Weight Loss Surgery Treats Diabetes
Study Shows Gastric Banding Surgery More Effective Than Lifestyle-Modification Programs
'Surgery Not a Last Resort'
It is increasingly clear that early, intensive treatment is associated with better outcomes among patients with type 2 diabetes.
Because of this, Dixon says weight loss surgery should no longer be considered a last resort used only in patients who are very obese.
Weight loss surgery is generally not considered for people with body mass indexes (BMI) of below 35, even if they have diabetes or other obesity-related maladies.
To put this number in perspective, a 5-foot 8-inch person who weighs 230 has a BMI of 35.
"Why shouldn't this very safe operation be offered to a diabetic with a BMI of 34 who has already struggled for years to lose weight?" Dixon asks.
Endocrinologist David E. Cummings, MD, says the evidence in favor of weight loss surgery as an early treatment for type 2 diabetes is mounting.
But in an editorial accompanying the study, Cummings questions whether the dramatic results achieved by Dixon and his colleagues would be seen in centers with less experience performing weight loss surgery and less intensive patient follow-up.
Cummings is a professor of medicine at the University of Washington, Seattle.
"The authors' surgical team in Melbourne, Australia, is among the most experienced groups in the world ... and their excellent results may not be readily reproducible elsewhere," he notes.
Cummings tells WebMD that the benefits of weight loss surgery as a treatment for diabetes appear to extend beyond weight loss alone.
This is illustrated by the fact that blood glucose levels often normalize in patients who have gastric bypass surgery within days or weeks, long before significant weight loss has occurred.
"I think it is reasonable to conclude that [weight loss] surgery should be offered to more people with diabetes," he says.
Don't Give Up on Diet and Exercise
But American Diabetes Association President of Medicine and Science John B. Buse, MD, says patients shouldn't take from the study that surgery is the only effective treatment for diabetes.
"I have a problem with telling people that they need to be surgically altered because we can't help them deal with an unhealthful lifestyle in other ways," he tells WebMD.
Weight loss through diet and exercise does work, Buse says, but patients rarely get the support they need to succeed.
"The idea that health insurers might pay for surgery but not a dietitian or weight loss drugs is troubling," he says.