Weight-loss surgery significantly reduces the risk of heart problems in obese teens with type 2 diabetes, a new study finds.
Teens who have the surgery can see their long-term risk for heart attack, congestive heart failure, stroke and coronary death lowered nearly threefold, compared with obese teens whose diabetes is medically managed, researchers say.
"The mitigation in risk does not seem to be completely activated or ascribed to weight loss, but largely to the remission of diabetes," said lead researcher Dr. Petter Bjornstad, an assistant professor of pediatric endocrinology at the University of Colorado.
After surgery, patients need to make significant changes in diet and lifestyle, he said.
"So even though we're seeing these great results, I think it's really important to acknowledge that this is a huge commitment, and it's not an easy fix," Bjornstad said.
The surgery itself is relatively safe and in the hands of an experienced surgeon results in few complications, though bleeding and damage to nearby organs is possible, Bjornstad said.
After surgery, patients are closely monitored to make sure they are getting enough nutrients and vitamins. They typically have a short hospital stay, but recovery continues at home for months as patients get used to their new diet and psychological adjustments, he said.
"If you're not prepared for these changes, that can be pretty stressful mentally," Bjornstad said. "That's part of this huge commitment that you need to prepare for before surgery and have really good follow-up after surgery, and that's why we encourage a multidisciplinary approach to try to mitigate these risks."
For the study, Bjornstad's team compared the odds for cardiovascular disease over five years in two groups of teens with type 2 diabetes. One group of 30 had weight-loss surgery; the other 63 teens did not.
While teens who had surgery saw their long-term risk for heart disease fall, those who didn't have surgery saw their risk rise. Researchers used a formula to calculate risk over 30 years.
Bjornstad said that obesity and type 2 diabetes are complex conditions in teens, and genetics and family history can play important roles. Weight-loss surgery is not a cosmetic procedure but one designed to improve health and help people live a long, productive life, he said.
"I think maybe people don't appreciate that -- this surgery is so much more than weight loss," Bjornstad said.
His team attributed the lower risk for heart disease after weight-loss surgery to lower blood sugar levels, lower weight, lower blood pressure and higher levels of good cholesterol (HDL).
Treatment of obesity is far more complex than eating less and exercising more, according to Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, who reviewed the findings.
"It is time for physicians, insurers and the general public to rethink the treatment of obesity and diabetes," he said.
Roslin said teens treated with weight-loss surgery not only have a lifetime reduction in the risk of heart disease, but previous studies have also shown that they do better in school, have improved emotional health and higher incomes when they enter the workforce.
He said many severely obese teens face prejudice, bullying and are then denied the best treatment for their condition.
"We can do better, and barriers for surgical intervention placed by insurers need to be removed," Roslin said.
The findings were published recently in the journal Surgery for Obesity and Related Diseases.
To learn more about weight loss surgery, visit the American Society of Metabolic and Bariatric Surgery.
SOURCES: Petter Bjornstad, MD, assistant professor, pediatric endocrinology, University of Colorado, Aurora; Mitchell Roslin, MD, chief, obesity surgery, Lenox Hill Hospital, New York City; Surgery for Obesity and Related Diseases, Sept. 8, 2020