Surgery as an Effective Early Intervention for Diabesity

We are currently in the midst of two closely linked epidemics: type 2 diabetes and obesity (1,2). At the present time, it is estimated that 190 million people worldwide have diabetes and that this will increase to 324 million by 2025 (3). This epidemic is taking place in both developed and developing nations. In the U.S. alone, at least 16 million people have type 2 diabetes, with 1 million more diagnosed annually (4). Obesity is also increasing at alarming rates. In the U.S., the majority diagnosed with type 2 diabetes are overweight, with 50% obese (i.e., BMI >30 kg/m2) and 9% morbidly obese (BMI >40 kg/m2) (5).There is a strong relationship between obesity and type 2 diabetes, and the term “diabesity” has been coined to suggest a single problem (6,7). A substantial portion of the health costs attributed to obesity is related to type 2 diabetes (8). The socioeconomic impact of type 2 diabetes and its complications are substantial to individuals and their families and to society (9). In particular, it is an inexorably progressive disease, leading to deterioration in multiple organs and systems, and is the most common cause of adult blindness, limb amputations, and renal failure in western communities, as well as the leading independent risk factor for coronary artery disease (10).Prevention of this diabesity epidemic through effective public health lifestyle and environmental initiatives to change the population’s dietary and movement behaviors should be of highest priority (2). For those already suffering from diabesity, effective treatment is important. A therapy that provides remission of both diabetes and obesity should attract enormous interest and activity.Theoretically, weight loss is such a therapy (11,12). However, although intentional weight loss through diet and exercise is associated with better control, …