The scientific evidence for treatment of obesity is trending in a very interesting direction. For years a safe and effective medication for weight loss has been sought, with only modest results. (I wrote about orlistat, the medication in Xenical and Alli, a year ago.) Surprisingly, for obese patients evidence is increasingly mounting in favor of surgery for weight loss, rather than medications or even diet and exercise.
In 2006 a randomized study demonstrated that patients with mild to moderate obesity lost more weight and had a better quality of life than patients randomized to diet, exercise and weight loss medications. Last week, the evidence got even better. A study published in the Journal of the American Medical Association examined the effect of laparoscopic gastric banding on obese patients with diabetes. The study randomized patients with recently diagnosed type II diabetes with body mass indexes between 30 and 40 (20 to 25 is normal) into two groups. Both groups received conventional diabetes care with medications, but only one group underwent laparoscopic gastric banding. The difference between the groups was very impressive. 73% of the surgical group had their diabetes entirely resolve, compared to 13% in the conventional therapy group. The surgical group lost an average of 20% of their body weight, compared to 1.7% in the conventional therapy group. Importantly, there were no serious complications in either group. The study generated a lot of media coverage, including this article in the LA Times.
So if you have diabetes and are very overweight, surgery is no longer the most radical option. It’s becoming the most conservative evidence-based option. If this trend continues, diet and exercise for obesity will be considered the radical fringe option.
(I’m grateful to Jay F. for pointing me to the LA Times article.)
My 15 minutes of fame is extended slightly by this article on concierge medicine.