Bariatric surgery: Editorial 'Why only a last resort?'

Source: The Lancet Diabetes & Endocrinology 2014

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, anti-obesity and anti-diabetic drugs are not without adverse effects, and some common anti-diabetic drugs actually induce weight gain. 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.

Bariatric surgery has substantial benefits in terms of weight loss, metabolic status, and quality of life. It is safe and effective, and the future savings made through prevention of comorbid diseases could counterbalance its high cost. The surgery should, therefore, be available as an option to use when appropriate, and not only when all other options have been eliminated. Bariatric surgery offers a real opportunity for preventing comorbid diseases and complications of obesity. If it is only used as a final resort, this opportunity will be missed.

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