Bariatric Surgery Resolves Diabetes 83 Percent of the Time
Cardiovascular disease, the number one cause of death in the U.S., is driven, in part, by modifiable risk factors such as obesity, diabetes, high blood pressure, and high cholesterol.
"All of these modifiable risk factors are improved by bariatric surgery," said Samuel Bledsoe, MD, FACS, FASMBS, Medical Director of Bariatric & Metabolic Surgery at Arkansas Heart Hospital's Encore Medical Center in Saline County. "This results in a longer and healthier life. Bariatric surgery resolves diabetes 83 percent of the time. Hypertension goes into remission in about 60 percent of cases. High cholesterol is improved in the overwhelming number of cases. Of course, obesity is dramatically impacted by bariatric surgery with most patients losing more than 50 percent of their excess body weight."
Of all the benefits, the improvement for people with diabetes is what Bledsoe finds most exciting. "The interesting thing is how quickly this happens, because the resolution of the diabetes can happen immediately," he said. "The patient can come into the hospital with diabetes and on multiple medications. They can then leave the hospital with normal blood sugar and on no medications. Most people, even most doctors, don't realize this."
Bledsoe said bariatric surgery decreases the risk of an individual with diabetes having a heart attack by 44 percent and the risk of a stroke by over 40 percent. Bariatric surgery has a protective effect in those with diabetes on diseases of the eye leading to blindness and on kidney diseases leading to dialysis.
"Bariatric surgery can also reverse the damage to the liver caused by non-alcoholic fatty liver disease, which is found at much higher rates in people with diabetes," Bledsoe said. "All of this results in a longer and healthier life span with a recent study showing an increase in lifespan of 5-10 years for the average patient receiving bariatric surgery."
Beginning in 2016, the American Diabetes Association (ADA) has stated in their Standards of Care that an individual with diabetes and a BMI of greater than 40 should go directly to surgery, and an uncontrolled diabetic should have surgery if the BMI is greater than 35. This recommendation from the ADA changed the rationale for bariatric surgery.
"In the past, we performed surgery for obesity and one of the downstream benefits was resolution of the diabetes," Bledsoe said. "Today, we do surgery for diabetes, and one of the downstream benefits is weight loss. For anyone who struggles with diabetes, they owe it to themselves to at least consider the possibility of bariatric surgery."
Bariatric surgery has definitely improved over the decades. Laparoscopy has allowed for minimal access to the abdominal cavity meaning a lower rate of complications and shorter recovery times. Increased education for patients and improved training for physicians and hospitals has allowed for better access for patients and better outcomes from the procedure. Bledsoe said that, at this time, having bariatric surgery is as safe as having your gallbladder removed and far safer than having colon surgery.
He considers sleeve gastrectomy a great innovation and is the procedure of choice for about 80 percent of his patients.
"It has a very safe track record and the results are outstanding," Bledsoe said. "Most patients lose an average of 60 percent of their excess body weight. This can all be accomplished with a very low risk of complications."
There are people who should consider a gastric bypass. A bypass can be a better procedure for patients with diabetes and those who suffer with severe reflux. Bledsoe said in those two situations, a bypass should be considered, but not required.
The pandemic has definitely been hard on people as it relates to their weight. People are exercising less and increasing their intake of unhealthy foods. This has led to the "Quarantine 15." While diet and exercise are worsening, sleep disorders, stress, and substance abuse issues are also increasing which can also have a detrimental effect on weight.
"I've seen a lot of anecdotal evidence of this 'Quarantine 15,'" Bledsoe said. "I have a number of patients who have lost a large amount of weight and have put some back on due, in part, to the pandemic and quarantine. Most of this was due to the interruption in the rhythm of their lives that resulted in them modifying what made them successful in the first place. Most of my patients struggle with their weight more than the average person. It stands to reason that they are probably struggling more now."
Bledsoe honestly believes that education is the key to long-term success with weight loss surgery. You can be given the tool, but if you misuse the tool, your results won't be as good long term.
"Everyone should meet with a dietician skilled with bariatric patients, an exercise specialist knowledgeable concerning the morbidly obese, and psychologists who truly understand the mental needs of this patient population," he said. "This pre-operative time is not to weed people out, but to help people succeed in their goals. It helps people understand how to best utilize their new tool. It teaches patients how to implement successful habits. It puts people in the best mental framework for continued success after life throws them the inevitable curve balls."
The long-term follow up is also important. The accountability and continued education are critical. Patients should meet with their surgeon several times in the first year after their procedure and at least annually thereafter. Bledsoe said this allows for typical post-operative checks, keeps them accountable for weight loss maintenance, and allows for continued education over time.
Bledsoe began training in bariatric surgery in 2004. When he completed his training in 2009, he made bariatric surgery the focus of his practice. Currently, bariatric surgery is more than 95 percent of what he does. By early 2022, he had done nearly 3,000 bariatric cases as primary surgeon.
After he completed his residency in Birmingham, Ala., initially he and his wife decided to go to Alexandria, La. There was a premier healthcare system in town with a talented group of surgeons who were looking to add another partner. Bledsoe took a job with them in 2009.
"Honestly, we made great friends and built a thriving practice in town," Bledsoe said. "We thought we were going to stay there forever."
In 2016, his brother, Arkansas Surgeon General Greg Bledsoe, MD, and his entire extended family came to visit over Memorial Day.
"He began telling me about Arkansas Heart Hospital," Bledsoe said. "It sounded intriguing, but I wasn't overly interested. I decided to go ahead and set up a time where I could meet with the administration of the facility. At the meeting, I was really captivated by the unique way Arkansas Heart Hospital takes care of patients and how responsive they were to the changing medical landscape.
"They were led by a physician, Dr. Bruce Murphy, who wanted to continue to grow the institution. Of course, bariatric surgery lends itself well to a facility that specializes in cardiology since cardiac patients are oftentimes candidates for bariatric surgery and bariatric surgery patients are often suffering from cardiac disease. It was a perfect match. After that meeting, I told my wife we really needed to consider moving back to Little Rock. Shortly, it became clear that we were destined to return to my home state of Arkansas and join the Arkansas Heart Hospital."
He started seeing his first patients at the Bariatric and Metabolic Institute in January of 2017. Since then, they have become one of the fastest growing bariatric practices in the country. They started with a staff of four and now have a staff of over 20. They have hired three more bariatric surgeons and have three additional providers seeing patients.
"We have about 1,200 patient encounters a month in the clinic, and we project to do over 1,000 surgeries in 2022," Bledsoe said. "January of 2021 was most notable in that we opened Encore Medical Center, a 90,000-square-foot facility in Bryant with a primary mission of bariatric surgery. The growth has been crazy, but fulfilling both personally and professionally."
The Bledsoe family is one of the most prominent medical families in the state. His mother, Sen. Cecille Bledsoe of Rogers, is chair of the Senate Health Committee. His father, James Bledsoe, MD, is Arkansas EMS and Trauma Director.
Get in touch with the Bariatric and Metabolic Institute by going online to bmi.arheart.com, filling out the information and watching an educational video. The office will check the patient's insurance and get back in touch. Patients can also call the office at (501) 219-7770 to make appointments with Bledsoe or any of his partners, J.D. Fuller, MD, JJ Tucker, MD, and Oscar Talledo, MD.