Obesity Surgery

, Volume 17, Issue 9, pp 1248–1256 | Cite as

The comparative effects of bariatric surgery on weight and type 2 diabetes

  • Pierre Levy
  • Martin Fried
  • Ferruccio Santini
  • Nick Finer
Systematic Review


Background: Epidemiological evidence confirms that risk of developing type 2 diabetes is related to weight gain. Weight reduction is beneficial as relative risk is reduced to 0.13 for weight loss >20 kg. This raises the question of effectiveness of bariatric surgery on 1) weight loss and 2) diabetes-related outcomes in morbidly obese patients.

Methods: We reviewed the literature using Medline. Only 2 meta-analyses reporting on both outcomes were included, as well as 50 systematic reviews or primary studies.

Results: Meta-analyses mainly based on case series data as well as controlled studies confirm that bariatric surgery is highly effective in obtaining weight reduction in morbidly obese patients up to 60% of the excess weight, along with resolution of preoperative diabetes in more than 75% of cases. Among bariatric surgery techniques, malabsorptive procedures (biliopancreatic diversion and gastric bypass) appear to be more effective on both outcomes than restrictive procedures (gastroplasty and gastric banding).

Conclusion: Even if more studies are needed to confirm current evidence, bariatric surgery is effective for controlling diabetes. It appears as an efficient strategy from economic modeling due to savings from reduction in diabetes-related costs.

Key words

Bariatric surgery type 2 diabetes mellitus morbid obesity literature review treatment outcome weight loss 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mokdad AH, Ford ES, Bowman BA et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003; 289: 76–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Mokdad AH, Ford ES, Bowman BA et al. Diabetes trends in the U.S.: 1990–1998. Diabetes Care 2000; 23: 1278–83.CrossRefPubMedGoogle Scholar
  3. 3.
    Gregg EW, Cadwell BL, Cheng YJ et al. Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the U.S. Diabetes Care 2004; 27: 2806–12.CrossRefPubMedGoogle Scholar
  4. 4.
    Fox CS, Pencina MJ, Meigs JB et al. Trends in the incidence of Type 2 diabetes mellitus from the 1970s to the 1990s: The Framingham Heart Study. Circulation 2006; 113: 2914–8.CrossRefPubMedGoogle Scholar
  5. 5.
    International Diabetes Federation, Diabetes Atlas — Executive Summary, ed. I.D. Federation. 2003. http://www.eatlas.idf.org/webdata/docs/Atlas%202003-Summary.pdfGoogle Scholar
  6. 6.
    The DECODE Study Group. Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European Cohorts. Diabetes Care 2003; 26: 61–9.CrossRefGoogle Scholar
  7. 7.
    Tunstall-Pedoe H. Preventing Chronic Diseases. A Vital Investment: WHO Global Report. Geneva: World Health Organization, 2005. pp 200. Also published on http://www.who.int/chp/chronic_disease_report/en.Google Scholar
  8. 8.
    Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001; 414: 782–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Caterson ID, Hubbard V, Bray GA et al. Prevention Conference VII: Obesity, a Worldwide Epidemic Related to Heart Disease and Stroke: Group III: Worldwide Comorbidities of Obesity. Circulation 2004; 110: e476–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Malnick SDH and Knobler H. The medical complications of obesity. QJM 2006; 99: 565–79.CrossRefPubMedGoogle Scholar
  11. 11.
    Hartemink N, Boshuizen HC, Nagelkerke NJD et al. Combining risk estimates from observational studies with different exposure cutpoints: A meta-analysis on body mass index and diabetes type 2. Am J Epidemiol 2006; 163: 1042–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Colditz GA, Willett WC, Rotnitzky A et al. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995; 122: 481–6.PubMedGoogle Scholar
  13. 13.
    Chan JM, Rimm EB, Colditz GA et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994; 17: 961–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Ford ES, Williamson DF, Liu S. Weight change and diabetes incidence: findings from a national cohort of US adults. Am J Epidemiol 1997; 146: 214–22.PubMedGoogle Scholar
  15. 15.
    Koh-Banerjee P, Wang Y, Hu FB et al. Changes in body weight and body fat distribution as risk factors for clinical diabetes in US Men. Am J Epidemiol 2004; 159: 1150–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Hamman RF, Wing RR, Edelstein SL et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care 2006; 29: 2102–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Avenell A, Broom J, Brown TJ et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess 2004; 8: iii-iv, 1–182.PubMedGoogle Scholar
  18. 18.
    Lean ME, Powrie JK, Anderson AS et al. Obesity, weight loss and prognosis in type 2 diabetes. Diabet Med 1990; 7: 228–33.CrossRefPubMedGoogle Scholar
  19. 19.
    Rigby N, James P. The obesity campaign view of diabetes prevention. Diabetes Voice 2003; 48: 20–3.Google Scholar
  20. 20.
    Buchwald H, Avidor Y, Braunwald E et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292: 1724–37.CrossRefPubMedGoogle Scholar
  21. 21.
    Maggard MA, Shugarman LR, Suttorp M et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005; 142: 547–59.PubMedGoogle Scholar
  22. 22.
    Shekelle PG, Morton SC, Maglione M et al. Pharmacological and surgical treatment of obesity. Evid Rep Technol Assess (Summ) 2004: 1–6.Google Scholar
  23. 23.
    Sugerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg 1987; 205: 613–24.CrossRefPubMedGoogle Scholar
  24. 24.
    Hall JC, Watts JM, O’Brien PE et al. Gastric surgery for morbid obesity. The Adelaide Study. Ann Surg 1990; 211: 419–27.CrossRefPubMedGoogle Scholar
  25. 25.
    Nilsell K, Thorne A, Sjostedt S et al. Prospective randomised comparison of adjustable gastric banding and vertical banded gastroplasty for morbid obesity. Eur J Surg 2001; 167: 504–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Morino M, Toppino M, Bonnet G et al. Laparoscopic adjustable silicone gastric banding versus vertical banded gastroplasty in morbidly obese patients: a prospective randomized controlled clinical trial. Ann Surg 2003; 238: 835–41; discussion 841–2.CrossRefPubMedGoogle Scholar
  27. 27.
    Westling A, Gustavsson S. Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial. Obes Surg 2001; 11: 284–92.CrossRefPubMedGoogle Scholar
  28. 28.
    Sjostrom CD, Lissner L, Wedel H et al. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res 1999; 7: 477–84.PubMedGoogle Scholar
  29. 29.
    Sjostrom CD, Peltonen M, Wedel H et al. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000; 36: 20–5.PubMedGoogle Scholar
  30. 30.
    Agren G, Narbro K, Naslund I et al. Long-term effects of weight loss on pharmaceutical costs in obese subjects. A report from the SOS intervention study. Int J Obes 2002; 26: 184–92.CrossRefGoogle Scholar
  31. 31.
    Sjostrom L, Lindroos AK, Peltonen M et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683–93.CrossRefPubMedGoogle Scholar
  32. 32.
    Long SD, O’Brien K, MacDonald KG Jr et al. Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. A longitudinal interventional study. Diabetes Care 1994; 17: 372–5.CrossRefPubMedGoogle Scholar
  33. 33.
    MacDonald KG Jr, Long SD, Swanson MS et al. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg 1997; 1: 213–20.CrossRefPubMedGoogle Scholar
  34. 34.
    Pontiroli AE, Folli F, Paganelli M et al. Laparoscopic gastric banding prevents type 2 diabetes and arterial hypertension and induces their remission in morbid obesity: a 4-year case-controlled study. Diabetes Care 2005; 28: 2703–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Hansen EN, Torquati A, Abumrad NN. Results of bariatric surgery. Annu Rev Nutr 2006; 26: 481–511.CrossRefPubMedGoogle Scholar
  36. 36.
    Pories WJ, Flickinger EG, Meelheim D et al. The effectiveness of gastric bypass over gastric partition in morbid obesity: consequence of distal gastric and duodenal exclusion. Ann Surg 1982; 196: 389–99.CrossRefPubMedGoogle Scholar
  37. 37.
    Van Rij AM. Gastric bypass and gastric partitioning in morbid obesity: results of a controlled trial. ANZ J Med 1984; 14: 340 (abst).Google Scholar
  38. 38.
    Dolan K, Hatzifotis M, Newbury L et al. A comparison of laparoscopic adjustable gastric banding and biliopancreatic diversion in superobesity. Obes Surg 2004; 14: 165–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Thorne A, Lonnqvist F, Apelman J et al. A pilot study of long-term effects of a novel obesity treatment: omentectomy in connection with adjustable gastric banding. Int J Obes 2002; 26: 193–9.CrossRefGoogle Scholar
  40. 40.
    Clegg AJ, Colquitt J, Sidhu MK et al. The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation. Health Technol Assess 2002; 6: 1–153.PubMedGoogle Scholar
  41. 41.
    Clegg A, Colquitt J, Sidhu M et al. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes 2003; 27: 1167–77.CrossRefGoogle Scholar
  42. 42.
    Salem L, Jensen CC, Flum DR. Are bariatric surgical outcomes worth their cost? A systematic review. J Am Coll Surg 2005; 200: 270–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Narbro K, Agren G, Jonsson E et al. Sick leave and disability pension before and after treatment for obesity: a report from the Swedish Obese Subjects (SOS) study. Int J Obes 1999; 23: 619–24.CrossRefGoogle Scholar
  44. 44.
    Gallagher SF, Banasiak M, Gonzalvo JP et al. The impact of bariatric surgery on the Veterans Administration healthcare system: a cost analysis. Obes Surg 2003; 13: 245–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Encinosa WE, Bernard DM, Chen CC et al. Healthcare utilization and outcomes after bariatric surgery. Med Care 2006; 44: 706–12.CrossRefPubMedGoogle Scholar
  46. 46.
    Martin LF, Tan TL, Horn JR et al. Comparison of the costs associated with medical and surgical treatment of obesity. Surgery 1995; 118: 599–606; discussion 606–7.CrossRefPubMedGoogle Scholar
  47. 47.
    van Gemert WG, Adang EM, Kop M et al. A prospective cost-effectiveness analysis of vertical banded gastroplasty for the treatment of morbid obesity. Obes Surg 1999; 9: 484–91.CrossRefPubMedGoogle Scholar
  48. 48.
    Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med 2002; 113: 491–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Narbro K, Agren G, Jonsson E et al. Pharmaceutical costs in obese individuals: comparison with a randomly selected population sample and long-term changes after conventional and surgical treatment: the SOS intervention study. Arch Intern Med 2002; 162: 2061–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Potteiger CE, Paragi PR, Inverso NA et al. Bariatric surgery: shedding the monetary weight of prescription costs in the managed care arena. Obes Surg 2004; 14: 725–30.CrossRefPubMedGoogle Scholar
  51. 51.
    Ackroyd R, Mouiel J, Chevallier JM et al. Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries. Obes Surg 2006; 16: 1488–503.CrossRefPubMedGoogle Scholar
  52. 52.
    Pinkney JH, Sjostrom CD, Gale EA. Should surgeons treat diabetes in severely obese people? Lancet 2001; 357: 1357–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg 2002; 236: 554–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Greenway SE, Greenway FL 3rd, and Klein S. Effects of obesity surgery on non-insulin-dependent diabetes mellitus. Arch Surg 2002; 137: 1109–17.CrossRefPubMedGoogle Scholar
  55. 55.
    Ferchak CV, Meneghini LF. Obesity, bariatric surgery and type 2 diabetes — a systematic review. Diabetes Metab Res Rev 2004; 20: 438–45.CrossRefPubMedGoogle Scholar
  56. 56.
    Douketis JD, Macie C, Thabane L et al. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes 2005; 29: 1153–67.CrossRefGoogle Scholar
  57. 57.
    Gumbs AA, Modlin IM, Ballantyne GH. Changes in insulin resistance following bariatric surgery: role of caloric restriction and weight loss. Obes Surg 2005; 15: 462–73.CrossRefPubMedGoogle Scholar
  58. 58.
    Mason EE. The mechanisms of surgical treatment of type 2 diabetes. Obes Surg 2005; 15: 459–61.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2007

Authors and Affiliations

  • Pierre Levy
    • 1
  • Martin Fried
    • 2
  • Ferruccio Santini
    • 3
  • Nick Finer
    • 4
  1. 1.LEGOSUniversity of Paris DauphinePARIS cedex 16France
  2. 2.Clinical Center for Minimally Invasive and Bariatric Surgery — ISCARE, and 1st Medical FacultyCharles University PraguePragueCzech Republic
  3. 3.Department of Endocrinology and Metabolic DiseasesPisa University HospitalPisaItaly
  4. 4.Wellcome Trust Clinical Research FacilityAddenbrooke’s HospitalCambridgeUK

Personalised recommendations