Bariatric Surgery Better Than Medication for Diabetes

A new study says people with type-2 diabetes may have more success in managing their diabetes with bariatric surgery rather than traditional medical therapies.

The study, published this week in the New England Journal of Medicine compared the standard treatment of medication, diet and exercise to weight-loss surgery, also known as bariatric surgery, for the treatment of type-2 diabetes.

“Research has already shown that gastric bypass surgery improves or resolves type-2 diabetes in days or weeks following surgery,” says Noel Williams, MD, director of the Penn Metabolic and Bariatric Surgery Program. “This new study shows that in addition to gastric bypass, sleeve gastrectomy has the same positive impact on type-2 diabetes and is more effective than medical management alone.”

During a sleeve gastrectomy, a sleeve-shaped tube is created from a small portion of the stomach and the majority of the stomach is removed. Food passes through the new stomach tube directly into the intestines. Nutrients and calories are absorbed from food normally, but patients feel full sooner and longer.

“It is important that patients choose an experienced physician to perform their weight-loss surgery,” says Dr. Williams. “The Penn Metabolic and Bariatric Surgery program performs more than 500 procedures every year and more sleeve gastrectomies than any program in the Philadelphia region.”

Type-2 diabetes is a chronic disease in which the body cannot or does not produce enough insulin to manage blood sugar levels. Type-2 diabetes is often associated with obesity, though people of average weight may also develop the disease.

“Research is proving that weight-loss surgery reduces the co-morbidities associated with obesity,” says Dr. Williams. “Following surgery some patients quickly see their blood sugar level return to normal and they are able to stop taking insulin and other medications.”

The study also found bariatric surgery helped people lower their blood pressure and cholesterol.

Read more about the study here.

Learn more about weight-loss surgery at Penn, and how it may help you control your diabetes by attending a free informational session about weight-loss surgery. 

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Having a Baby After Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, and Monica A. Mainigi, MD, fertility specialist at Penn Fertility Care, provide important information for women trying to become pregnant and maintain a healthy pregnancy after weight loss surgery.

Many women struggle with fertility as a result of their weight. In fact, obesity puts women at greater risk for ovulation dysfunction and menstrual irregularity, both of which can interfere with fertility. In addition, obesity can lead to an increased risk of miscarriage and decreased success with fertility treatments. For overweight women who are having a hard time conceiving, weight loss surgery may be an option to consider.

For women considering pregnancy after they have had bariatric surgery, it is important to keep the following information in mind.


Fertility boost
Obesity can interfere with hormone production, making it more difficult to get pregnant.  Weight loss after bariatric surgery can lead to regular cycles and ovulation, and improved fertility. In fact, a 2005 study published in the Journal of Clinical Endocrinology and Metabolism found that surgical weight loss for women with PCOS often resolved their reproductive and metabolic abnormalities. 

Healthier pregnancy, healthier baby
After weight loss surgery, medical conditions such as high blood pressure and diabetes are significantly improved or resolved leading to a lowered risk of developing serious complications during pregnancy or delivering a baby born with complications.  Many women are still obese after weight loss surgery which places them at a higher risk for gestational diabetes and preeclampsia, but the risk is far less than before surgery.  Pregnant women who have had bariatric surgery should see a high-risk obstetrician to best manage prenatal care.

Give it time
It is important to wait at least 18 months after surgery to start trying to get pregnant. In the period immediately following gastric bypass or sleeve gastrectomy, rapid weight loss causes stress on the body, including diminished nutrition intake, which can cause complications for an expecting mother and growing baby. Effective contraception is absolutely critical for women pursuing weight loss surgery.  For women with an adjustable gastric band, fluid may be removed from the band during pregnancy to accommodate the need to eat more calories.

Keep supplementing
Good nutrition is especially important for women trying to conceive.  After weight loss surgery, patients are at a higher risk for deficiencies of certain nutrients, including vitamin B12, folic acid, calcium, iron, and vitamin D. It essential to continue taking vitamin and mineral supplements as recommended by the bariatric team.

Be ready for weight gain
After having weight loss surgery, it can be difficult to accept that pregnancy is a time when it is normal, healthy and necessary to gain weight.  Healthy weight gain during pregnancy is important to nourish a growing baby, but work with the program dietitians to avoid unhealthy weight gain during pregnancy.

The Penn Metabolic and Bariatric Surgery Program offers lifelong follow-up care and nutritional support for patients who have had weight loss surgery. Women considering pregnancy after weight loss surgery should discuss their plans with the bariatric surgery team.

For more information on fertility services at Penn Medicine, visit the Penn Fertility Care website.

- Cara Stewart, RD, LDN and Monica Mainigi, MD

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