Silent Assassin: Experts weigh in on bariatric surgery, type 2 diabetes remission

Diabetes educator Annette Parkes-Considine, nutrition and dietetics Laureate Professor Clare Collins, and obesity surgeon Dr Dhan Thiruchelvum all agree that better early education about what constitutes a healthy diet and lifestyle is necessary to tackle the type 2 diabetes crisis from the ground up in Australia.

But better and more affordable access to the medications and surgeries that can help people with type 2 diabetes live a longer, healthier life was also vital.

"Bariatric surgery needs to become more accessible and affordable," Mrs Parkes-Considine, of Hunter Diabetes Centre, said.

"We know that it's not an easy option, but in a lot of cases, there is no other alternative. They've tried everything.

"But you pretty much need to to have private health insurance to get it. A lot of people are having to take money out of their super to have the surgery that will help them - and that's not fair."

Laureate Professor Clare Collins, of the University of Newcastle, said there was evidence that supported people adopting healthier lifestyles for diabetes prevention, for management of chronic disease and treating obesity - but it was "very difficult" to access this support.

"We have evidenced-based treatment - bariatric surgery - but you can't get it if you're from a low socioeconomic background because it is not available in a public hospital," Professor Collins said.

Bariatric surgery includes laparoscopic adjustable gastric band, sleeve gastrectomy and gastric bypass operations. The surgery allows only small meals, that satisfy like larger ones.

It is considered a highly effective treatment for obesity where diet and exercise haven't resulted in weight loss. In terms of diabetes, its effects are immediate.

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Dr Thiruchelvum, of Newcastle Weight Loss Surgery, explained that a day after bariatric surgery, he was already adjusting patients' medications for diabetes.

"This is because there are the immediate effects of the bariatric surgery, and then there are the weight loss effects," Dr Thiruchelvum said.

"The immediate effects are seen straight away. On day one after surgery, we are already reducing their insulin or stopping their oral hypoglycaemics, because there are weight-independent factors of how bariatric surgery works."

He explained that changes in hormones - essentially "gut signalling" hormones - changed the way the body processed sugar.

In 2014-15, there were about 22,700 admissions to hospital for weight loss surgery, up from about 9,300 in 2005-06. About 90 per cent were performed in private hospitals.

Dr Thiruchelvum said the population had become overly-reliant on processed and ultra-processed foods.

"There is a very poor understanding of how bad a lot of these food groups are," he said.

"We are just not made to eat highly refined, processed food. But they are quick and convenient, and they come be someone's entire diet."

Dr Thiruchelvum said while surgery may seem extreme, the complication risks of bariatric surgery were "no different" to the removal of a gallbladder.

"Once people become morbidly obese, there is nothing that works as effectively as bariatric surgery for the amount of weight that is lost, and also the persistence of that weight loss," he said.

Dr Thiruchelvum said a lot of problems with nutrition started during childhood.

"If you were a small child and raised on an ultra-processed diet and that is all you know, and you were never educated about a normal diet and you became obese, as hard as you try - most will struggle to get their weight down and keep it off," he said.

"I have a box of tissues in my consulting room for the fact that so often patients will get upset because they blame themselves for the problem - because that is what society says - and that stigma is prevalent."