ADA Gets Behind Bariatric Surgery

A few weeks ago, we posted a piece by Dr. Nick Yphantides lamenting what he sees as the unquestioned spread of bariatric (weight-loss) surgery. Wisely or not, the surgery is being viewed by more and more people — including doctors — as an option for treating Type 2 diabetes.

In its brand new Standards of Medical Care in Diabetes for 2009, the American Diabetes Association has, for the first time, given the procedure a qualified recommendation. The guidelines say that doctors should consider the surgery for their patients with Type 2 diabetes who have a body-mass index (BMI) of at least 35, especially if their diabetes is difficult to control under current therapy. A recent study, they note, found that adjustable gastric banding caused “remission” of diabetes in 73% of the participants assigned to receive it, compared with only 13% of those assigned to the “best available” nonsurgical treatment.

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The ADA also writes, however, that bariatric surgery carries risks, some of which have not been studied thoroughly. For this reason, it recommends more randomized controlled trials of the surgery that compare it with “optimal medical and lifestyle therapy.”

What do you think — did the ADA jump the gun? Does this make you more likely to consider bariatric surgery? Less likely?

  • Steve Parker, M.D.

    I haven’t read the guidelines yet, but the recommendations you mention above sound reasonable.

    Remember, candidates for surgery have tried and failed numerous nonsurgical weight-loss methods already. When the death rate for surgery is about 1 in 200, surgery will never be the first choice for weight management.

    A recent study out of Sweden shows that people who undergo various bariatric surgeries reduce their risk of death over the next 11 years by 25%.

    Even better results were found back in the U.S. Researchers in Utah looked at mortality rates of 7925 patients who had undergone gastric bypass surgery between 1984 and 2002. They compared death rates to a control group (also 7925 people) of obese people who applied for driver’s licenses. Subjects were matched for sex, body mass index, and age. Average BMI of the surgical group was 45.

    Over the course of seven years, there were 321 deaths in the control group and 213 in the surgery group. Deaths from any cause were reduced by 40% in the surgery group, compare to the control group. Surgery patients had less death from cardiovascular disease, diabetes, and cancer.

    -Steve brief biography

  • Gyanofcary@yahoo.com

    I had a BMI of >35 and had gastric by-pass surgery 13 months ago. Now my BMI is 27 and going down. My pre HbA1C was 9+ with Lantis and three oral medications. Now it is 6.2 with only one oral medication. HURRAY.

    I have been diabetic for more that 12 years. For me it was a choice between future diabetes related complications or living relatively healthy. Given these choices, decision to get the surgery done was rather easy. Fortunately, I didn’t have any complications from the surgery. As I had the surgery before developing any of the diabetes related complications and reaching very high BMI(>40).

    I am a huge supporter of the by-pass (not banding) surgery as it has changed my life. It has given me a tool to manage my weight and health. This may not be for everyone but worth looking in to it.

    I am of Asian-Indian ethnecity and had developed diabetes at a lower BMI and younger age(38) and, therefore, it is taking me longer time to lower HbA1C. Nonetheless, I feel I am in charge now and can manage it with diet and excercies.