Weight-Loss Surgery May Reduce Heart Risks in People With Type 2 Diabetes

The surgery works— when things go well in appropriately selected, motivated patients. Readers make no mistake, it’s major surgery. I have seen many patients with complications after the various Bariatric procedures, they are not to be taken lightly (by you or your doctors). While many morbidly obese patients fail conservative approaches, the non surgical route should always be tried with know,Ed Abel practitioners before jumping to the OR.

"The study, carried out at the Cleveland Clinic, was partly funded by Medtronic, a company that makes medical equipment used in weight-loss surgery." Hello? This kind of interest in the results of the study does not exactly predict any kind of impartiality. And thus far, in other studies, after the "honeymoon" period was over, and a large percentage of participants had already dropped out, the initial reduction in blood sugar ceased, and patients once again reverted to pre-surgery levels. Oh, and many gained the weight back, besides. Hmm. Sounds like another failed diet, to me.

I've been following bariatric surgery since 1970, when I started my surgical residency at the University of Pennsylvania. At that time, surgeons were doing "14/4" procedures that essentially created a short gut syndrome. Yes, patients lost weight. They also became severely depleted of essential elements that needed to be absorbed, and also developed liver failure and gallbladder disease. Fast forward to 2019. Surgeons have experimented on many different procedures over the years to cause patients to lose weight. All basically followed the principal of damaging the digestive system so that it essentially failed. Human experimentation. Only allowed because patients were obese. If it worked, they would then try it on animals (this is sarcasm). Behavior modification and a motivated patient is necessary for these procedures to work. Behavior modification and a motivated patient will work without surgery.

I think we need a good prospective study before we can routinely recommend bariatric surgery. The study underestimates the number of patients who develop multiple complications secondary to surgery. The long term complications of altering the gut remain unclear. Clearly gut altering surgery changes a person's microbiome. We are just beginning to understand the implications of altering the gut microbiome. It is also unclear how bariatric surgery decrease cardiovascular mortality. It also worrisome to see bariatric surgery patients switch from food to Alcohol increasing the incidence of liver disease. This is another area to studied further. Clearly we should also explore other modalities of care to improve diet and nutrition. Bariatric surgery, I am afraid, is not the answer.

Before you do this surgery I would try a low carb diet. I have lost over 50 lbs on it and my wife has lost 34 lbs on the Keto diet. Our glucose levels have normalized. I am off diabetic drugs and the wife is in the process of coming off of them. Our doctor is being more cautious with her. There are are significant drawbacks with this surgery. The reason the surgery works is because of the instant state of fasting. The fat around the pancreas and other internal organs is burned off first. With the fat gone the pancreas comes back to life and your body cells burn off excess sugar and become once again sensitive to insulin. This happens even before much weight is lost. The low carb diet is a fast mimicking diet. Dr Fung's books explain how this works.

Of course these findings, if substantiated, will increase demands that health care pay for such operations for obese persons, instead of encouraging them to simply lose weight and go on a healthy diet. The fast food plutocrats and the surgeons are rubbing their hands at the thought.

I had bariatric surgery; I lost the weight over the course of 9 months. 3 years later, I remain at my goal weight, and I am no longer hypertensive. Not only that, but I fit in airplane seats easily, and my sleep apnea went away.

The control group (non-surgical) had DOUBLE the smoking rate of the surgical group??? Wake me when the study is redone with a matched control group for comorbidities. This one is literally uninterpretable. And yet it will probably change practice patterns. Bad science makes for bad practice.

Known people who have had several different types of bariatric surgeries. All were morbidly, or even super morbidly obese (https://en.wikipedia.org/wiki/Classification_of_obesity). Every surgical outcome is unique, as they say. The people I've known all sustained their wight loss. Women who wanted to get pregnant did and started families. Advanced in their careers. Lead more healthy and active lives. Became more social. Ate healthier. Those who had comorbidities (or the pre-- version) all saw the comorbidities go away. Anecdotally, the surgery has been a godsend to many. What amazes me is that there is so little study of it. As one commenter pointed out (@Ernie Cohen): "I look forward to hearing about the design of a double-blind experiment where neither the patients nor the doctors can tell who is having bariatric surgery." That seems to be insurmountable and me by why a "gold standard" of study cannot be accomplished.

I and several other people I know have gone to Mexico for gastric sleeve surgery. Cheap and easy in Mexico. My SO no longer needs hypertension or cholesterol medicine, nor a CPAP machine, and is no longer prediabetic. Although I never had high blood pressure or cholesterol, my doctor told me my blood pressure and cholesterol numbers are those of a teenager. I'm 60. I'm sure gastric sleeve is not easy for everyone, but for my SO and I, it was a piece of cake! And the facilities in Mexico were wonderful. It has been several years since the surgery and we are within 5 pounds of our low weight.

Bariatric surgery is a quick fix for the obese. For some people it works for others it does not as they go back to an addictive food consumption habit which defeats the purpose of the bariatric surgery to begin with; sad but true.

Any hope as a treatment for non overweight diabetics?

Just"may"? Our bodies are far more complex than that, and so are genes. Too many studies are obvious careerist advert, m e h.

How about instead of spending $20K on expensive surgery with frequent side effects and many thousands more on follow-up care, helping families make lifestyle changes that they can live with for the rest of their lives. This includes a family orientation to weight loss, teaching patients, spouses and their older children how to cook healthy food and make healthy food choices. You also need to include personal trainers for both cardio and resistance training. It would cost less and the life skills will benefit everyone in the family, perhaps for generations to come.

I look forward to hearing about the design of a double-blind experiment where neither the patients nor the doctors can tell who is having bariatric surgery.

The experience of a triple-bypass patient who went to classes to learn how to keep healthy found diet and exercise helps a lot. The patient also learned the men did not want to read the fine print on food labels, or weigh the portion of vegetables and fruit to eat each day. They just want to take a pill and be done with it. Or as this 'study' shows, hire a surgeon and be done with it. Go back to smoking and drinking and life is good, again. Meanwhile, life is good once again if you are a gastric bypass surgeon.

This just in: "Weight-Loss Surgery May Reduce Heart Risks in People With Type 2 Diabetes!!" On the other hand, weight loss, which costs nothing and is free from the many risks of surgery, ALSO will reduce the risk of heart disease in obese people with type 2 diabetes. It can also reverse type to diabetes, prevent many cancers associated with obesity, prevent obesity-related arthritis and many other obesity related illness. Oh, and it can cut the overall risk of cardiovascular events and premature death! Surgeons and hospitals make billions performing these monstrous surgeries. Weight loss, which is achieved through many means, including fasting, intermittent fasting, healthier food choices and portion control. This is what the Times should be emphasizing. But oh no!! That would be fat shaming. Better to push dangerous surgical procedures instead. The world truly has gone mad.

Whenever I read or hear about bariatric surgery, I am reminded of the refrain from the 1977 Chiffon Margarine commercial: "It's Not Nice To Fool Mother Nature!" Since this was not a randomized controlled test (RCT) and there were, I my opinion, remarkable differences between the study and control groups, I can offer my observations with N=4: three living people and once deceased person that had the surgery. Only one maintained her weight loss but she has significant side effects: chronic constipation, blood sugar disorders, and hospitalization for a bezoar (gastric stone). One lost some weight but the procedure made her asthma worse and she suffers from chronic anemia. Another one gained most of the weight back. The deceased one had, so I heard, problems following the "rules" about the timing of eating and drinking and vomited often after meals. It appears to be very difficult to manage one's nutrition after this surgery. Maybe it's just easier to count calories and watch portion sizes.