Tackling diabetes with weight loss surgery

21 February 2023

Tackling diabetes with weight loss surgery

This is music to a Bariatric Surgeon's ears!! It is definitely good to hear people talking about the issues related to Obesity.  And, yes, prevention has not been taken seriously as yet.  It is an issue that needs a concerted effort on the part of regulators and politicians and health care providers alike.  Our society is obesogenic and the messages that come through to us in our everyday life promote overeating and sedentary activities as the norm.  This is going to be a very difficult process to reverse.  The good news is that Bariatric Surgery is an effective treatment for Type 2 Diabetes and the other metabolic consequences of being obese.  This is now accepted by both Surgeons and Medical Physicians such as Dr Jeremy Krebs as quoted in the article below.  I personally think that this is a step in the right direction and that Weight loss surgery can be the turning point for lots of people who have lost the battle with their BMI.  If you want more information, please drop me a note through the website. Happy holidays! 

Steph Ulmer 

Bariatric Surgeon

Weight loss surgeries in New Zealand are on the rise, along with increased funding for the procedures.

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."


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."


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."

Families with better communication improve their children's eating habits

21 February 2023

Families with better communication improve their children's eating habits

Hi All,

Would you have thought that it was that important to eat dinner together if you want to influence you children's body weight?  Well, it looks like it is a big factor and it assists with improving your children's healthy eating habits.  I suppose it makes sense though as a lot of a child's behavior is directly attributable to copying what they have watched their parents doing.  Make healthy eating and positive comments about food a usual part of your family communication and that will pay dividends for your children.  Give it a go!

Kind regards,




Less family discouragement and better family communication is associated with a higher likelihood to eat evening family meals and family breakfasts together, and not in front of a television, according to the paper, ‘Family Meal Practices and Weight Talk Between Adult Weight Management and Weight Loss Surgery Patients and Their Children’, published in the Journal of Nutrition Education and Behavior.

Researchers studied 259 parents who were also patients at either The Ohio State University or Wake Forest University accredited weight management programmes (n=101, WMPs) and bariatric surgery (n=158, weight loss surgery, WLS) and their children (aged 2–18 years), and identify predictors associated with specific family meal practices and weight talk among patients. This is the first study specifically looking at family meal practices among adult patients enrolled in weight-management or weight-loss surgery programmes.

They found that patients had increased odds of engaging in family dinners if they reported lower family discouragement (p=0.003) and had younger children (p<0.001), and increased odds of engaging in family breakfast if they had higher family communication ( p=0.002) and younger children (p=0.020).

"It's important to note all family members in the home have influence," said lead study author, Dr Keeley J Pratt, The Ohio State University, Columbus, OH, USA, said of the findings that any family member can influence the adoption and maintenance of healthy patterns and behaviours in the home. "Even if someone doesn't have the most power to influence the family (like children), they are all influencing each other."

Previous research has shown parental obesity is typically the strongest risk factor for children to have an obese weight status over time. The study's authors also found parents who perceived their child to be overweight or obese were more than four times as likely to talk to them about the child's weight, also called ‘weight talk’.

While open communication with children about health is beneficial, "it's important to ensure communication directly about children's weight is not harmful in their development of a healthy body image and behaviours. That includes older children and adolescents who are at greater risk of developing eating disorders and disordered eating behaviours," added Pratt.

There was no significant difference between male and female children in this study other than families with female children were more likely to eat dinner together without a television five to seven times a week. Families with younger children, regardless of gender, were more likely to eat family dinners and breakfasts together, and parents of older children were more likely to talk about their own weight with the child.

The paper concluded that “additional research assessing the family meal practices and weight talk in the families of adults pursuing weight loss could yield important evidence that could lead to improved patient outcomes, and safely promote healthy behaviours and prevention of obesity in children.”

"Understanding these associations will provide essential evidence needed to design future family-based interventions for these patients to help in their behaviour change and weight loss, prevent the onset of obesity in children, and enhance positive family meal practices and healthy communication about weight," Professor Pratt said.

Weight loss surgery slashes mortality rate.

7 February 2023

Weight loss surgery slashes mortality rate.

Hi again,

If you are wondering if Bariatric surgery is right for you, then, keep reading!  This pooled data study includes good quality studies that have been meticulously analysed.  This inclusion process culminated in 18 studies being assessed, with data from a total of 1.5 million patients.  It showed that patients who had weight loss surgery (including gastric bypass/sleeve/band/BPD) were 38% less likely to die from any cause (heart attack, stroke, cancer etc) compared with a matched group of people who hadn't had bariatric surgery.  What an astounding result!  Not only that, but the list of other medical benefits of having weight loss surgery is long - see below.  Obviously bariatric surgery is not a magic bullet on its own, and operating on people who are not prepared for the lifestyle changes that it brings about, will not do well in the longterm.  However, governments should take notice of this type of research and facilitate surgery for those who need and want an operation.  I'm sure you agree..!  Happy New Year and lets talk soon!

Kind regards




A pooled analysis of large-scale registry studies by UK researchers suggests that bariatric surgery is associated with reduced long-term all-cause mortality and incidence of obesity-related diseases (new-onset diabetes, high blood pressure, high cholesterol and heart disease etc) in patients with obesity for the whole operated population. The outcomes highlight that broader (increased) access to bariatric surgery for people with obesity may reduce the long-term sequelae of this disease and provide population-level benefits.

For the study, ‘Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: A systematic review and meta-analysis’, published in Plos Medicine, the researchers performed a systematic literature search and found 18 studies suitable for inclusion encompassing some 1,539,904 patients with 269,818 receiving bariatric surgery and 1,270,086 control patients.

The types of surgery were gastric bypass (n=137,578, 51%), sleeve gastrectomy (n=58,916, 22%), adjustable gastric band (n= 52,973, 20%), vertical banded gastroplasty (n=6,397, 2%), biliopancreatic diversion (with or without duodenal switch) (n=1,002, 0.4%) and an alternative procedure or unspecified operation (n=12,952, 5%). Median patient follow-up across all studies was 59 months (range 18 to 144 months).

The authors report that 11 studies found a significant reduction in relative risk of long-term all-cause mortality for patients following bariatric surgery compared to controls with a pooled odds ratios (PORs) of 0.62 (95% CI 0.55 to 0.69, p<0.001). A further three studies reported significantly reduced relative risk of cardiovascular mortality for patients following bariatric surgery vs controls (POR 0.50, 95% CI 0.35 to 0.71, p<0.001).

In addition, the study found:

  • Six studies reporting a reduction in incident T2DM after bariatric surgery vs controls (POR 0.39, 95% CI 0.18 to 0.83, p=0.010)
  • Five studies found that incident hypertension was reduced after bariatric surgery vs controls (POR 0.36, 95% CI 0.32 to 0.40, p<0.001)
  • One study reported incident obstructive sleep apnoea relative to controls (therefore it was not possible to do a pooled analysis) with a reduced rate of new-onset obstructive sleep apnoea in patients undergoing bariatric surgery (new-onset obstructive sleep apnoea rate of 1.1%), vs controls (2.0%) (HR 0.55, 95% CI 0.37–0.82, p=0.004)
  • Two studies reported significantly reduced incident dyslipidaemia following bariatric surgery vs controls (POR 0.33, 95% CI 0.14 to 0.80, p=0.010)
  • Five studies reported significantly reduced incident ischemic heart disease after bariatric surgery vs controls (POR 0.46, 95% CI 0.29 to 0.73, p=0.001)
  • Two studies reported the rate of incident cardiac failure and found no statistically significant protective association with bariatric surgery (POR 0.23, 95% CI 0.05 to 1.10, p=0.066)
  • One study reported incident venous thromboembolism in bariatric surgery patients relative to controls (therefore it was not possible to undertake a pooled analysis), demonstrating a reduced incidence of new-onset venous thromboembolism in bariatric surgery patients (1.7%), vs controls (4.4%) (HR 0.60, 95% CI 0.43 to 0.84, p=0.003)

Adjusted ORs for incident comorbidities revealed the same patterns with reduced incidence of T2DM (POR 0.28, 95% CI 0.11 to 0.73, p=0.009), hypertension (POR 0.32, 95% CI 0.21 to 0.47, p<0.001), ischemic heart disease (POR 0.67, 95% CI 0.49 to 0.90, p=0.009), and cardiac failure (POR 0.43, 95% CI 0.29 to 0.64, p<0.001) in bariatric surgical patients vs controls.

“To our knowledge, this is the first published study of pooled data from population-based studies of incident disease following bariatric surgery. Our results represent real-world data that may be generalisable to routine clinical practice…This meta-analysis of large-scale registry studies indicates that patients receiving bariatric surgery have improved long-term mortality rates compared to controls at a population level,” the authors concluded. “They also have significantly reduced incidence of obesity-related disease including T2DM, hypertension, dyslipidaemia and ischemic heart disease. Healthcare providers may use the data on relative risk reduction as part of the discussion with patients considering bariatric surgery."


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