Bariatric surgery is more effective than lifestyle changes

Researchers reported that bariatric surgery improved cholesterol and triglyceride levels more effectively than medical or lifestyle modifications. High cholesterol levels are a risk factor for heart disease.

Participants who underwent surgery also had consistently lower HbA1c levels and better glycemic control at all follow-up time points, despite starting the study at higher baseline levels.

Findings also included:

• At seven years of follow-up, 18% of participants achieved diabetes remission, compared with 6% in the medical and lifestyle groups.
• Over a 12-year follow-up, participants who underwent surgery achieved an average weight loss of 19%, compared to just under 11% in the group that received medical and lifestyle interventions.
• Anemia, bone fractures, and adverse gastrointestinal symptoms such as nausea and abdominal pain were more common in patients who underwent bariatric surgery.

The researchers noted that even participants who did not achieve diabetes remission had better blood sugar control and used fewer diabetes medications than those who made lifestyle changes.

“In my practice, I have seen patients who undergo weight loss surgery be able to discontinue diabetes, hypertension, and lipid-lowering medications,” says Mir Ali, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center. the doctor says. from California's Orange Coast Medical Center was not involved in the study.

Confirmation from the study that bariatric surgery is more effective than lifestyle interventions comes from the study, which is based on a study published in the University of Pittsburgh School of Medicine's Department of Minimally Invasive Bariatric and General Surgery.

““What's new is that this is the largest study of its kind and has the longest follow-up period of seven to 12 years,” she said. Today's medical news. “Also, this study included 37 percent of participants with a BMI (body mass index) less than 35 and class 1 obesity, and in this subset, surgery was more effective than medical/lifestyle treatment in the long term. These findings, combined with existing evidence, suggest that bariatric surgery may be used to treat type 2 diabetes in people who cannot achieve glycemic control with nonsurgical means. Very strongly supported. ”

Dr. Eliud Sifonte, an endocrinologist at NYU Langone Medical Associates in West Palm Beach and Delray Beach, Florida, who was not involved in the study, agreed.

“This study supports previously known research showing the benefits of bariatric surgery in patients with metabolic diseases such as diabetes and the effectiveness of early intervention in the progression of diabetes,” he said. Ta. Today's medical news. “There is also support for the effectiveness of a weight-centered approach compared to traditional glucose-centered approaches to treating metabolic disorders.”

“We believe this confirmation may be key in some patients' decision to undergo bariatric surgery, especially as it indicates the possibility of remission, and this may be a key factor in the decision to undergo bariatric surgery in patients with new-onset diabetes. “It's something that a lot of people are interested in,” Sifonte added. “In my practice, I often discuss bariatric surgery with patients who have a history of obesity with metabolic complications, regardless of typical thresholds.”

Researchers say the study's results were consistent across weight groups, showing that surgery is equally beneficial for people with a body mass index (BMI) below or above 35 kg/m2. reported.

Doctors usually do not recommend surgery for people with a BMI level below 35.

“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. “In fact, many people miss even high amounts of sugar. All of the leading causes of death in the West are related to metabolic disease. This includes heart disease, cancer, and neurodegenerative diseases.”

“Bariatric surgery, which is well matched to the brain and gastrointestinal tract and provides a long-term control mechanism that reduces hunger and maintains satiety, is the best and perhaps only treatment for long-term control of metabolic syndrome. ,” Dr. Roslin said. Today's medical news. “Obesity impairs metabolism, but [disease] Even more common is that people with a low BMI often have metabolic diseases. Additionally, metabolic diseases increase with age. ”

“therefore, [I have] “I am comfortable offering bariatric surgery to low BMI patients with metabolic syndrome,” he added. “As with any therapy, [some] Things will be stopped and other things will be more likely. The advantage is a lower risk of heart disease and cancer. [but] Increased risk of osteoporosis and anemia. In my opinion, this risk can be reduced through post-surgery follow-up, diet, and exercise. ”

The researchers found no differences in mortality or major cardiovascular events between the different weight class groups.

In many cases, the final decision to undergo bariatric surgery is not made by the doctor or patient.

“The decision is up to the health insurance company,” Mill said. Today's medical news. “Insurance companies are often very strict about approvals. People with a BMI below 35 are often not approved. In some cases, having other health conditions, such as diabetes, may prevent you from being approved for payment. Often times they deny the claim.”

Ali said he and other doctors have been trying to get insurance companies to lower the BMI threshold for weight-loss surgery, but so far have been unsuccessful.