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Bariatric Surgery = Weight Loss Surgery = Metabolic Surgery = Surgery for Diabetes!

Metabolic syndrome is a disease of modern society. It has become a public health nightmare and this is especially true in Malaysia. It is estimated that individuals with metabolic syndrome have a fivefold greater risk of developing type 2 diabetes. To date, the treatment for obesity and diabetes is still heavily dependent on medicine. However, as the relation of gut physiology and nutrition metabolism is better defined, more recent studies suggest that surgery can be used to treat obesity, diabetes and other metabolic disorders. Evidences are available to support surgery as an early approach for metabolic syndrome treatment will maximise patient’s health outcome.

What is Metabolic Syndrome?

American Heart Association

Waist Circumference
  • Men > 40 inches (102cm)
  • Women > 35 inches (88cm).
  • For Asian, the waist circumference is defined Men >90cm, women >80cm.
Elevated Blood Pressure
  • ≥ 130/85 mm/Hg OR
  • Use of anti-hypertensive medication
Reduced HDL ("good") Cholesterol
  • Men < 40mg/dL (1.03mmol/L)
  • Women < 50mg/dL (1.29mmol/L)
Elevated Fasting Glucose
  • ≥ 100mg/dL (5.6mmol/L) OR
  • Use of hypoglycemic agent
Elevated Triglycerides
  • ≥ 150mg/dL (1.7mmol/L)

There are evidences now to support bariatric surgery not only reduces individual’s weight, it also reduces the metabolic syndrome associated with obesity and diabetes mellitus. First paper with 5 years long-term follow-up was published in The Lancet journal in September 2015 showed diabetic patients who underwent bypass surgery has 37% to 63% chances of resolution of diabetes in 5 year compared to 0% in medically treated group! Forty-two percent to 68% of them were able to keep their HbA1c below 6.5% compared to only 27% in medically treated group.

The second paper was recently presented at American College of Cardiology in April 2016 comparing surgery vs medical treatment also confirmed remission of diabetes were higher in surgical group. Five year results showed 29% of bypass-patients, 23% of “sleeve” patients, and only 5% of medical treated patients, achieved remission of diabetes. The rate of reduction of HbA1c is significant over 5- year period.

Mean changes in blood glucose by type of diabetes control, baseline to 5 years

Shown are the percentage change in glycated hemoglobin (HbA1c) levels over 5-year period among patients receiving intensive medical therapy only, sleeve gastrectomy, or gastric bypass. Glycated hemoglobin is a type of blood protein used to measure glucose in the bloodstream.

Mean glycated hemoglobin values for each interval
(Median values in parentheses)
Value at visit Baseline Month 12 Month 24 Month 36 Month 48 Month 60
Medical 8.8(8.6) 7.3(6.8) 7.5(7.2) 8.4(7.7) 8.6(8.2) 8.5(8.0)
Medical 9.3(9.4) 6.4(6.2) 6.5(6.4) 6.8(6.6) 6.8(6.6) 7.3(6.9)
Gastric bypass 9.3(9.4) 6.4(6.2) 6.5(6.4) 6.8(6.6) 6.8(6.6) 7.3(6.9)
Sleeve 9.5(8.9) 6.7(6.4) 6.8(6.8) 7.0(6.7) 7.0(6.7) 7.4(7.2)

SOURCE: Clevand Clinic | William Neff | The Plain Paper

It is important to know that, each percentage point reduction of HbA1c bring significant risk reduction of morbidity and mortality in diabetic patient over times.

Bariatric surgery also improves other conditions associated with metabolic syndrome, especially high blood pressure, sleep apnea, and high cholesterol levels.

Medical Outcomes of Bariatric Surgery
Condition/Disease % Resolved or Improved % Resolved
Type 2 Diabetes 86 76.8
Hypertension 78.5 61.7
Obstructive Sleep Apnea 85.7 83.6
Hyperlipidemia 78.5 61.7

SOURCE: ASMBS.org

Bariatric & Metabolic Surgery is a safe operation. It is even safer than gallbladder removal surgery or hip replacement surgery. Studies have shown that bariatric surgery mortality rate is about 0.1% compared to gallbladder removal surgery (0.7%) and hip replacement surgery (0.93%). The overall complication rate is about 4.3%. (ASMBS.org)

The evidences to perform surgery for cure of diabetes and other obesity related medical conditions are stronger than ever. There is no good reason we do not want to consider surgery as part of the early treatment for metabolic syndrome.

Weight Loss Surgery Malaysia Patient Support Group Weight Well Malaysia
(Disclaimer: weight loss results and experiences may vary from person to person)

Bariatric, Metabolic, and Diabetes Surgery in Malaysia