With all of the emphasis on using new diabetes drugs to treat obesity, I thought it might be a good time to reflect on what we know actually works well in terms of managing both diabetes and obesity. 

Diabetes is an enormous problem in our society. The CDC suggests the 30% of American adults will have type two diabetes by the year 2030 which is literally just right around the corner. Diabetes is the number one cause of renal failure, amputation and blindness. More importantly, diabetes is a major contributor to the development of heart disease and strokes.

Most folks are not aware that the American Diabetes Association changed their guidelines for the use of bariatric surgery to treat diabetes back in 2016.  It used to be that Bariatric surgery was only recommended for individuals who had poorly controlled diabetes with optimal medical management. The guidelines changed in 2016 because we came to understand that the primary driving force for the development of type two diabetes was obesity. Some very important work was done in the decades preceding 2016, which demonstrated that surgical weight loss for obesity could potentially result in either curing or improving diabetes and its associated complication.

In particular, there was a study performed, called the Stampede Study where scientists from the Cleveland Clinic and Harvard collaborated to compare the results of weight loss surgery versus optimal medical management for patients who had poorly controlled type two diabetes. In the surgical arm for this study, the majority of these patients were either able to go off their diabetic medicine completely, or at the very least decrease their use of diabetic medicines to control their diabetes. The patients who had only medical treatment arm did not demonstrate any ability to normalize a decrease of their medication use. Rather, the majority of those patients required significantly more diabetic medicine to control their disease as the study went on. As a result of this work and other large studies, the guidelines for the recommendation for weight loss surgery shifted. 

We understand that there is a close relationship between OBESITY and type two diabetes, and 90% of patients who have type two diabetes are at least 50 pounds overweight. As a consequence of this reality the guidelines shifted to suggest that any patient who is at least 75 pounds overweight, who has a diagnosis of type two diabetes, should be offered weight loss surgery as a primary treatment strategy to either cure or improve their type two diabetes. For patients who are less than 50 pounds overweight, weight loss surgery can still be recommended for those individuals who have poorly controlled diabetes.

Obviously, to most folks, these are pretty radical recommendations as the majority of people still believe that weight loss surgery is dangerous. What most people don’t realize is that the risk related to weight loss surgery have decreased dramatically in the last 20 years with the development of minimally invasive surgery techniques. We are now able to perform all of these operations with either very small incisions, or no incisions at all. As a consequence of this, the risks related to weight loss surgery are actually less the many common surgical procedures, such as cholecystectomy or hysterectomy. The majority of patients leave the hospital either the same day or the following morning. In addition, most folks are back to a relatively normal life with respect to activities within 1 to 2 weeks. 

Finally, it is important to appreciate that, on average, a patient who has weight loss surgery will extend their lifespan by about 10 years. We all know how difficult it is to lose weight and certainly these new drugs hold some promise. However, for my money, weight loss surgery still offers the most effective remedy for managing diabetes and obesity.

Tucson Bariatric Surgeon, Dr. Patrick Chiasson, specializes in minimally invasive Weight Loss Surgery (Endoscopic and Laparoscopic). His procedures include Endoscopic Sleeve Gastroplasty (ESG), Heartburn, and Hiatal Hernia / LINX procedures.