Bariatric Surgery Beats Diet and Exercise in a Head-to-Head
What to Know
Roux-en-Y gastric bypass (RYGB) surgery makes the stomach smaller and allows digestion to bypass part of the intestine. The procedure can dramatically improve blood glucose control in people with type 2 diabetes. It can even lead to diabetes remission (a state in which all signs and symptoms of diabetes disappear). Similar improvements can be gained with very low calorie diets when paired with intense exercise. Few studies, however, have compared RYGB with aggressive diet and exercise.
In a relatively small study, researchers compared the outcomes of 32 obese people with type 2 diabetes who were randomly assigned to one of two groups: RYGB or diet and exercise. Their ages ranged from 25 to 64. The RYGB group participated in behavioral therapy both before surgery and for 10 months after surgery. The other group followed a diet designed for weight loss and lowering blood glucose levels. Both groups received standard diabetes medical treatment for 1 year.
The researchers found that 60% of the RYGB group experienced diabetes remission compared to 6% of the diet and exercise group. A year after surgery, the RYGB group had lower A1C levels (average blood glucose over the past two to three months) and required fewer diabetes and blood pressure medications. They also lost more weight and had a lower BMI (body mass index, a measurement of body weight relative to height). The exercise group improved their cardiovascular health, while the RYGB showed no such improvement.
According to a growing body of research, including this study, surgical procedures like RYGB out-perform lifestyle modifications and medical interventions in terms of weight loss, diabetes remission, glycemic control, and heart health for at least one to three years in people with type 2 diabetes and obesity. Such procedures may also benefit people who are less obese than those typically considered for weight loss surgery. Longer studies involving more—and more diverse—patients need to be done.
Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial, by David E. Cummings and colleagues. Diabetologia 2016;59:945–953. https://doi.org/10.1007/s00125-016-3903-x