A (former) skeptic’s view of bariatric surgery
The first meta-analysis included 11 randomized trials, 4 nonrandomized controlled trials, and 17 cohort studies and showed probable reductions in all-cause mortality and possible reductions in cancer and cardiovascular events.2 The second demonstrated significant improvements in microvascular and macrovascular disease and reduced mortality.3 The data were limited, however, because of the lack of large randomized trials with long-term follow-up.
The Stampede trial is one of a few bariatric surgery randomized trials focusing on patients with diabetes.4 The 5-year follow-up results are impressive. Nearly 30% of patients who had gastric bypass and 23% who had sleeve gastrectomy had an A1C ≤6 at 5 years compared to only 5% of those treated medically. Some patients discontinued all medications for diabetes, hypertension, and hyperlipidemia.
There is now adequate research to show that bariatric surgery provides significant benefits to properly selected patients who understand the risks. I no longer hesitate to refer patients for bariatric surgery who have been unsuccessful with weight loss—despite their best efforts.
Where do you stand?
