Comparing Bariatric Surgery and Standard Medical Therapy

In a in the East Meadow Patch, I discussed the increasing evidence pointing to the growing role of bariatric surgery in the management of obesity. 

This week, two landmark studies published in the New England Journal of Medicine went even a step further and looked at the question of how surgery compared to standard medical therapy for Type 2 diabetes. The first significant studies to analyze the issue both concluded, with certain caveats, that surgery was more likely to lead to either a complete remission, or to better control with less medication, than a combination of drugs and advice for diet and exercise.

Type 2 diabetes is a fast growing epidemic, affecting all communities and all regions of the country. In the United States, the number of cases has tripled over the last three decades, and continues to rise. The long range complications of this condition-including heart attacks, strokes and kidney disease-are common, costly and devastating. Once diagnosed the traditional treatments of lifestyle modification and medications rarely lead to total remission of disease.

For years it has been noted that bariatric surgery for obesity could sometimes get rid of diabetes. However, this had not been evaluated in a formal, scientific study. In the two new reports, surgeries of stomach stapling or intestinal bypass (and NOT lap band) were analyzed. One study from the Catholic University in Rome showed a 75-95 percent percent remission rate with surgery. A second study, from the Cleveland Clinic, using a stricter definition of remission, showed such rates of about 40 percent.

There still are many unanswered questions. Will these small studies be replicable at other centers? Would a study of lap band surgery reveal the same results? How long lasting are the results, and will the long range complications of Type 2 diabetes be affected?

Current guidelines for bariatric surgery relate solely to its effect on obesity. The National Institutes of Health says the surgery can be offered to patients with a body mass index (BMI) of over 40, or over 35 if a person has diabetes, hypertension or high cholesterol ( to calculate your BMI go to www.nhlbisupport.com/bmi/). It is unlikely that the new studies will lead to an immediate change in these guidelines, but there are large number of patients who fit these criteria.

If your BMI is over 40, or if you have Type 2 diabetes and a BMI over 35, you should speak to your primary care physician. If you would like to speak with one of the surgeons at the NuHealth Bariatric Surgery Center of Excellence, please call 516-572-4848 for an appointment.