Bariatric surgery for "overweight" patients - Really?
Bariatric surgery, one of my favorite topics. Look at these “news” headlines:
These articles report on the findings of a presentation by doctors from the Cleveland Clinic at the 2015 American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society.
“Cleveland Clinic researchers say this study is the largest ever-published series of bariatric surgery in patients with type 2 diabetes and body mass index (BMI) of 35 kg/m2 or less. They studied 1,003 patients from North America with a BMI of between 25 and 35, with the average BMI being 33.5 kg/m2. Forty-six patients had a BMI of 30 or less. All had weight-loss surgery, or what is known as bariatric or metabolic surgery, between 2005 and 2013.”
"Bariatric surgery is emerging as a safe and effective option for managing type 2 diabetes in patients with mild obesity," said lead study author Ali Aminian, MD, Laparoscopic and Bariatric Surgeon at the Cleveland Clinic Digestive Disease Institute. "We are seeing significant improvement or remission of type 2 diabetes in most lower BMI patients. Current evidence suggests that baseline BMI is unrelated to diabetes remission following bariatric and metabolic surgery.”
"A two-hour operation and a two-day hospital stay has the potential to resolve or improve what is a chronic, progressive and dangerous disease," said John M. Morton, president of the ASMBS and Chief, Bariatric and Minimally Invasive Surgery.” Ref
Looks good, huh. NOT SO FAST! These articles conveniently left out some significant facts including statements from the study’s authors:
“However, these RCTs [randomized controlled trials] cannot clearly resolve the safety concerns of bariatric surgery in a subgroup of patients with T2D [type 2 diabetes] who are overweight and mildly obese because such studies are small trials unlikely to reveal uncommon but clinically serious complications. In addition, many of the trials have screened out low-body mass index (BMI) and high-risk patients deemed unfit for participation in the study.” Ref
The subjects have been cherry picked … hmmm
And other trials are unlikely to reveal serious complications … hmmm
Out of the 1003 subjects, there was a 30-day postoperative mortality rate of 0.2%. In English, this means that at least 2 people DIED (were killed?)! What about after the first 30 days? Hmmm
The “incidence of all major complications was less than 0.5% except post-op bleeding, which was 1.6%” I love this - the incidence of all major complications was < 0.5% EXCEPT post-op bleeding. Hmmmmm
"The risk-benefit profile that has emerged for bariatric surgery in people with type 2 diabetes and low BMIs is very favorable and should be considered as a treatment option in carefully selected patients." Really? Hmmmm
And at the very end of one of the articles it does state, “In a follow-up question-and-answer period, Aminian said further studies should compare outcomes for this patient demographic that receive bariatric surgery with those that do not.”
So, let the trumpets sound that bariatric surgery is “safe” for a population that should absolutely use lifestyle management when in reality it is not only not safe, but outright crazy!
Want more? Here’s a study that says bariatric surgery is safe, but safe only up to 5 years post surgery:
“For mildly obese patients with T2DM, the improvement in glycemic control from metabolic surgery lasts at least 5 years. However, the survival benefit and lifelong adverse outcomes require more than 5 years to be established.”
And more here – bariatric surgery for adolescents! Again, improvement … oops … only 3 years post surgery have been studied!
“In this multicenter, prospective study of bariatric surgery in adolescents, we found significant improvements in weight, cardiometabolic health, and weight-related quality of life at 3 years after the procedure. Risks associated with surgery included specific micronutrient deficiencies and the need for additional abdominal procedures.”
And lastly, bariatric surgery is “ more effective than medical treatment for the long-term control of obese patients with type 2 diabetes and should be considered in the treatment algorithm of this disease.” BUT … “However, continued monitoring of glycaemic control is warranted because of potential relapse of hyperglycaemia.”
Things that make you go hmmmm. Get educated about your health!