Bariatric/metabolic surgery for the obese with Type 2 diabetes with BMI <35 kg/m2: why caution is required

Abstract

SUMMARY Bariatric/metabolic surgery is now widely accepted as a powerful tool for the management of Type 2 diabetes in patients with morbid obesity (BMI >35 kg/m2). Some position statements recently suggested the possibility that bariatric/metabolic surgery may also have a role in the management of obese class I (BMI 30–35 kg/m2) patients with Type 2 diabetes. Efficacy of bariatric/metabolic surgery in this particular group of patients was, however, supported largely by uncontrolled observational short-term studies, and we do not yet have any study analyzing its effects in the prevention of both macro- and micro-vascular hard end points. On the other hand, recent data suggest that the reduction in cardiovascular events and mortality that may be expected from weight loss in patients with Type 2 diabetes and moderate obesity may be smaller than that observed in patients with more severe obesity. Intentional weight loss seems to result in more harm than benefit in some particular subgroups. Bariatric/metabol...