Bariatric Surgery: Effects on the Metabolic Complications of Obesity

Bariatric surgery is increasing at an enormous rate in all countries but the indications for the operation on the basis of metabolic derangements are not clear, as only one controlled randomized trial specifically for a comorbidity has been performed. Thus, it is not clear if bariatric surgery should be offered to all obese patients with long standing type 2 diabetes or poorly controlled hypertension or hypertriglyceridemia, even though these conditions clearly respond in most patients to bariatric surgery and weight loss. It would appear that patients with early type 2 diabetes with reasonable control and a greater body mass index gain more benefit from the operation. More randomized trials are required.