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Why is This a Last Resort?

last_resort_bariatricsA new editorial in the journal The Lancet: Diabetes & Endocrinology asks why bariatric surgery is only being used as a “last resort”.  Obesity is a cause of major health concerns like diabetes, high blood pressure, and is a risk factor for many types of cancer. A significant point in the editorial is that “despite the fact that early intervention is known to be important to prevent the development of obesity-related comorbidities, bariatric surgery is almost always used to treat patients who have severe obesity and progressive comorbid disease.” There is likely a combination of reasons for this delay, including a majority of people – obese and otherwise – planing the majority of the blame for obesity on the simple reason that a person ate too much and exercised too little. With this extreme oversimplification of the disease, it is easy to see how bariatric surgery is not seen as a significantly important treatment.

The study author says: “Bariatric surgery procedures have evolved over the past two decades, and are now considered to be a safe and effective treatment for obesity. Bariatric surgery not only induces weight loss, but also improves metabolic status. Patients with diabetes who have bariatric surgery can experience remission and existing diabetic organ damage can be reversed. Although there are risks entailed in bariatric surgery, the alternatives—antiobesity and antidiabetic drugs—are not without adverse effects, and some common antidiabetic drugs actually induce weight gain.”

The field of bariatric and metabolic surgery is relatively new, and because of this, major improvements in technique and understanding have happened over the last few decades. Bariatric surgery is now as safe as other abdominal surgeries such as gall bladder removal. Dr Matthew Brengman wrote an article for our Gut Feelings column where he said “Bariatric surgery is misunderstood and misrepresented. The fact is, bariatric surgery is the only treatment scientifically shown to result in substantial, sustained weight loss in patients who are severely and morbidly obese.  There are now many studies showing the effectiveness of surgical weight loss in the treatment of dozens of diseases, including diabetes, heart and vascular disease and cancer… that we will stop seeing these procedures referred to as ‘last ditch treatments’ or ‘drastic measures'”.  As obesity rates increase, and even more studies show the safety and efficacy of bariatric surgery, hopefully more people can get access to these medical treatments at a time when it can be most beneficial to them. Waiting until bariatric surgery is a ‘last resort’ does not benefit patients.

You can read the editorial here.

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