Once viewed as a fringe treatment for obesity, bariatric surgery has received respectful assessments in recent months from two of the most prestigious medical publications in the world as a treatment for Type 2 diabetes. • In September, the Journal of the American Medical Association (JAMA) published the results of a study that followed hundreds of "extremely obese" people for six years, and found that pre-existing cases of Type 2 diabetes went into remission 62 percent of the time. The risk of developing diabetes went down by an impressive 80 percent. • ("Extremely obese" was defined as a body-mass index, or BMI, of 40 or greater. That's about 250 pounds for a woman 5-foot-6, and about 290 pounds for a man just under 6 feet tall.) • People who had the surgery not only lost roughly one-third of their body weight, — often more than 100 pounds — but also they kept most of it off.
After six years, the patients who had surgery were still about 28 percent lighter than they had been before the surgery.
In comparison, people involved in weight-loss programs that emphasize diet and exercise lost only 5 to 9 percent of their body weight after one year, and after four years reported weights only 2 to 6 percent less than when they started.
Another article in the same issue of JAMA on the Swedish Obese Subjects study — the largest and longest ever conducted on people who have had bariatric surgery — found that those who had the surgery experienced sustained weight loss, and a reduced incidence of diabetes, heart attacks, strokes and cancer.
Two studies published in the March 2012 issue of the New England Journal of Medicine (NEJM) mirrored these results, finding that gastric bypass outperformed all other medical treatments for Type 2 diabetes.
In one study, known as Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE), 150 obese patients with uncontrolled Type 2 diabetes had their diet and exercise rigorously monitored. Then they were divided into three groups. One continued to receive only lifestyle modification. The second received the type of bariatric surgery known as Roux-en-Y, or RYGB (the same type used in the first JAMA study mentioned above). The third received a form of bariatric surgery known as sleeve gastrectomy.
In the RYGB group, 42 percent achieve normal levels of blood glucose after 12 months, as did 37 percent who received sleeve gastrectomy. Only 12 percent of the diet-and-exercise group achieve normal blood glucose.
In the second study, 60 severely obese patients with advanced diabetes and a BMI greater than 35 were divided into three groups. One received RYGB. A second group received a form of surgery known as biliopancreatic diversion (BPD). Members of the third group had their diet and exercise rigorously monitored.
Remission of diabetes occurred in 95 percent of those who underwent BPD, and in 75 percent of those receiving RYGB. Remission didn't occur in any of the people who practiced only lifestyle modification.
Also, the surgery patients showed decreases in their total cholesterol and triglycerides, and increases in their HDL (the "good" cholesterol), suggesting that bariatric surgery also improves a patient's cardiovascular risk.
"Although bariatric surgery was initially conceived as a treatment for weight loss, it is now clear that surgery is an excellent approach for the treatment of diabetes and metabolic disease," senior author Dr. Francesco Rubino said in a statement issued when the NEJM article appeared.
The authors of an editorial in the same issue of the NEJM agreed: "Although type 2 diabetes has been the domain of physicians, surgeons may now be able to claim greater success in achieving improved metabolic control."
Tom Valeo writes frequently about health matters. He can be reached at [email protected]