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1.  Intestinal Malabsorption

• Weight loss reduces insulin resistance

• Glucose malabsoprtion reduces stress on islet cells

• Fat malabsorption reduces circulating free fatty acids
& improves insulin sensitivity
2. Hormonal Changes

Re-routing of food alters the dynamic of gut-hormone secretion

Increased levels of glucagon – like peptide 1 (GLP-1) increases insulin production

Decrease in plasma levels of leptin & insulin

Increased levels of adiponectin & peptide YY restor
beta cell function & improves insulin sensitivity

3.Rearrangement of GI anatomy

• “Hindgut hypothesis”

• “Foregut hypothesis”

4. The Foregut Theory

Exclusion of the duodenum results in inhibition of a “putative”signal that is responsible for insulin resistance and/or abnormal glycemic control (T2DM).

5. The Hindgut Theory

The more rapid delivery of undigested nutrients to the distal bowel upregulates the production of L-cell derivatives like GLP-1.

Liposuction is a cosmetic procedure in which fat is removed from the body using suction.
The main purpose of liposuction is to reshape or improve the body contour of one or more
areas of the body and not to reduce weight.
People who expect liposuction to help them loose weight are usually disappointed.

“Bariatric surgery should be considered for adults with BMI ≥ 35 kg/m 2 and type 2 diabetes, especially if the diabetes is difficult to control with lifestyle and pharmacologic therapy.”

– American Heart Association (2011)


“When indicated, surgical intervention leads to significant improvements in decreasing excess weight and co-morbidities that can be maintained over time.”

– American Heart Association (2011)


“Bariatric surgery is an appropriate treatment for people with type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies.”

– International Diabetes Federation (2011)


“The beneficial effect of surgery on reversal of existing DM and prevention of its development has been confirmed in a number of studies.”
– American Association of Clinical Endocrinologists (2011)


“The Endocrine Society recommends that practitioners consider several factors in
recommending surgery for their obese patients with type 2 diabetes, including patient’s BMI and age, the number of years of diabetes and the assessment of the (patient’s) ability to
comply with the long-term lifestyle changes that are required to maximize success of surgery and minimize complications.”

“… remission of diabetes, even if temporary, will still lead to a reduction in the progression to secondary complications of diabetes (such as retinopathy, neuropathy and nephropathy), which would be an important outcome of … surgery.”
– The Endocrine Society (March 2012)

Bariatric & Metabolic Procedures

  • Banded Sleeve Gastrectomy
  • Mini Gastric Bypass Surgery
  • Gastric Banding Surgery
  • Gastric Bypass Surgery



Hear From Weight Loss & Diabetes Specialists