A model depicting the adjustable gastric band device.
This article describes a small randomized clinical trial comparing the results of weight-loss surgery (with either the gastric bypass procedure or placement of an adjustable gastric band) to dietary and exercise (“lifestyle”) treatments to rid people of type 2 diabetes. The 61 obese adults in the study were taking either insulin or oral anti-diabetic medication, were mostly women and Caucasian, and were followed for three years. Overall, the story does a good job of laying out the benefits and goes to great lengths to put the results in context, noting in the lede sentence that this study is merely “adding” to the “growing body of evidence” favoring surgery over life style treatments for diabetes resolution. It also quotes those who caution readers about some limits of the study and warn against a willy-nilly rush to the operating room. The article would have benefited from some information about the costs and potential harms of bariatric surgery, as well as details on availability and barriers to access for these procedures.
Several types of surgery that essentially restrict stomach size and bypass portions of the intestine that absorb nutrients have been shown to result in long-term weight loss. These bariatric surgeries are not without risk, but have become increasingly popular, particularly for the severely obese. And as this new study suggests — and for reasons the article makes clear are not completely understood — the surgical treatments appear to not only significantly reduce weight, but also alter the biology of glucose and diabetic risk. They seem to do this better than lifestyle -based interventions, which often produce limited reductions in weight that returns all too quickly. Stories like this matter, not only because of the potential impact on public health, but also because bariatric surgery is expensive and has become a marketing opportunity for many medical centers and clinics. Readers need good, evidence-based reporting to distinguish help from hype.
The article carries no information about the cost of bariatric surgery, particularly some of the newer, more minimally invasive procedures. Costs are not trivial, particularly because the overall economic costs of type 2 diabetes aren’t either. The piece cries out for some dollar signs.
The story quantifies overall outcomes and benefits for the 61 patients followed for three years in absolute terms. It notes that “Forty percent of those who had received a gastric bypass procedure and 29% who received a gastric band were considered in remission from diabetes and no longer needed to take medication after three years. In comparison, no one in the group who received intensive lifestyle intervention resolved their diabetes.”
The story would have benefited from more information about the participants’ full spectrum of risk factors and the impact of the surgery on those markers (e.g. blood pressure). It also would have been more enlightening if it had stated clearly how many of the 61 study subjects got what kind of bariatric surgery and supplemental therapy. But the story does a good job of covering the necessities here.
This is a big hole. As noted earlier in this review, bariatric surgery is not without risk of complications, particularly in people with multiple morbidities and older age or very young age. It behooved the story to say something about this, including the risks and harms of untreated diabetes or diabetes and obesity in people who have tried everything and failed to resolve either condition.
The article does a good job of noting the strengths of the study and addresses important study limitations with a quote about needing a longer-term, multi-site study. One limitation not addressed, but which seems important to us, is the fact that the bariatric procedure discussed here is a very invasive, life altering surgery that carries a risk of serious complications, whereas the lifestyle intervention was comprised mainly of twice-monthly talk therapy sessions for 30-45 minutes. Is this a fair comparison? One could argue that a much more intensive and demanding lifestyle program — including gym membership, trainer, meals, etc. — would be needed to make this a fair test of the two approaches.
No mongering detected, but the article could arguably have used a bit of it, at least to note the increasing public health threat of diabetes and obesity in the young.
Then again, the uncertainty about long-term benefits for these procedures is concerning given marketing that targets adolescents.
The Not Satisfactory rating here doesn’t tell the whole story. The article makes good and broad use of sources, beyond the authors of the research publication. The article has some input from those who point out the need for longer term follow-up. And it does an especially good job of bringing out information about clinical guidelines and how they might change in response to the growing evidence for the benefits of weight loss surgery. Alas, the editorialist quoted at the end of the study, who very enthusiastically endorses wider use of bariatric surgery, acknowledged speaking fees from a number of companies who manufacture bypass surgery equipment. The story does not alert readers to this conflict of interest, which triggers an automatic Not Satisfactory rating here.
This is a tough call. The study in question was designed to compare bariatric surgery against specific lifestyle therapies. And the story capably provides that comparison. But while it’s a splendid thing to be able to “cure” diabetes in some obese patients who have weight loss surgery, it’s also important to mention the role of medication and diet in maintaining good management of the disease and preventing complications. The story doesn’t really address this. A word about strategies for preventing diabetes in the first place would also have been welcome here.
Readers would have benefited from some information about the availability of weight loss surgery in the U.S. Is the newer sleeve gastrectomy procedure available everywhere across the country? What are the criteria for insurance coverage?
The article does a good job of noting that there are other studies past and planned designed to test the value of bariatric surgery compared to other interventions for obesity and diabetes.
The article quotes a variety of sources who were not involved with the research, so we can be sure it went beyond any news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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