Bariatric surgery: results in obesity and effects on metabolic parameters - Introduction

A Special Author Introduction
Current opinion in Lipidology
ISSN: 0957-9672 • Frequency: 6/year • Subscribe Now • Journal Website


By Peter M. Clifton

The rate of type 2 diabetes has doubled over the last ten years in most parts of the world, mirroring the increase in overweight and obesity. The expense of medication and treatment of complications such as retinopathy, cardiovascular disease, amputations and renal disease threatens to overwhelm the health system. Can a very expensive option such as gastric bypass ($US 17-30K), be a viable solution? Resolution rates for type 2 diabetes across all forms of bariatric surgery are about 75%-this means no medication and an HbA1c of <6.5%. Only about 15% of patients do not improve and these tend to be on insulin and have had diabetes for a longer period of time (>10 years). Better results are seen with more invasive surgery such as gastric bypass compared with adjustable gastric banding. Hypertension, hyperlipidemia and sleep apnea have similar good resolution rates with the potential for a large reduction in medication costs. For patients with a BMI above 35 surgery is cost effective with costs of $US5-10K for QALY at 20 years. Although the evidence is only preliminary it would appear bariatric surgery saves lives in most patient groups but large randomised studies are required. It would also appear that surgery should be performed early when there is still residual pancreatic function, preferably within the first 5 years of the disease.

To read the full article, click here.