Weight loss surgery to tackle Type 2 diabetes

NICE has updated its guideline on the identification, assessment and management of overweight and obesity. NICE has a suite of guidance available to help prevent obesity and help people to lose weight.

Dr Rachel Batterham, Head of Obesity and Bariatric Services at University College London Hospital Trust, who was involved in developing the guidance, said: “We know that surgery can make a real difference for people with recently diagnosed Type 2 diabetes, so the guideline now recommends that if someone is diagnosed with Type 2 diabetes and their BMI is 35 or over then they should be offered an early, rapid assessment for weight loss surgery. 

The earlier you have the surgery in your diabetes course, then the more likely you are to have remission

“If we look at the latest report of bariatric surgery done in the UK, there were 4,000 patients with Type 2 diabetes who had surgery. Of them, 65 per cent were no longer on any diabetes medications 2 years later.

“The health benefits of weight loss surgery are so great that it should be considered as part of the treatment for obese diabetics. The earlier you have the surgery in your diabetes course, then the more likely you are to have remission or a really good improvement.”

Last year, 6,500 weight loss procedures were performed in the UK, with gastric bypass and sleeve gastrectomy the most common types of surgical intervention. Both work on the principle of surgically altering the digestive system so it takes less food and makes the patient feel fuller quicker after eating.

It is estimated that an additional 5,000 weight loss surgeries will be carried out each year if the guidance is fully implemented.

NICE recommends that doctors consider surgery for people of Asian family origin who have recent-onset Type 2 diabetes at a lower BMI than other populations, as the point at which the level of body fat becomes a health risk varies between ethnic groups. Asian people are known to be particularly vulnerable to the complications of diabetes.

Professor Alex Blakemore, representing patients and carers on the group that developed the guideline, has had the surgery: “Surgery isn’t a magic spell or an easy option, it helps you lose weight, but it doesn’t happen overnight and there is still a lot of work to do, it requires changing your lifestyle.

“One of the most surprising effects for me was the rapid effect it has on diabetes, some of which happens immediately, before weight loss. On the day that I had my own surgery, another woman had her operation too. She had diabetes and was on insulin and already had severe complications including constant pain from nerve damage. Four days later she went home without her insulin and within six weeks she was off her other medication too. That all happened before weight loss. Sadly, although her diabetes went into remission the complications remained, if she had had surgery earlier, this could have been prevented.

“The updated guideline puts a lot of emphasis on follow up after surgery, ensuring that people have support to help improve their diets, be more active and make lifestyle changes to ensure they lose the weight and keep it off.”

Recommendations include:

The public health aspects of NICE’s original obesity guideline are not addressed in this update, but some sections are in the process of being updated by the Centre for Public Health at NICE.