Experts say the surgery can provide more than just weight loss. It can also lower the risk of heart attack and stroke.
Share on PinterestBariatric surgery can be beneficial for people with diabetes but getting insurance to cover the procedure can be difficult. Getty Images
Bariatric surgery may seem like an invasive and risky option for those who are obese.
However, recent research shows that people who are obese and have diabetes may benefit from the surgery in more ways than just weight loss and improved blood glucose levels.
Types of bariatric surgery include:
- gastric banding
- gastric bypass
- gastric sleeve
- gastric plication
- duodenal switch
- incision-free surgeries
- the Maestro system, which is an implantable device that reduces appetite
In a recent study, researchers reported that “people who were severely obese and had diabetes had 40 percent fewer heart attacks and strokes — and 67 percent fewer deaths — within five years after weight loss surgery.”
The study also found a 50 percent reduction in a person’s risk for diabetic neuropathy in their hands or feet.
“Macrovascular disease is a leading cause of morbidity and mortality for patients with type 2 diabetes,” explained the researchers, “and medical management, including lifestyle changes, may not be successful at lowering risk.”
Most significant, however, is that about half of the people with diabetes who specifically underwent gastric bypass were in diabetes remission for an average of seven years as a result of significant weight loss and improved overall health markers, including blood glucose levels.
What the study showed
The study, published in a recent issue of the Journal of the American Medical Association, was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
It was researched at four locations: Kaiser Permanente’s Washington, Northern California, and Southern California locations as well as the HealthPartners Institute in Minnesota.
The study consisted of more than 5,000 Kaiser Permanente patients and 247 HealthPartners patients with diabetes who had a body mass index (BMI) of 35 or higher and had received bariatric surgery.
Those patients were then contrasted with a control group of 15,000 people who were obese and have diabetes who received traditional medical care to manage their weight and blood glucose levels.
“If you tried to duplicate bariatric surgery with medications, it would probably take a minimum of 18 pills,” said Dr. Mitchell Roslin, director of Bariatric and Metabolic Surgery at Lenox Hill Hospital in New York.
Roslin told Healthline that the benefits of bariatric surgery are far more significant than simply weight loss.
“It lowers blood pressure, reverses insulin resistance, lowers abdominal pressure, changes levels of sex hormones, lowers cholesterol, and changes the gut-brain interaction,” explained Roslin. “Obesity is an inflammatory disease and bariatric surgery reverses this process. Weight loss is partially responsible but not the complete story. Changes in neurological pathways and hormone levels play a key role. It is far more than mechanical.”
“Bariatric surgery is also called metabolic surgery because of the positive effects it has on putting into remission metabolic diseases and conditions such as type 2 diabetes,” Lillian Craggs-Dino, DHA, leading expert in bariatric nutrition for the Cleveland Clinic in Fort Lauderdale, Florida, told Healthline.
“Research is strong to show the positive effects the surgery has and is even accepted as a treatment option and supported by the American Association of Clinical Endocrinologists and the American College of Endocrinology,” she told Healthline.
Craggs-Dino added that a large analysis of 135 studies on bariatric surgery showed that 86 percent of patients had either a dramatic improvement or total remission of type 2 diabetes.
“However, choosing to undergo surgery for weight loss and treatment for diabetes should not be taken lightly,” cautioned Craggs-Dino. “There is a specific patient selection process and an intensive preoperative workup by an interdisciplinary team. Lifestyle modification, exercise, and lifelong vitamin and mineral intake follow-up is a critical part of postoperative care.”
In 2016, the American Diabetes Association officially endorsed bariatric surgery as an effective treatment for some patients with type 2 diabetes.
Insurance coverage isn’t easy
Getting insurance coverage for bariatric surgery isn’t an easy feat.
Bariatric surgery comes with a price tag ranging from $18,000 to $35,000, depending on the type of surgery chosen.
According to the National Institutes of Health, about one-third of people with type 2 diabetes have a qualifying BMI at or above 35, but meeting those two criteria isn’t necessarily enough.
“Private insurers have many restrictions and even exclusions,” explained Roslin. “This is very unfortunate and demonstrates the bias against obese individuals, as few procedures have ever shown benefits equivalent to this study with any medical therapy.”
Without type 2 diabetes, most patients would need to have a BMI greater than 40, according to the NIDDK, unless they also have sleep apnea or heart disease.
“Name any procedure that prevents heart attacks, strokes, and deaths, including CABG [coronary artery bypass graft], stents, or carotid endarterectomy,” added Roslin. “They have never approached these results. This data shows that bariatric surgery saves lives in obese diabetics.”
Frustrated with lack of insurance coverage for bariatric surgery, Roslin points out that too often, the medical system treats the cardiac disease or other symptoms while ignoring the cause: obesity and its related complications.
“This data is phenomenal,” said Roslin, “and should make exclusions for bariatric surgery in diabetics illegal and immoral. We need to stop blaming patients for obesity.”
Keeping the weight off
“Successful bariatric patients become very structured,” Roslin said. “They use the procedure and early improvement to make lifestyle changes.”
Roslin added that those who do struggle to sustain their weight loss only gain weight up to a certain limit.
“Bariatric surgery changes ‘set point,’ so even if there is weight regain, they virtually never exceed their pre-op weight,” he said. “What also needs to be kept in mind is that without surgery, the average patient that meets criteria continues to gain on average 5 to 6 pounds per year. They do not stay static.”
Despite keeping the weight off successfully, the NIDDK explained that many bariatric surgery patients will experience potentially lifelong side effects, including osteoporosis, vitamin deficiencies, anemia, and difficulty digesting solid foods that can result in vomiting.
Despite significant findings, the study’s authors added that the overall design of this study is flawed for several reasons.
First, it was an observational study, rather than a randomized clinical trial.
“Ideally, randomized clinical trials would confirm — or refute — our findings,” explained Dr. David P. Fisher, the study’s first author and a recently retired bariatric surgeon. “But such trials are expensive and difficult to conduct, and they probably couldn’t be done with enough patients to assess these relatively rare outcomes.”
Other flaws in the study included:
- patient data was collected during routine doctor’s appointments which means some data was missed
- some patients left the study before it was complete
- the overall size of the study wasn’t large enough to properly compare bariatric surgery with alternative methods of weight loss
“For most people with diabetes and severe obesity, lifestyle changes and medication may not be successful at significantly lowering those risks,” said Dr. David Arterburn, MPH, a corresponding author, internist, and a senior investigator at Kaiser Permanente Washington Health Research Institute.
“Our results add to the evidence that should inform conversations between people with diabetes and severe obesity and their healthcare providers about the potential benefits and risks of weight loss surgery,” Arterburn said. “We hope this helps them make more informed decisions about their care.”
The bottom line
For people who are obese and have type 2 diabetes, bariatric surgery should be part of the discussion when working with healthcare professionals to improve their overall health.
In addition to weight loss, bariatric surgery greatly reduced the risk of neuropathy, heart disease, and death from heart attacks and strokes for participants in a recent study.
A number of participants also experienced diabetes remission within seven years of having surgery and losing weight.
The most difficult part of getting bariatric surgery for many is insurance coverage.
The cost of the surgery is anywhere from $18,000 to $35,000 depending on the type of surgery chosen.