Weighing in on Bariatric Surgery and the NEJM recent reports

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.

Comments

[joana]

Bariatric surgery is of great help to the patient and families of those suffering from severe obesity. Sometimes, when numerous diets etc. failed, surgery has come to the rescue of many. Definitely, consult your doctor before taking this step, but remember that a weight loss surgery clinic is as good as its follow up treatment which is why, My Weight Loss Surgeon (http://www.myweightlosssurgeon.com/) is a great place for weight loss surgery.

[Stephanie Tanner]

Hello,

Because of this blog featuring diabetes, the International Diabetes Federation (IDF) would greatly appreciate it if you help us out a bit.

We are in the midst of our preparations for the first UN-observed World Diabetes Day (www.worlddiabetesday.org) on 14 November this year, and I wanted to ask you if you would like to help us to spread awareness of this worldwide event and the theme we have chosen for it this year - Diabetes in Children and Adolescents.

It is estimated that over 200 children develop type 1 diabetes every day and there's no question that the disease often hits disadvantaged communities the hardest, and that children in the developing world can die because their parents are unable to afford medication. In many countries diabetes is still considered an adult disease and as a result can be diagnosed late with severe consequences, including death. Even after diagnosis many children experience poor control and develop complications early.

This is why one of our key objectives for World Diabetes Day this year is to double the number of children covered by the Life for a Child Program - http://www.worlddiabetesday.org/go/wdd-2007/life-for-a-child. We also want to encourage initiatives that can help to reduce diabetic ketoacidosis (diabetic coma) and to promote the sort of healthy lifestyles which can prevent the onset of type 2 diabetes in children.

A version of the diabetes circle, the icon we used for our Unite for Diabetes campaign http://www.unitefordiabetes.org/ has now been adopted for World Diabetes Day and we have produced a number of web banners that you can view and download here http://banners.worlddiabetesday.org.

The way in which you can help us spread awareness of World Diabetes Day is to add one of the banners to your own blog, which we would really appreciate.

The UN's World Diabetes Day Resolution (61/225) was really just the first goal of an ambitious campaign that we have been leading. This is the first time a non-communicable disease has been recognised as a serious threat to global public health and we are hoping now to further raise awareness globally of the disease that is predicted to contribute to 6% of the world’s mortality in 2007.

If you would like to know more about the UN Resolution and our plans for World Diabetes Day this year, just drop me a line and I will get back to you with more information.

Many thanks,
Stephanie Tanner
IDF- Communications Assistant

[olive]

It works because you don't absorb as much food, which means you become malnourished. Easier to eat low carb than get your insides amputated.