Weight loss surgery more effective than lifestyle intervention in type 2 diabetes

[DCUK NewsBot]

Bariatric (weight loss) surgery is more effective than lifestyle changes and medicine in reversing type 2 diabetes, according to new research. Scientists at the University of Washington report that a specialist type of gastric bypass can reverse the condition in people with mild-to-moderate obesity better than other methods. It may no longer be appropriate to consider someone for a gastric bypass based simply on their body mass index (BMI), the study also found, but doctors should look into whether they have diabetes. The research, published in the prestigious Diabetologia journal, examined the Roux-en-Y gastric bypass (RYGB) procedure, which is where a small part of the stomach is used to create a new pouch, roughly the size of an egg. The study showed that diabetes remission at one year was 60 per cent with RYGB versus 6 per cent with most rigorous intensive lifestyle and medical intervention (ILMI). Lifestyle intervention involved participants undertaking 45 minutes or more of aerobic exercise for five days a week, a glucose-lowering diet and optimal diabetes medical treatment for one year. At the same stage, those in the weight loss group lost 25.8 per cent of their body weight; patients in the lifestyle intervention lost 6.4 per cent Despite having difficulties in finding patients that would agree to be randomly selected for surgery, a total of 32 volunteers were analysed for the whole year. The groups were equivalent regarding all inclusion criteria (age 25-64, with type 2 diabetes and a BMI 30-45 kg/m2) and were split with 15 participants for RYGB and 17 for IMLI. "These results apply to patients with a BMI of 30-35 kg/m2, as well as to more obese patients, and our study and others show that neither baseline BMI nor the amount of weight lost dependably predicts diabetes remission after RYGB, which appears to ameliorate diabetes through mechanisms beyond just weight reduction," said the researchers. "These findings call into serious question the longstanding practice of using strict BMI cut-offs as the primary criteria for selection for bariatric surgery among patients with type 2 diabetes. "Compared with the most rigorous intensive lifestyle and medical intervention (ILMI) yet tested against surgery in a randomised trial, RYGB yielded greater type 2 diabetes remission in mild-to-moderately obese patients recruited from a well-informed, population-based sample." While gastric bypass surgery is very effective for reducing body weight and improving blood glucose levels, it carries its own risks. These include complications from surgery, and patients are required to take nutritional supplements for the rest of their lives.

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[Neohdiver]

As I suspected, it is not a study that really measured surgical intervention against meaningful dietary intervention. Here is the description of the dietary intervention:

"Although reduced calorie intake and weight loss were strongly encouraged, participants were not given specific weight loss goals. Instead, the dietary intervention emphasised food quality by encouraging consumption of protein, fresh fruits and vegetables, and avoidance of processed foods. The programme advocated a slightly higher percentage of energy from protein and fat, combined with avoidance of high glycaemic index foods. In the second 6-month phase of the study, participants were contacted weekly by the dietitian via telephone or email, and were encouraged to attend monthly in-person group nutrition sessions."

In other words - 100% of the surgical group had effective (as to that intervention) interventions; the dietary group were "strongly encouraged," "advocated," to make small dietary changes ("slightly higher percentage of energy from protein,") and even with that weak (compared to 100% surgical) intervention, they don't stratify the results as to those individual who actually made the minor changes, "strongly encouraged."

http://link.springer.com/article/10.1007/s00125-016-3903-x/fulltext.html

#notimpressed.

(That is not to say that no one benefits from bariatric surgery - clearly some do. Many others also benefit from a very low carb diet. It would be nice to see a true head-to-head study, in which only those who actually followed a true low carb diet were ranked against those in the bariatric surgery group. Or at least a study that included details of the diets actually followed by the non-surgical group, before declaring that bariatric surgery is a more effective treatment. I can easily believe bariatric surgery for obese patients is better than doing almost nothing.)

 

[Lamont D]

Can't believe that advocating surgery must be always the last resort!

It is never mentioned that most bariatric patients have to have supplements and it doesn't always work.
It is never mentioned that ten percent of this type of surgery, develop a form of reactive hypoglycaemic. Of which most of the doctors, surgeons and GPs know absolutely very little and wouldn't recognise the condition.

The figure comes from a RH paper I read, as a summary by an endocrinologist specialising in after care for bariatric surgery in the US.

Sorry, no link!

 

[Robbity]

As I suspected, it is not a study that really measured surgical intervention against meaningful dietary intervention.
...
In other words - 100% of the surgical group had effective (as to that intervention) interventions; the dietary group were "strongly encouraged," "advocated," to make small dietary changes ("slightly higher percentage of energy from protein,") and even with that weak (compared to 100% surgical) intervention, they don't stratify the results as to those individual who actually made the minor changes, "strongly encouraged."
...
#notimpressed.

So presumably well biased in favour of the results they were looking for...Perhaps they should try again with volunteers from some of our (possibly longer term) low carbers, and see what they find then.

I also fail to see the logic in using expensive surgery when a meter, test strips and some instructions on how to use them correctly could be a safer and much heaper option.

Robbity