[Indications and principles of metabolic surgery]

Bariatric surgery is known to be the most effective and long lasting treatment for morbid obesity and many related conditions, but now mounting evidence suggests it may be among the most effective forms of treatment for metabolic diseases and conditions including type 2 diabetes, hypertension, high cholesterol levels, non-alcoholic fatty liver disease and obstructive sleep apnea. Surgery for severe obesity goes way beyond weight loss. This surgery results in the complete remission or significant improvement of type 2 diabetes and other life-threatening diseases in most patients. The new name metabolic surgery was created and reflects this expanded and evolving view of surgery. Therefore, metabolic surgery is expected to play an ever increasing role in managing these diseases. New research results indicate that metabolic surgery may improve insulin resistance and secretion by mechanisms independent of weight loss, most likely involving changes in gastrointestinal hormones. Many patients with type 2 diabetes experience complete remission within days of metabolic surgery, long before significant weight is lost. This has led to a new concept that metabolic surgery may also be appropriate for diabetic individuals who are of normal weight or only slightly overweight.