WASHINGTON - Bariatric surgery shrinks the stomach so people battling obesity can lose weight and regain their health. It’s a drastic, life-changing procedure, but some doctors think it should be done more often before patients become severely obese.

Shaun Rogers struggled for more than 20 years to manage his weight even as his diabetes kept getting worse.

“By just dieting and continuing the cycle with the insulin, I was never going to lose the amount of weight I needed to, to change the whole cycle and get the diabetes under really good control,” he said.

Insulin can make people feel hungry, making it even harder to lose weight.

Expensive treatment

Yet resorting to bariatric surgery is expensive. In the U.S., health insurance companies won’t pay for the procedure unless a patient’s body mass index, or BMI, is at least 35, even if a patient’s diabetes is uncontrolled.

BMI is a measure of body fat based on a person’s height and weight. Dr. Stacy Brethauer at Ohio State University says BMI is not always an indication of how well a patient is responding to treatment for diabetes.

“BMI is not really a fair or accurate representation of who should be getting therapy,” he said.

Brethauer says the criteria for the surgery is outdated.

“The patient who doesn’t get the operation, we know very well that their disease will progress, their lifespan will be shortened if they don’t get effective treatment,” he said.

The American Medical Association classifies obesity as a complex, chronic disease that requires medical attention. If it’s left untreated, obesity can lead to heart disease, cancer and diabetes. Brethauer advocates early treatment for both obesity and diabetes.

Double standard?

“No one asks somebody with cancer or heart disease to ‘just do it themselves.’ Patients have to participate in their care and do the right things, but there’s also effective therapy being offered to those patients at the same time,” he said.

Since he had surgery to reduce the size of his stomach, Rogers has lost a significant amount of weight. His diabetes is also under control. He no longer needs oral medication, and has gone from nearly 500 units of insulin per day to about 10.

“It’s changed my life so much,” he said, “I would tell anyone do it.”

Diabetes is a global health issue. More than 400 million, one in 11 adults, have this disease. The World Health Organization estimates that number will rise significantly in the near future.

If people with diabetes have bariatric surgery early on, their diabetes can be cured. For those who have had the disease for ten years or more, and need insulin shots, bariatric surgery won’t reverse their diabetes, but Brethauer says it can greatly improve their health.