Weight Loss Surgery and Diabetes Management
This week one of the main health stories has been surrounding the latest announcement that weight loss surgery will indeed reduce the risk of developing Type 2 diabetes. With World Diabetes day on the 14th of November, in this blog we look at the article at the heart of this story and what it means for overall health and sustainability.
What does the reports actually say?
With the media reporting that this piece of research should be used to bring about more widespread bariatric surgery in order to help tackle the current obesity and diabetes epidemic, a closer look at the article itself will show that even the authors themselves are cautious about their findings as they acknowledge the several limitations of this study.
This paper looked at a large section of the population who had undergone bariatric surgery for obesity reasons, but had not been diagnosed as being diabetic before surgery. This population, was then “matched” with individuals who were also obese and had no history of diabetes.
These two groups of patients’ records were analysed over a 7 year period and incidence of diabetes was recorded i.e. how many individuals from each group developed diabetes over this period - this was the only aspect under investigation.
Whilst this study has a lot of strong points, mainly that it looked at such a large population which was widespread throughout the UK. But also taking into account other health issues present within the two groups at the start of the 7 year period, mainly looking at depression diagnosis, smoking status, cholesterol markers, hypertension, as well as stroke and coronary heart disease, all of which were more prevalent in the group that underwent bariatric surgery.
It is important to note that the group which underwent surgery had a higher incidence of depression diagnosis, higher blood pressure, higher cholesterol all of which were not due to chance.
It would be interesting to see if the individuals who underwent bariatric surgery went on to lower their BMI and indeed improve their overall health on the same level as seen for diabetes.
A key issue that has been raised within the paper is the fact that the individuals who undergo bariatric surgery have greater medical follow up. Could this also mean that the lower incidence seen in this group is due to better education on how to maintain their weight? As the control group i.e. the individuals who did not undergo surgery were not given any differential treatment than currently seen as standard care.
Could it be that the answer to the obesity and diabetes epidemic is better follow up with individuals who start showing signs of ill-health? Could it be that if these same individuals were given the same after-care given to the surgery patients, they would have also seen an improvement in diabetes incidence?
The way we at the Natural Low Carb Store see it is that this paper is saying that an improvement in current primary clinical care is required for prevention and treatment of diabetes and obesity rather than simply stating that surgery is the answer.
Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study
Helen Booth MSc,Omar Khan FRCS,Prof Toby Prevost PhD,Marcus Reddy FRCS,Alex Dregan PhD,Judith Charlton MSc,Mark Ashworth DM,Caroline Rudisill PhD,Prof Peter Littlejohns MD,Dr Prof Martin C Gulliford FFPH
The Lancet Diabetes & Endocrinology - 3 November 2014DOI: 10.1016/S2213-8587(14)70214-1