Monday, June 26, 2017

Cross-questionings

This blogpost is inspired from an article I read in the May-June 2017 issue of the magazine "Diabetic Living". The article led me to deep introspection and there were a number of points that stoked the ego of the fitness-freak in me and also stimulated the advocate of physical activity in me. Some facts stipulated in the article left me bewildered and some left me with questions many in number. Few seemed incredible and the rest scientific and concept-wise knowledge imparting. 

The title of the article was - WEIGHT LOSS SURGERIES : What you need to know now. 
I will take the article statement by statement and express my personal opinions, few statements of course. These are not meant to offend anyone or disrespect the contributors of this information in this magazine, but these are my views that came up to me as I read the article. One can assume that my opinions are manifestations of my curious nature to know about the labyrinth of diabetes. 

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), surgery can improve type 2 diabetes in 90% of patients and cause remission of type 2 diabetes in 78% of them. 

Ok. So far so good. I wonder however, the implication of this independent claim. Since we know multiple ways in which the diabetic condition can be improved in people, wouldn't it have been more information-giving to readers had a comparison been presented? A table may be? 

In fact, weight loss surgery is now considered a standard treatment option for people with type 2 diabetes based on a joint statement of 45 international professional organizations. (some big organizations name list)

Interesting! Standard treatment option for people with type 2 diabetes!! Is it considered standard for it fetches huge money or because of its fast-forward nature of treatment or for the sustenance of the solutions? Am I the only one who feels an analogy of chemotherapy here? 

Bariatric and metabolic surgeries have become more common, given the success rates in helping people lose weight and improve their diabetes. For some morbidly obese people with diabetes, surgery is the best option. But research is also beginning to show it could also help people with prediabetes or type 2 diabetes in less-dire circumstances.  

Okay, let's go line by line here. The first line states that the surgeries are becoming more common, given the success rates in helping people lose weight and improve diabetes. Where are the success rates of lifestyle interventions? "Common" is a very abstract term. Diabetes is a serious issue and sending out the message that "surgeries are becoming common" to people who live in apprehension with diabetes , much worse, who cannot afford surgeries, what about them? This headlong advocating of surgeries is a recipe for people forgetting that their health is in their hands and in wise decisions. Besides, should not we be working with people to prevent them from becoming "morbidly obese" rather than broadcasting in broad day light that surgery is the best option for those who already are morbidly obese? Isn't there a lack of focus here? In a way the second lines seems to be saying that, "Go on, become morbidly obese, there is nothing to fear, you can always get a surgery done". I mean, why such a subtle promotion of surgeries? I would want to know the statistical comparison which led to this conclusion of "best option". And the most insidious sentence is the last one. Until now, surgery was limited to people with "morbid obesity" and now it intends to lay its hands over prediabetes and diabetes for which research is abound citing the benefits of lifestyle interventions. But I know, I think I understand why such "quick-fix" solutions steal all the limelight away. It is not rocket science! They steal away the limelight because people are looking for fast solutions, to get rid of their conditions, to get rid of the health outcomes that took some time to manifest and they want to obliterate it within few hours in operation theatres. People and their propensity to get immediate gratification is driving these surgeries. Now, I know, everyone wants to get cured fast, it is human and I do not question the nature of this feeling, I respect it. However, would not it be wise to save all that money and rather invest it in your healthy eating before you become morbidly obese & ready to go under knife? Healthy eating costs much less than the cost of operations and surgeries, isn't it? And No! We do not want surgeries to annex prediabetes, please. That would be too much of medically uncalled for intervention. 
In fact, these procedures and surgeries may be offered to more people in the future, says Suneil Koliwad, M.D., Ph.D., assistant professor in the Diabetes Center at the University of California San Francisco. Obese people are experiencing improvements in blood sugar control right after surgery. This suggests that the surgery itself, not just the subsequent weight loss, can help people with their diabetes. 

So, that is what Diabetes Research Centers at UCSF are doing? Curative research? How many people can pay for these procedures and surgeries? Much less than those afflicted with diabetes. "Right after the surgery" improvements - the main driver for the bariatric surgery operations! I believe we have become so hedonistic when it comes to food that we are okay with coming under knives and reduce our weight rather than exercise some restrain and discipline and let the weight manage it itself. Appalls me, terribly. The kind of message that is being conveyed is unsustainable, threatening to the health economy of the nations and might seem to provide some soothe in short term but is not at all helpful in making the 19 years old kids active whose activity levels match those of 60 years old. Do I smell, "inverse care law" here?
Some experts now suggest people with diabetes could still benefit from the surgery's effect on their blood sugar levels, even if they don't meet the obesity requirements currently recommended for surgery. 

Is this good news? Or is it a bait to attract helpless people, those fearing diabetic neuropathy, diabetic nepropathy, diabetic retinopathy or amputations? Would not it be more sustainable and promising to teach people , "how to fish rather than giving them a fish"? We cannot grow treating the symptoms, we have to attack the root cause and the root cause lies in the behavior of people. Behavioral change is more challenging but sustainable. We need to promote those stories !! Where are they?

Also consider the importance of good postoperative care. It's vital to a surgery's success, including resources such as support groups to help you cope with side effects and to teach how to eat appropriately. You will have to eat differently for the rest of your life. 

This is an interesting sentence. I wonder  we never paid attention to pre-operative precautions, interventions (well not that much as surgeries) and if we had may be we could have a clause that, "If you do not see changes in this amount of time, we will go ahead with surgery". "How to eat properly", when a man or a woman can follow this advise after the operation or a surgery, can't he/she be counseled to do exactly the same before surgery? Won't that be more effective and save his finances? But yeah, medical industry thrives on sickness. 
The magazine left me with loads of information. But it also left me with a lot of fodder to ponder upon. And now I know what I have to do. Research on Metabolic and Bariatric surgeries!! 

As for those who read this post, I just want to say one simple thing: 
"If Exercise were a medicine, it would be have been the most expensive one. It's time to take ownership of your health"

Love & Blessings. 

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