A couple of studies published this week showed that bariatric surgery is more effective in preventing type 2 diabetes than is medication, diet, and exercise advice from their doctors. Apparently some doctors are using this as an indication that weight loss surgery should be one of the first avenues explored rather than as a last resort. I’m not so sure. I think it’s great that these positive benefits of bariatric surgery are being found. However, I am not sold on the idea that we should now be turning straight to surgery for obese patients.
There are a number of things to consider. I think it’s important to note that the patients in the studies were morbidly obese and had minimum BMIs of 40. These are not your average person who wants to lose a few pounds. Also, the decreased risk of type 2 diabetes most likely resulted from the weight loss, not from anything inherently related to the procedure itself. This means that, had the patients in the diet and exercise group managed to sustain similar amounts of weight loss, they too would most likely have seen the same improvement in diabetes rates. A final important consideration are the risks and long lasting effects of bariatric surgery. As with any surgery, there are risks of complications, more so with some gastric procedures than with others. Life long side effects may include: dumping syndrome, extremely odorous flatulence and feces, nutrient malabsorption (which can lead to nutrient deficiencies if life long supplementation is not adhered to), changes in food preferences and ability to tolerate. Gastric surgery is not something to be entered into lightly. I’m not saying no one should have surgery, for some people it is the best solution. I’m simply saying that perhaps we shouldn’t be too hasty in picking up the scalpel.
Perhaps we should take a closer look at the lifestyle interventions being provided by doctors. I’m fairly confident that the majority of these efforts are ineffective and could be vastly improved. We should also be looking more at prevention than at treatment. As I’m always going on about, obesity is a result of our environment, not individual choices. We need to remove the onus from the individual and start working on changing the world we live in, and the way we live in it.