For people with obesity and diabetes, there’s growing evidence of the benefits of weight-loss surgery.
A new study published Monday in the "Journal of the American Medical Association" details findings from Cleveland Clinic researchers.
Their study revealed that in patients with both obesity and uncontrolled diabetes, weight loss surgery is associated with a 40% reduction in heart issues and death. This is in comparison to the usual recommendation of lifestyle changes and medications.
In absolute terms, weight-loss surgery is associated with an 8% reduction in risk of death over 8 years.
“Both obesity and diabetes are chronic conditions and in some patients, we basically cannot control their metabolic disease and their diabetes, and that’s why they need more. They need a stronger tool, a stronger management,” said Cleveland Clinic bariatric surgeon Dr. Ali Aminian.
Aminian says that the positive effects stem from the weight loss itself, but it’s also about the hormonal changes that happen in the body after weight-loss surgery because of the re-routing of the GI (gastrointestinal) tract.
This was an observational study so it can’t show cause and effect, but Metrohealth obesity medicine specialist Dr. Eileen Seeholzer says that it adds to the mounting evidence behind weight-loss surgery.
"What’s changed with this study, and several that have come out recently, is that you can more specifically say to people, particularly with diabetes: 'The sooner you do this, the better your outcome will be,'" said Seeholzer.
Seeholzer cautions though that this study did not take into account smoking rates, which were significantly lower in the non-surgical group and could skew the results. “The current smoking rates are 14% in the group that did not have surgery and only 7% in the group that did,” she said.
Also, Seeholzer notes that there’s a likely difference in motivation between the surgical and non-surgical patients.
“People who are choosing metabolic surgery have chosen personally to undergo a process to improve their health. They’ve decided they are ready to change and improve their health,” she said. We don’t have enough information about the motivation and commitment level of those who didn’t choose surgery, says Seeholzer.
The complication rate from weight-loss surgery is 3-5%, according to Aminian. It costs on average $12-26,000 and insurance coverage varies. It is usually covered for those with a BMI (body mass index) of 35 or more who also have uncontrolled diabetes, according to Aminian. And more employers who are self-insured, like the Cleveland Clinic, are starting to cover it for even lower BMIs, he says.
Aminian says the Cleveland Clinic is pursuing a randomized control trial to build upon these findings, and expects to have it up and running in a couple years.