Theres Still Only One Effective Treatment For Obesity, And Its Life-Saving – Forbes

Posted: March 19, 2020 at 8:47 am

Dietary doctor with patient with overweight

Obesity kills. It leads to diseases like diabetes that, in turn, increase the risk of fatal cardiovascular diseases such as strokes and heart attacks. Wouldnt it be nice to have a treatment that forestalled all this misery and mortality?

Unfortunately, many treatments dont work well, either to combat obesity or to hold off its consequences. There are a slew of medicines that treat the consequences of obesitysugar-lowering pills to control diabetes, antihypertensive pills to control blood pressure, cholesterol pills to well, you get the idea. But there arent many good ways to combat the obesity at the center of these other problems.

Diets? They might work for a few months, but few people achieve sustained and significant weight loss through dieting.

Diet pills? Youve got to be kidding!

Fortunately, there is an obesity treatment that works and, for people with diabetes, it appears to be life-saving. It is called metabolic surgery by many physicians, but is known more colloquially either as gastric bypass or bariatric surgery. Physicians have renamed this procedure metabolic surgerybecause the operation has wide-ranging effects on the nerves serving the gastrointestinal system, and therefore alter the hormones that the body releases to influence appetite and metabolism.

Weve known for a while now that such surgeries are the best way to achieve sustained weight loss for people with obesity. Now, a study in JAMA suggests that metabolic surgery is also an effective way to reduce mortality among obese people with diabetes.

I say suggests rather than proves because the study wasnt a randomized trial. Instead, researchers compared obese patients with diabetes who either received or didnt receive metabolic surgery and assessed their risk of subsequent cardiovascular disease.

Obesity is defined as a Body Mass Index (BMI) of 30 or greater. For a 5-foot-10-inch man, that amounts to weighing 210 lbs or more; for a 5-foot-4-inch woman, that amounts to weighting 175 lbs or more. The BMI is an imperfect measure of obesity. For example, there are muscular people who have BMIs of 30 or greater despite carrying little or no body fat.

In any case, the people in this study not only had BMIs that were 30 or greater, but also suffered from type 2 diabetes, suggesting that their high body weight was causing metabolic disturbances. In line with that, many of these people experienced cardiovascular events in subsequent years. However, people receiving metabolic surgery had a dramatically lower risk of cardiovascular disease. And Im not just talking about minor heart attacks. People receiving the surgery were significantly less likely to die than people who didnt. Heres a picture of that result:

There's Still Only One Effective Treatment for Obesity, And Its Life-Saving_Figure_1

A couple scientific cautions to keep in mind:

This was an observational study

Its possible that some people did not receive surgery because their physicians believed that their health was too tenuous to undergo such an arduous procedure

The researchers tried to control for such factors, but such statistical adjustment is never perfect.

With those precautions in mind, we should still feel excited about these findings. For example, look at the percent of people who needed to take diabetes medicines among those who did and did not receive metabolic surgery. About two-thirds of surgery patients got so much better from the procedure that they no longer needed to take those medications anymore:

There's Still Only One Effective Treatment for Obesity, And Its Life-Saving_Figure_2

Metabolic surgery is a major procedure, with accompanying risks and harms. But for obese people with diabetes, its probably life-saving.

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Theres Still Only One Effective Treatment For Obesity, And Its Life-Saving - Forbes

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