Nearly 180,000 people underwent gastric-bypass operations in the US last year (the most common type of bariatric surgery in which the volume of the stomach is reduced). Patients and health care professionals are taking a new look at bariatric surgery (surgery used to treat morbid obesity) in light of two landmark studies published in the August 23rd New England Journal of Medicine (NEJM).
The studies found that bariatric surgery reduces long-term mortality by as much as 40% and death from diabetes by a remarkable 92%. Coinciding with these studies, the American Society for Bariatric Surgery (ASBS) announced that they are adding “metabolic” to their name. They will now be called American Society for Metabolic & Bariatric Surgery (ASMBS). The organization says this change in name reflects the organization’s new focus on bariatric surgery as a treatment that goes beyond weight loss. We find the name change very interesting –it would seem to help surgeons who would like to target bariatric surgery at those with metabolic disease not just those who are morbidly obese – traditionally the target for bariatric surgery.
Although bariatric surgery has never been considered a treatment for type 2 diabetes, this could change with time in light of the most recent data. As bariatric surgery is framed as a health intervention rather than a cosmetic surgery, it seems certain that the number of patients undergoing this procedure will increase in the future. Of course, gastric bypass surgery is not for everyone; this is major surgery with many risks - mainly infection, bleeding, obstruction of the opening of the stoma, and potentially fatal leaking from the stomach (blood clots) - and the procedure is quite expensive, costing roughly $25,000. Then again, drugs can easily exceed $3,000 year for patients with more advanced type 2 diabetes – so the return on investment for bariatric surgery might actually be quite good, particularly when the disease is resolved over a long period of time. Considering that patients are being diagnosed earlier and earlier, that payoff may well be worth it for some patients – it will be important to see long-term data for bariatric surgery patients for whom diabetes is resolved to see what happens a few years out. Currently, the National Institutes of Health guidelines indicate that bariatric surgery should only be considered for patients with a BMI of more than 40 or more than 35 for patients with coexisting illnesses like diabetes - we believe it’s likely these NIH guidelines will be reconsidered in light of the latest data. To learn more on current NIH guidelines, click here.