| Abstract: |
This article brings readers up to date on current options of bariatric surgery in patients with morbid obesity and type 2 diabetes. The authors briefly review the various approaches to weight loss, including lifestyle intervention, diet therapy, behavior modification, exercise programs, and drug therapy, noting that these usually result in only modest and transient weight loss, particularly in patients with severe obesity. Recent studies show that surgical treatment was significantly more effective than nonsurgical therapy in reducing weight, resolving the metabolic syndrome, and improving quality of life during a 24-month treatment program. The authors summarize the different types of bariatric surgical procedures that can be used and report the results found with each type. They discuss the reversibility of type 2 diabetes after bariatric surgery, observing that euglycemic and normal insulin levels can occur within days after surgery, long before there is any significant weight loss. Other topics discussed include perioperative risk and care of bariatric surgery; and the complications, failures, and weight gain that can be seen as long-term results after bariatric surgery. The authors conclude that the only effective and enduring therapy for morbid obesity is weight-loss surgery. Certain risks exist for weight-loss surgery that can be reduced by surgical experience and patient selection, education, and lifelong surveillance. 65 references. |