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VOLUME 10 NUMBER 4 • NOVEMBER 2013
REPORT
SA JOURNAL OF DIABETES & VASCULAR DISEASE
range of health benefits that go far beyond
the cosmetic.’
In summary, Dr Ellis argued that bariatric
surgery is highly effective, sustained in the
majority of patients, and has benefits beyond
glycaemic control, including mortality rate,
blood pressure, hyperlipidaemia, obstruc-
tive sleep apnoea and improved quality of
life. And even though it’s expensive, it might
well be more cost effective than it appears
at first glance. ‘We should be more interven-
tionist than in the past’, he concluded. ‘Bari-
atric surgery is a cure for diabetes.’
No!
Dr Ray Moore, Umhlanga Centre for
Diabetes and Endocrinology
Bariatric surgery is not the answer to type
2 diabetes. On that point Dr Moore was
adamant. ‘Not only will it leave you with a
lighter wallet, but it carries a 5.5% risk of
any complication and a 2.2% risk of a seri-
ous complication. It can even cause death.’
The complications include stomal ulcer or
stricture, wound infection, gastric ulcera-
tion, internal hernias, anastomotic leaks,
small bowel or Roux loop obstruction and
cholelithiasis.
It is also associated with increased sub-
stance abuse. While smoking and alcohol
intake are decreased at one month post
surgery, they are increased at each suc-
cessive visit, reaching significance at two
years. ‘If you can no longer get pleasure
from food, you’ll find it elsewhere.’ Vari-
ous studies have shown too that only a
relatively small proportion of those who
undergo bariatric surgery achieve com-
plete remission of their diabetes at five
years and that there is also a relatively
high rate of weight regain.
So is there an alternative to bariatric
surgery? Some investigators led by Prof
Roy Taylor from Newcastle University, UK,
have shown in a recent series of articles
that rapid reversal of type 2 diabetes with a
very low-calorie diet can be achieved in the
same time frame as with bariatric surgery.
Using sophisticated MRI techniques, they
showed that this reversal was associated
with rapid reduction of the fatty infiltration
of the liver and pancreas.
‘So weight loss from any cause sees a
return towards normal functioning’, con-
tinued Dr Moore. ‘Even though, once
established, type 2 diabetes seems inevi-
tably progressive, it might just be a conse-
quence of too much fat in the pancreas,
while insulin resistance is the result of too
much fat in the liver.
‘So who needs bariatric surgery? Why
choose an expensive surgical option when
a commercially available low-calorie diet
can achieve the same result at a fraction of
the cost, with no risk of the various compli-
cations mentioned earlier? Over and above
everything else, bariatric surgery confers
little or no long-term survival benefit. A
diabetic patient should not qualify for
bariatric surgery based on BMI alone. It
should be reserved for only a highly selec-
tive group of patients.’
