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 It's still to early to say whether mildly obese people with diabetes
live longer after weight loss surgery than those who receive
non-surgical treatments, however.
"The mortality data take a long time to show up," said Dr. Robin
Blackstone, a weight loss surgery expert who wrote an editorial on
the new study in JAMA Surgery.
Weight loss operations, or bariatric surgery, use various methods to
shrink the size of the stomach. They reduce hunger and limit the
body's ability to absorb food.
Over the years, bariatric surgeries have proved effective for
treating type 2 diabetes, but most studies were done in people who
are morbidly obese, with a body mass index (BMI) of 35 or above.
BMI, a measure of weight in relation to height, is considered normal
between 18.5 and 24.9. A BMI of 25 or higher indicates that someone
is overweight, and people with a BMI over 30 are considered obese.
(You can calculate your BMI here: http://1.usa.gov/1D0ZqDv.)
For the new study, researchers from Taiwan's Min-Sheng General
Hospital used data collected since 2007 in a trial comparing two
kinds of bariatric surgery - gastric bypass and sleeve gastrectomy -
to medical treatments for type 2 diabetes in people who were mildly
obese.
The average BMI among those who had surgery fell from 31 to 24.5 by
the end of their fifth year in the study. Meanwhile, the BMI among
those receiving non-surgical diabetes treatments stayed about the
same at 29.
Among those who had surgery, diabetes resolved completely in 36
percent and partially in 28 percent. In the medically-treated group,
by comparison, diabetes resolved completely in only 1 percent and
partially in only about 2 percent.
In addition, control of blood pressure, triglycerides, and "bad" LDL
cholesterol "was generally better in the surgical group," the
authors found.
The researchers also monitored patients' blood levels of hemoglobin
A1c, which reflect blood sugar levels over time. Hemoglobin A1c is
best kept below 7 percent, the researchers write. After surgery, the
average hemoglobin A1c level fell from about 9 percent to about 6
percent. In the medical therapy group, however, it remained steady
at about 8 percent.
But this better "glycemic control" - as reflected by the improved
hemoglobin A1c levels - did not reduce the mortality rate at five
years, according to lead researcher Dr. Chih-Cheng Hsu and
colleagues.
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The research team also compared average outcomes with the two types
of surgery. At the fifth year, compared to the sleeve gastrectomy
group, the bypass surgery group had lost more weight (18.7 vs 14.2
kg), achieved larger drops in BMI (7.4 vs 5.1) and in hemoglobin A1c
(3.1 percent vs 2.1 percent) and were more likely to have complete
diabetes remission (46.9 percent vs 16.7 percent).
While the new study does not show a survival benefit or surgery
after five years, there is evidence from a study of heavier people
in Sweden that surgery does lead to a longer life, says Blackstone,
of the University of Arizona College of Medicine–Phoenix.
In the Swedish study, obese people who had bariatric surgery were
about 29 percent less likely to die over 15 years, compared to a
group who tried more conventional methods.
Though the new study didn't show a benefit in survival among surgery
patients, Blackstone said it's reassuring for people with a BMI
under 35 interested in the procedure.
"This is where this paper is critical, because it says this surgery
is safe in that lower BMI group," with no increased risk of death or
renal disease, she said.
Blackstone added that people and their doctors should start taking
weight seriously once the patient's BMI falls between 27 and 30.
"I think we wait too long to get people to be serious about this,"
she said. "I think that once they’ve accumulated these genetic
changes that hardwired their bodies into obesity and diabetes,
reversing that is really hard."
SOURCE: http://bit.ly/1Lyse9K and http://bit.ly/1LyshCl JAMA
Surgery, online September 16, 2015.
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