Gastric Bypass in Mild Obesity and Diabetes?

The latest in a string of impressive studies of gastric bypass surgery was published in JAMA this week. In a randomized, controlled trial of people with mild or moderate obesity and poorly controlled diabetes, gastric bypass gave better diabetes control than intensive medical and lifestyle treatment. After one year, more than twice as many people receiving gastric bypass had their diabetes, blood pressure, and cholesterol under control.

Serious complications occurred in 37% of surgery patients, compared to 25% of people who received only medical and lifestyle treatment. The difference was entirely due to complications of surgery.

These results are promising, but the long-term outcomes for people with diabetes and mild or moderate obesity have yet to be published. So it’s a little too soon to say that the benefits are likely to outweigh the risks. The investigators conclude:

The merit of gastric bypass treatment of moderately obese patients with type 2 diabetes depends on whether potential benefits make risks acceptable. Bariatric surgery can result in dramatic improvements in weight loss and diabetes control in moderately obese patients with type 2 diabetes who are not successful with lifestyle changes or medical management. The benefits of applying bariatric surgery must be weighed against the risk of serious adverse events.

So the jury is still out on surgery for people with mild obesity and uncontrolled diabetes. Caution is wise. Inaction is not. For people with severe obesity, there’s no doubt. Bariatric surgery can be life saving. It’s a big commitment and it’s not easy. But all too often, advice to be cautious becomes an excuse to do nothing.

Click here to read more in the Seattle Times, here to read more in Healthline, here to read the study in JAMA, and here to read a companion editorial.

Laparocopic Surgery, photograph © U.S. Air Force / flickr

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