Obesity: Surgical treatment of diabetes mellitus type 2

Martin Fried
Professor of Surgery, Charles University, Head of OB Klinika – Center for Treatment of Obesity and Metabolic Disorders, Prague, Czech Republic

The modern world faces the obesity as a serious crisis that has an epidemic character. Obesity negatively and significantly affects general health of population worldwide. Obesity is considered to be a strong risk factor for developing type 2 DM, and prevalence of diabetes is rising tremendously all over the world.

However obesity is considered to represent substantial risk factor for increased prevalence and development of several other health affecting conditions which shorten life expectancy by ten and more years when compared to lifespan of non-obese population of the same age group.

Obesity and type 2 DM is associated and increases risk of deteriorating conditions and diseases, such as micro and macrovascular complications, changes in serum lipids, and systemic inflammation. Obesity is associated with increased risk of chronic kidney disease. Obesity leads to hypertension and increased weight negatively affects the entire cardiovascular system.

Some sixty years ago, in the beginning of history of bariatric surgery, the only indication criterion for operation was basically the sole criterion of weight loss.

On the turn of this Century the possibility of treating some obesity-related metabolic diseases occurred, and metabolic surgery gradually gained substantial importance.

The most important indication criterion for metabolic operations became the ultimate goal to improve and/or resolve obesity related co-morbidities, such as Type 2 Diabetes Mellitus. Thus the criterion of successful treatment shifted from assessing the amount weight loss as criterion of success towards consideration of improvement or resolution of metabolic parameters success factor regardless impact of surgery on body mass index and weight changes.

In conjunction with importance of metabolic surgery, more emphasis is given to the effort to improve surgical technical equipment in order to lower the invasivity of so far available minimally invasive/laparoscopic approaches and operations as well, as to introduce anatomically less invasive, digestive tract sparing/reversible surgeries.