Weight loss surgery (bariatric surgery) might not be the preferred way to reduce diabetes, but it's emerging as one of the most effective.
Surgeries like a gastric bypass or gastric banding could reduce the risk of developing type 2 diabetes by around 80 per cent in obese people, compared with standard care, according to new research published in The Lancet Diabetes & Endocrinology journal.
"Our results suggest that bariatric surgery may be a highly effective method of preventing the onset of new diabetes in men and women with severe obesity," says study author Professor Martin Gulliford of King's College London.
Other studies have shown bariatric surgery to reverse diabetes in some cases, sending it into remission in half to two-thirds of diabetic patients who have the procedure.
Though it's still not known how long these effects last, evidence for the case of surgical intervention is mounting.
Like most working in this field, Gulliford would prefer to see changes in people's environment so they don't become obese in the first place, but the problem is here and it needs addressing.
"Unfortunately, we are now faced with a situation in which about one quarter of adults are obese and one in 50 have morbid obesity (BMI over 40)," he told Fairfax from London.
Being overweight or obese is the main modifiable risk factor for type 2 diabetes.
"For people with morbid obesity, weight loss surgery may relieve or prevent some of their health problems. Over a 20-year perspective, the procedures are cost-effective."
MORE SURGERIES THE ANSWER?
So, does this mean weight loss surgery should be used more widely as an intervention for morbid obesity?
Gulliford is keen to know more, especially how weight loss surgery might be combined with other interventions, such as healthy eating and physical activity, as part of a diabetes prevention strategy.
But not everyone sees surgery as part of the answer. AUT professor of nutrition Elaine Rush says public dollars would be better spent on prevention rather than treatment.
"Long-term, prevention will give us the biggest bang for our buck compared with the 'ambulance at the bottom of the cliff' response."
Rush is all for bariatric surgery on an individual level, but says on a population level "we can't afford it".
"When you look at the cost-effectiveness of bariatric surgery, it's an enormous amount of money that has to be invested. But if you look at early childhood interventions, it costs much less for a longer-term outcome."
PUBLICLY-FUNDED OPTIONS FOR KIWIS
Funding for weight loss surgeries in New Zealand has already increased over the past four years, and with that, so have the number of procedures performed.
In the 2013/2014 year 399 publicly funded bariatric procedures were performed, compared with 131 procedures in 2007/2008.
With this year's budget it was announced $10 million would be set aside to fund at least 480 surgeries over the next four years, in addition to the bariatric procedures already funded out of DHB elective surgery budgets.
Different types of bariatric surgeries have their own pros and cons. Some not only restrict food intake by creating a very small stomach pouch for food to go into, but also have metabolic effects to combat diabetes.
According to Dr Jeremy Krebs, endocrinologist and a leading voice for diabetes in New Zealand, for some people surgery is the only option.
"There is unquestionably a place for bariatric surgery in the management of obesity, particularly for those individuals who have already developed either pre-diabetes or diabetes."
He says lifestyle interventions such as diet and lifestyle changes are obviously the preferred approach, and in the case of pre-diabetes can reduce the progression to diabetes by as much as 70 per cent.
"But for many individuals, achieving the sustained lifestyle changes they need, is extremely difficult."
He says a multi-factorial approach is needed. "Simply doing it with personal responsibility and education is not going to work. It's going to require a regulatory environment, which is able to change the food environment we live in. And unless that happens we're not going to win the battle."
He says bariatric surgery has a place among a host of other factors in managing obesity at large.
While procedures are on the increase both publicly and privately, Krebs says strict criteria means that those who could benefit from surgery don't always make the cut.
"I think there is definitely room for an increase in the number of operations being performed here. I think there's scope for these surgeries to grow – there is a clinical need out there."