Obesity surgery may reduce heart risks for diabetics
Every year, hundreds of thousands of obese Americans undergo weightloss surgery in a lastditch effort to shed pounds and control their Type 2 diabetes.
Now a new study, carried out at the Cleveland Clinic, suggests that bariatric surgery may also have other significant health benefits, cutting the overall risk of serious cardiovascular events and premature death by almost half.
The study, published in the medical journal JAMA on Monday, is not definitive. Though it compared the longterm outcomes of about 2,300 bariatric surgery patients with some 11,500 closely matched patients who had not undergone surgery, it was an observational study, not a randomized controlled trial of the kind considered the gold standard in medicine.
But the findings were so striking that an editorial accompanying the paper suggested that weightloss surgery, rather than medications, should be the preferred treatment for Type 2 diabetes in certain patients with obesity.
“The new information here is the ability of bariatric surgery to control macrovascular events like strokes, heart attacks, heart failure and kidney disease,” not just improve weight and diabetes control, said Dr. Edward Livingston, the editorial’s author. “That’s a big deal.”
But other scientists were less certain, and even the study’s authors said the findings must be confirmed in clinical trials that randomly assign patients to have surgery or continue with regular care.
“This study needs to be taken with a giant grain of salt,” said Dr. David Nathan, director of the Diabetes Center and Clinical Research Center at Massachusetts General Hospital and a professor at Harvard Medical School, who was not involved in the study.
A similar observational study last year that compared 5,301 obese patients with Type 2 diabetes who had bariatric surgery with 14,934 patients who served as controls also found improved outcomes in patients who underwent the operation.
Both Nathan and Livingston said the comparisons between patients who had surgery and those who did not were flawed, because people who elect to undergo weightloss surgery are in many ways different from those who do not. Surgical patients are highly motivated, for instance, and healthy enough that surgeons do not turn them away.