Has Research Optimized the Targeted Use of Weight Loss Surgery for Glucose Control?

Abstract

For the foreseeable future, weight loss surgery is here to stay as a preferred medical treatment for obesity. Bariatric surgery is often described as a therapy of last resort, reserved only for those at the most extreme levels of obesity who have failed previous therapies. However, some are advocating expansion of the clinical indications for weight loss surgery to include more people with chronic diseases that respond favorably to surgically induced weight loss and lower thresholds of baseline body weight. This is seemingly welcome news in the sense that surgery is the most effective obesity therapy currently available. Weight loss surgery patients can expect to lose roughly one-third of their preoperative body weight during the first postoperative year,1 and roughly two-thirds of patients can expect to maintain this weight loss during several years. Perhaps more importantly, at least from a disease-management perspective, several articles from a recent issue of the New England Journal of Medicine (NEJM) found that weight loss surgery was superior to standard medical treatment for type 2 diabetes.2,3 One of these studies2 found that, compared to the standard treatment group, the proportion of participants with normalized blood glucose after 1 year was nearly four times higher in the group that had weight …