Bariatric surgery more effective than lifestyle
- Researchers report that bariatric weight loss surgery offers more long-term benefits in managing type 2 diabetes than lifestyle changes.
- They said bariatric surgery also improves cholesterol and triglyceride levels more effectively than medical or lifestyle changes.
- Currently, people with a body mass index below 35 are not eligible for surgery according to the guidelines of most health insurance companies.
Bariatric surgery offers more benefits than lifestyle changes in managing type 2 diabetes, study finds.
As part of the research, participants with type 2 diabetes and obesity enrolled in one of four randomized clinical trials conducted between May 2007 and August 2013.
Participants underwent bariatric surgery or followed a medical and lifestyle program based on established interventions known to reduce the risk of diabetes.
Interventions included physical activity, nutrition monitoring, increased engagement with a care team, stress management, support groups, and medications. The trials took place before the availability of GLP-1 receptor agonist drugs such as Ozempic for diabetes management and weight loss.
Researchers followed most of the participants for 12 years.
Researchers reported that bariatric surgery improved cholesterol and triglyceride levels more effectively than medical or lifestyle changes. High cholesterol is a risk factor for heart disease.
Participants who underwent the surgery also consistently had lower HbA1c levels, indicating better blood sugar control at each follow-up point, despite starting the study with higher baseline levels.
Results also included:
- At the seven-year follow-up, 18% of participants achieved diabetes remission, compared to 6% in the medical and lifestyle groups.
- At the 12-year follow-up, the surgical participants achieved an average weight loss of 19%, compared to just under 11% in the medical and lifestyle intervention group.
- Anemia, fractures, and adverse gastrointestinal symptoms, such as nausea and abdominal pain, were more common among those who had bariatric surgery.
Participants who did not achieve diabetic remission nevertheless had better blood sugar control and used fewer diabetes medications than those who made lifestyle changes, the researchers noted.
“In my practice, I have seen patients who undergo bariatric surgery be able to stop their diabetes, high blood pressure and lipid-lowering medications,” said Dr. Mir Ali, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center. at Orange Coast Medical Center in California who did not participate in the study.
The confirmation of study results that bariatric surgery is more effective than lifestyle interventions did not surprise Dr. Anita Courcoulas, head of the section of minimally invasive bariatric and general surgery at the Faculty of Medicine. Medicine from the University of Pittsburgh and one of the study’s authors.
“What is new is that this is the largest study of its kind and the follow-up time of 7 to 12 years is the longest,” she said. Medical news today. “Additionally, this study includes 37 percent of participants with a BMI (body mass index) less than 35 and class 1 obesity and also reveals long-term superiority of surgery over medical/lifestyle treatment in this subset. These findings, combined with existing evidence, strongly support the use of bariatric surgery to treat type 2 diabetes in people who are unable to control their blood sugar levels by non-surgical means.
Dr. Eliud Sifonte, an endocrinologist at NYU Langone Medical Associates – West Palm Beach and Delray Beach in Florida, who was not involved in the study, agrees.
“This study confirms already known results showing the benefits of bariatric surgery in people with metabolic diseases such as diabetes and the effectiveness of early interventions in the course of a diabetic,” he said. Medical news today. “This also supports the weight-centered approach to treating metabolic disorders compared to the traditional glucose-centered approach.”
“I think this confirmation could be critical in helping some patients make the decision to undergo bariatric surgery, especially since it presents the possibility of remission, which is of interest to many people with new-onset diabetes “added Sifonte. “In my practice, I typically discuss bariatric surgery with patients who have a history of obesity with metabolic complications, regardless of the typical threshold. »
The researchers reported that the study results were consistent across all weight class groups, indicating that surgery was equally beneficial for people with a body mass index (BMI) below and above 35 kg/m2.
Typically, doctors do not recommend surgery for people below 35 BMI.
“BMI is not an ideal marker of metabolic disease,” said Dr. Mitchell Roslin, chief of bariatric surgery at Northwell Lenox Hill Hospital in New York, who was not involved in the study. ‘study. “In fact, many people miss even high sugar content. All major causes of mortality in the West are linked to metabolic diseases. This includes heart disease, cancer and degenerative neurological diseases.
“Bariatric surgery which provides a long-term control mechanism that better matches the brain and gastrointestinal tract, reduces hunger and prolongs satiety, is the best and perhaps only treatment to provide long-term control metabolic syndrome,” Roslin said. Medical news today. “Although obesity makes metabolic (diseases) more common, many people with lower BMIs suffer from metabolic disease. Additionally, as people age, metabolic diseases increase.
“So, (I have) no hesitation in offering bariatric surgery to low BMI patients with metabolic syndrome,” he added. “Like any therapy, (some) things will be avoided and others more likely. The benefit is a lower risk of heart disease and cancer and (but) an increased risk of osteoporosis and anemia. In my mind, this risk can be mitigated by follow-up after surgery, diet and exercise.
The researchers found no differences in mortality or major cardiovascular events in the different weight category groups.
In many cases, the final say in bariatric surgery lies with neither the doctor nor the patient.
“The decision is up to their health insurance company,” Mir said Medical news today. “A lot of times, insurance companies are very strict when it comes to approval. People with a BMI below 35 are often not approved. Sometimes if there are other health conditions, such as diabetes, we may ask them to approve payment. Most often, they deny this statement.
Ali said he has worked with other doctors to try to get insurance companies to lower the BMI threshold for bariatric surgery, but so far he has had no luck.
