Dead End

Last Resort: A False Premise for Bariatric Surgery

Entrenched habits die hard. So it is with treating bariatric surgery as a last resort. In case you had any doubt, a new study in PLOS Medicine provides more reason to rethink this is a false premise for bariatric surgery. Jans Anders and colleagues found that when more time passes between the onset of diabetes and  bariatric surgery, diabetes remissions become less likely.

Observational Research

This is a registry-based cohort study. The researchers followed 8,546 patients in Sweden. They all had type 2 diabetes and a mean BMI of 42. For every year that passed between diabetes onset and surgery, the odds of stopping diabetes meds went down by 20 percent. The odds of a complete remission came down by 13 percent. Insulin treatment also predicted lower odds of remission.

In sum, this paints a picture of urgency for treating type 2 diabetes before it becomes irreversible. Time is not on your side when this disease progresses.

A Similar Picture in Youth

Earlier this year, in the New England Journal of Medicine, we saw a similar pattern. When teens wait until adulthood to have surgery, the weight outcomes are similar. But the health outcomes are worse. Remissions from diabetes were more likely for the youth who didn’t wait. The same was true for hypertension.

But here’s the thing. Patients face providers, payers, peers, and family who discourage them from seeking out surgery. “You’re not going to resort to that, are you?” is a common response. Drastic is a word that people use. And of course payers want to dodge the bill for the surgery. Maybe they won’t be on the hook for the longer-term complications.

Objectively, the data has been clear for some time now. Bariatric surgery is not a last resort. It’s a most effective treatment for people who need it. We would not encourage someone with heart disease or cancer to wait until they’re desperate to opt for an effective treatment. We encourage them to do whatever it takes to reclaim good heath.

People with obesity deserve no less.

Click here for the study in PLOS Medicine. Here and here you can find further perspective on delayed versus early treatment.

Dead End, photograph © Gwyn Michael / flickr

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December 10, 2019

One Response to “Last Resort: A False Premise for Bariatric Surgery”

  1. December 10, 2019 at 11:06 am, Allen Browne said:

    Yes. Patients need a goal and then they need help to get there by the best means possible. What this really means is a continuum of treatment until the goal is attained. A trial of healthy living or meds or devices is reasonable with strict time limits to check for response, but surgery is the best for most people at this time. Working this process through with a patient is best done in an interdisciplinary program including a trained weight management specialist.