44year old woman of 43 BMI who was recently detected to have Type 2 DM proved by GTT with a HBA1C of 8.U/S showing grade 2 fatty liver.NO joint pains or sleep apnoea.or Hypertension.She is not Hypothyroid.She has two children and now her Menstrual periods are prolonged.Hormonal studies are normal.
Although the bariatric surgery is recommended for this kind of patients, in case the patient hasn't tried the diet procedure yet, as a dietitian I would recommend a weight loss diet approach as first attempt.
A weight loss diet could be 1000kcals below the patient's energy requirements for a 4kilos loss per month (it will be much more in the first 2 weeks leading to a weight loss 6-8 kilos the first month). The macronutrients percentages could be 25%protein, 35%lipid (>15% monounsaturated) and 40%carbohydrates mainly of low glycemic index. Meals and snacks should be 5-7/day for appetite and glucose control, and carbohydrates distributed in these meals/snacks.
I am not an expert of this field but the basic guidelines mentioned in the article below seems to be appropriate for the above patient. http://dx.doi.org/10.2337/dc16-S009
As mentioned there, the strategies include diet, physical activity, behavioral therapy, pharmacological therapy, and bariatric surgery.
Dear Reddy,
I am a general surgeon, and in a team of surgeons who performs weight loss surgery.
In our center we perform surgery after dietitian and endocrinologist controls and recommendations.
First i have to ask about diabetes of the patient.
If it is uncontrolled Type 2 DM, controlled with insulin, we perform laparoscopic sleeve gastrectomy and loop bipartition.
If it is controlled Type 2 DM, we perform only laparoscopic sleeve gastrectomy as first step of surgery. if it does not resolve the problem, we add any other operation, e.g, loop bipartition, procedure.
I would also recommend reviewing evidence based practice guidelines for the management of obesity and overweight, for example: The Dietitians Association of Australia Best Practice Guidelines for the Treatment of Overweight and Obesity in Adults. This document outlines and ranks the body of evidence that can be trusted to guide practice.
Click on Link to view document
http://daa.asn.au/wp-content/uploads/2011/03/FINAL-DAA-obesity-guidelines-report-25th-January-2011-2.pdf
As a dietitian in the Netherlands I agree completely with the first answer. first try a diet before bariatric surgery.
Thankyou all,I totally agree the standard practice guidelines are first try with Life style modification if these donot work due to what ever is the reason consider next option.
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