A week after long-awaited obesity surgery, a Texas girl with a rare metabolic problem that left her starving but gaining weight is out of the hospital and already meeting critical health milestones, doctors said. 
 
 Alexis Shapiro, 12, no longer needs insulin or other medication to control type 2 diabetes and she’s feeling signs of fullness when she eats, rather than the insatiable hunger that drove her to top 200 pounds on her 4-foot-7 frame. 
 
 Both are the immediate results of sleeve gastrectomy weight-loss surgery, a procedure aimed at halting her massive weight gain and improving life-threatening health problems, said Dr. Thomas Inge, the pediatric obesity expert at Cincinnati Children’s Hospital Medical Center who has led her care. 
 
 “There was no sign of her diabetes 24 hours after the surgery,” Inge said. “My guess is she will not need insulin or anything else at this point.” 
 
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 Alexis was discharged from Cincinnati Children’s late Friday, a week after the March 21 surgery. The Cibolo, Texas, girl drew international attention earlier this year after NBC News first reported that insurers were refusing to pay for doctor-recommended weight-loss surgery to treat hypothalamic obesity, a rare condition that developed after Alexis had brain surgery two years ago. 
 
 “There was no sign of her diabetes 24 hours after the surgery. My guess is she will not need insulin or anything else at this point.” 
 
 She’ll remain in Cincinnati under close monitoring for about another week with her parents, Jenny and Ian Shapiro, who have two other children staying with family back home. 
 
 "It's really exciting stuff," said Jenny Shapiro. "She's in much better spirits now being here at the hotel." 
 
 The sleeve gastrectomy surgery, which removed about 80 percent of Alexis’ stomach, reversed the diabetes by immediately affecting glucose metabolism, or the process of converting sugar into energy for cells to use. The procedure likely boosts production of anti-diabetic hormones from the lower portion of the gut and changes the processing of nutrients that act as metabolic signals. 
 
 At the same time, the surgery also appears to have affected Alexis’ appetite, kicking in key signals that indicate satiety, or a feeling of fullness. Her diet has been limited to protein drinks and soft foods like special protein-enhanced puddings and yogurt, typically 4 to 5 teaspoons at a time, Inge said. After 3 teaspoons, Alexis is saying she's getting full. 
 
 "Some part of the brain is still switched on and is listening to these cues," Inge said. 
 
 Alexis is likely also losing weight, although doctors won’t be able to judge how much for about another week, when her fluids rebalance after surgery. Inge anticipated that Alexis could stop gaining weight and lose perhaps 20 percent of her body mass, or about 40 pounds, in the early months after surgery, even as she gets taller. 
 
 Inge originally had planned to perform a different weight-loss operation, gastric bypass surgery, but discovered during surgery that her liver was much larger than expected, which forced a change in plans. 
 
 It’s all good news for the child who was a normal 9-year-old before she developed a rare benign brain tumor. Surgery successfully removed the tumor, but it sent her metabolism haywire, Inge said. 
 
 Her story prompted interest from media outlets around the world and prompted strangers to donate more than $85,000 for her care. Inge said he’s very pleased at Alexis’ progress — and at the attention she’s generated for other people with rare, medically induced obesity. 
 
 “This one particular patient is doing well, but her message is being heard all over the globe,” Inge told NBC News. “Maybe it will get more medical attention now because of this one girl with her very private battle that became a public battle.” 

 As many of you were watching the details of Alexis Shapiro’s surgery unfold on Twitter (#HyObesity) last Friday, you might have been wondering about the benefits of the sleeve gastrectomy for patients with hypothalamic obesity. 
 
 This procedure surgically removes 75-80% of the patient’s stomach leaving only the inner curve of the stomach (the “lesser” curve), which permanently reduces its size. 
 
 The most notable and immediate impact of the sleeve gastrectomy is the major reduction in hunger and the major enhancement in satiety (that feeling of fullness) with only a very small meal, but other significant metabolic changes happen relatively quick after sleeve gastrectomy. 
 
 This is good news, especially as it pertains to type 2 diabetes. This progressive disease has devastating side effects, such as deterioration in blood flow to vital organs due to disease within the small blood vessels that supply the kidney, retina, feet, and heart. This reduction in blood flow can lead to devastating complications within the first decade after diagnosis, and can ultimately cause renal failure, blindness, amputations, and heart attacks. Thus it is important to get diabetes under control, and keep it under control, as quickly as possible. 
 
 Gastric bypass procedures have been clearly associated with reversal of diabetes as early as one-day post-surgery, wherein the patient’s insulin medications are stopped and blood sugars drop to acceptable levels. In fact, research has also shown that adults who undergo sleeve gastrectomy enjoy early (within months) and major improvements in type 2 diabetes following the sleeve procedure. 
 
 How is this possible? Even before the body has the opportunity to lose weight following sleeve gastrectomy, the procedure affects glucose metabolism, or the process of converting glucose into energy for cell utilization. This most likely has something to do with enhanced production of anti-diabetic hormones that come from the gut, and surgically-induced changes in the processing and handling of specific nutrients that may act as metabolic signals. This is a very exciting area of current research here in Cincinnati and elsewhere. 
 
 The other positive impacts of sleeve gastrectomy, which we expect to see very quickly after an operation, are reduction in weight and BMI, food cravings, and improvements in liver size. What is not known very well is how early and how lasting the positive effects of the sleeve gastrectomy on type 2 diabetes can be seen in young patients. 
 
 The goal is achieving a healthy weight and maintaining it. We participated in a study that showed weight loss of 20% in patients with hypothalamic obesity who received the gastric bypass or sleeve gastrectomy within the first twelve months post-surgery. But the sleeve gastrectomy patients seemed to be at higher risk for regaining some of that weight thereafter. 
 
 For some patients, surgeons may recommend a “staged” approach, which means that a sleeve is done initially and then it is converted to a gastric bypass. This is a decision that is usually made after the first months to one year, and would be based on a number of factors. These include not only weight loss success but success in durably reversing other major health problems as well. So close monitoring, counseling, encouragement, and compassion are important parts of the follow up care. 
 
 But for now, a 12 year old girl who within days of operation no longer needs insulin or any other diabetes medication, and has no signs of type 2 diabetes at all, is taking big steps in the right direction. 

 As many of you were watching the details of Alexis Shapiro’s surgery unfold on Twitter (#HyObesity) last Friday, you might have been wondering about the benefits of the sleeve gastrectomy for patients with hypothalamic obesity. 
 
 This procedure surgically removes 75-80% of the patient’s stomach leaving only the inner curve of the stomach (the “lesser” curve), which permanently reduces its size. 
 
 The most notable and immediate impact of the sleeve gastrectomy is the major reduction in hunger and the major enhancement in satiety (that feeling of fullness) with only a very small meal, but other significant metabolic changes happen relatively quick after sleeve gastrectomy. 
 
 This is good news, especially as it pertains to type 2 diabetes. This progressive disease has devastating side effects, such as deterioration in blood flow to vital organs due to disease within the small blood vessels that supply the kidney, retina, feet, and heart. This reduction in blood flow can lead to devastating complications within the first decade after diagnosis, and can ultimately cause renal failure, blindness, amputations, and heart attacks. Thus it is important to get diabetes under control, and keep it under control, as quickly as possible. 
 
 Gastric bypass procedures have been clearly associated with reversal of diabetes as early as one-day post-surgery, wherein the patient’s insulin medications are stopped and blood sugars drop to acceptable levels. In fact, research has also shown that adults who undergo sleeve gastrectomy enjoy early (within months) and major improvements in type 2 diabetes following the sleeve procedure. 
 
 How is this possible? Even before the body has the opportunity to lose weight following sleeve gastrectomy, the procedure affects glucose metabolism, or the process of converting glucose into energy for cell utilization. This most likely has something to do with enhanced production of anti-diabetic hormones that come from the gut, and surgically-induced changes in the processing and handling of specific nutrients that may act as metabolic signals. This is a very exciting area of current research here in Cincinnati and elsewhere. 
 
 The other positive impacts of sleeve gastrectomy, which we expect to see very quickly after an operation, are reduction in weight and BMI, food cravings, and improvements in liver size. What is not known very well is how early and how lasting the positive effects of the sleeve gastrectomy on type 2 diabetes can be seen in young patients. 
 
 The goal is achieving a healthy weight and maintaining it. We participated in a study that showed weight loss of 20% in patients with hypothalamic obesity who received the gastric bypass or sleeve gastrectomy within the first twelve months post-surgery. But the sleeve gastrectomy patients seemed to be at higher risk for regaining some of that weight thereafter. 
 
 For some patients, surgeons may recommend a “staged” approach, which means that a sleeve is done initially and then it is converted to a gastric bypass. This is a decision that is usually made after the first months to one year, and would be based on a number of factors. These include not only weight loss success but success in durably reversing other major health problems as well. So close monitoring, counseling, encouragement, and compassion are important parts of the follow up care. 
 
 But for now, a 12 year old girl who within days of operation no longer needs insulin or any other diabetes medication, and has no signs of type 2 diabetes at all, is taking big steps in the right direction.
– Texas 12-year-old Alexis Shapiro had long-fought-for the obesity surgery she got on March 21, and just a week later, the girl's situation has dramatically improved. She's already off the insulin she had to take in connection with her type 2 diabetes and, most significantly, her body is indicating to her that it feels full after she eats—in comparison to her feeling constantly starved before. The absence of that fullness cue pushed her weight to more than 200 pounds on her 4-foot-7 frame, a condition that resulted from damage her hypothalamus sustained during surgery she underwent two years ago related to a benign brain tumor. “There was no sign of her diabetes 24 hours after the surgery,” said Dr. Thomas Inge, the doctor in charge of Alexis' care at Cincinnati Children’s Hospital Medical Center (he explains how this is possible on the hospital's blog). Alexis left the hospital on Friday; after another week in Cincinnati for observation, she'll head back to Cibolo, Texas. The sleeve gastrectomy surgery she underwent left no more than 25% of her stomach intact, per the blog; Alexis is currently on a soft diet of protein drinks, yogurts, and puddings, consumed roughly five teaspoons at a time. She has reported feeling full after three, reports NBC News. Doctors won't know how much weight she may have already lost for about another week, but Inge predicts she could drop about 40 pounds in the next few months.