Surgery Beats Diet and Exercise for Diabetes Remission
Another study is adding to the evidence that bariatric surgery is probably the best bet we have for diabetes remission. In a randomized, controlled clinical trial, David Cummings and colleagues found that surgery beats diet and exercise for remission of type 2 diabetes. In this relatively small, well-controlled study, 60% of surgery patients had remission of their diabetes after a year, compared to just 6% who in the control group that received intensive lifestyle intervention with diet and exercise. The average BMI of people at the start of the study was between 37 and 38. The minimum to participate was 35. The authors concluded:
Our trial and other relevant RCTs demonstrate that commonly used bariatric/metabolic operations (RYGB, sleeve gastrectomy, and gastric banding) are all more effective than a variety of medical and/or lifestyle interventions to promote weight loss, diabetes remission, glycaemic control, and improvements in other CVD risk factors, with acceptable complications, for at least 1–3 years.
So why are people so slow to consider it? The answer is complicated, but it boils down to three major factors: stigma, risk perceptions, and money.
Stigma works in two ways. Both the disease of obesity and the surgery that can treat it so effectively are highly stigmatized. People living with obesity are commonly told, even by doctors, that they ought to be able to “get it under control” themselves. But worse, research shows that further discrimination awaits people who clear the hurdles to treat their obesity with bariatric surgery.
That stigma helps fuel false risk perceptions that deter people from considering surgery, even when it would be a good option for them. “Why have a risky surgery when I ought to be able to control this myself” represents a very common line of thinking.
All that stigma and self-doubt sets up a situation ripe for health insurers to exploit for their financial advantage. Bariatric surgery commonly costs between $15,000 and $25,000, which is a pretty reasonable cost for a procedure that can be life changing and life saving. Health plans restrict coverage because they can — the outcry is muted. Though coverage is improving, lengthy approval processes and high out-of-pocket costs are common. It’s enough to deter many people who need this treatment.
Despite these barriers, utilization is growing steadily. The American Society for Metabolic and Bariatric Surgery estimates that the number of bariatric surgeries grew by 22% between 2011 and 2014. This follows a significant drop in surgeries after the Great Recession of 2008.
The burden of type 2 diabetes is growing dramatically. With the growing recognition that surgery is the best bet for putting it into remission, we can expect that its utilization will continue to grow, perhaps at a quickening rate.
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March 20, 2016