Objective: This study investigated the practical clinical consequences of offering surgery for metabolic disease and diabetes as opposed to weight loss. Background: The terms “metabolic” and “diabetes surgery” indicate a surgical approach whose primary intent is the control of metabolic alterations/hyperglycemia in contrast to “bariatric surgery,” conceived as a mere weight-reduction therapy. Methods: A “metabolic surgery” program distinct from the “bariatric surgery” program was recently established at a tertiary US academic medical center. The 2 programs differ in their stated goals but offer the same procedures and use identical eligibility criteria for patients with morbid obesity. Demographics, clinical characteristics, and 30-day postoperative morbidity and mortality were assessed from a prospective database of 200 consecutive patients who underwent surgery at these units. Results: Metabolic surgery patients were older (45.8 ± 13.4 v 41.8 ± 11.7, P < 0.05), had a lower body mass index (42.4 ± 7.1 vs 48.6 ± 9.5 kg/m²; P < 0.01), and a higher prevalence of being of the male sex (42% vs 26%, P < 0.05), having diabetes (62% vs 35%; P < 0.01), hypertension (68% vs 52%; P < 0.05), dyslipidemia (48% vs 31%; P < 0.05), and cardiovascular disease (14% vs 5%; P < 0.05). Diabetes was more severe among metabolic surgery patients (higher glycated hemoglobin levels; greater percentage of insulin use). There was no mortality, and there were no differences in perioperative complications. Conclusions: Offering surgery to treat metabolic disease or diabetes rather than as a mere weight-reduction therapy changes demographical and clinical characteristics of surgical candidates. This has important and practical ramifications for clinical care and support consideration of metabolic/diabetes surgery as a novel practice distinct from traditional bariatric surgery.

Objective To elucidate the specific role of gastric vs. intestinal manipulations in the regulation of body weight and glucose homeostasis. Design and Methods The effects of intestinal bypass alone (duodenal-jejunal bypass -DJB) and gastric resection alone (SG) in Zucker Diabetic Fatty (ZDF) rats were compared. Additional animals underwent a combination procedure (SG + DJB). Outcome measures included changes in weight, food intake (FI), oral glucose tolerance (GT) and gut hormones. Results DJB did not substantially affect weight and FI, whereas SG significantly reduced weight gain and food consumption. DJB rats showed weight-independent improvement in GT, which improved less after SG. Furthermore, SG significantly suppressed plasma ghrelin and increased insulin, glucagon like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide and peptide YY response to oral glucose whereas DJB had no effects on postprandial levels of these hormones. DJB restored postprandial glucagon suppression in diabetic rats whereas SG did not affect glucagon response. The combination procedure (SG + DJB) induced greater weight loss and better GT than SG alone without reducing food intake further. Conclusions These findings reveal a dominant role of the stomach in the regulation of body weight and incretin response to oral glucose whereas intestinal bypass primarily affects glucose homeostasis by a weight-, insulin- and incretin-independent mechanism

Soo Min Ahn. JOMES 1999;0:. https://doi.org/10.7570/jomes19073

Background: On November 25, 2021, the IFSO-Asia–Pacific Chapter (IFSO-APC) Virtual Meeting 2021 was held online, and the representatives from the Asia–Pacific region presented 10 years of change in bariatric/metabolic surgery and the influence of COVID-19 in the special session of “IFSO-APC National Reports 2010–2020”. We herein report the summarized data. Methods: National bariatric/metabolic surgery data, which included the data of 2010 and 2020, were collected from the representatives using a questionnaire that consisted of 10 general questions. At the congress, the data were calculated and summarized. Results: Thirteen of the 14 national societies responded to the survey. From 2010 to recent years, the populations of individuals with obesity (BMI ≥ 30 kg/m²) and individuals with diabetes both significantly increased. Eight countries and regions expanded the lower limit of criteria for bariatric surgery by 2–5 kg/m² (BMI), and 5 countries newly established criteria for metabolic surgery in the last ten years. Sixty-nine percent of the countries currently run public health insurance systems, which doubled from 2010. The number of bariatric surgeons and institutions increased more than threefold from 2010. In 2010, 2019, and 2020, surgeons in IFSO-APC societies performed 18,280, 66,010, and 49,553 bariatric/metabolic surgeries, respectively. Due to the COVID pandemic, restriction policies significantly reduced access to surgery in South and Southeast Asian countries. The biggest changes included increased numbers of bariatric surgeons and institutions, operation numbers, public insurance coverage, raising awareness, and national registry systems. Conclusion: For the last 10 years, bariatric/metabolic surgery has rapidly grown in the Asia–Pacific region.

Lee HK, et al. Yonsei Med J. 2003 Dec;44(6):1040-1044. http://dx.doi.org/10.3349/ymj.2003.44.6.1040