works by placing a restriction around the upper part of the stomach," said Clements. "You don't get the immediate effect of rerouting the bowels and redirecting hormones."
Recognition of Benefits on the Rise
Surgeons say there's more awareness of the benefits that bariatric surgery can offer people with weight-related problems. Just last month, a U.S. Food and Drug Administration panel voted in favor of lowering the eligibility limit for lap band procedures to a BMI of 30 for those with conditions like diabetes and 35 for those with no weight-related problems.
"I think absolutely the BMI limits for diabetics are going to be lowered," said Khalili.
"If we're talking about gastric bypass, we would be doing it for metabolic reasons in addition to weight loss," said Clements.
They also say insurance companies may soon be more willing to pay for bariatric surgery given the benefits it provides.
"Multiple studies have shown weight loss surgery to be cost-effective over a period of 18 to 24 months," said Khalili. "Insurance companies recoup the cost within two years."
Blair's insurance company paid for her surgery because of her diabetes, but she said if she had to, she would have paid for it out of of her own pocket. She said it's far cheaper to pay for the surgery than it is to pay for years of diabetes drugs.
"The surgery is cheaper than medications and complications related to diabetes," she said.
Blair said she is thrilled with her medical progress. She's already lost about 50 pounds and may soon be off all her diabetes medications. She also says it's been easier to eat since the surgery than it was before.
"I can eat more normally than I have since I was diagnosed with diabetes," said Blair. "I can't eat a lot, but I can eat carbs without sending my blood sugar off the charts."
Although doctors say they absolutely do not recommend that patients intentionally gain weight, Blair says she has very different advice.
"I tell people that have type 2 diabetes that are the slightest bit chubby to not lose weight. They should gain it."