Is metabolic surgery safe in a 44-year-old with diabetes?

Question

Hello doctor,

I am 44, obese with a body mass index (BMI) of 40, and honestly, I feel stuck. My blood pressure is constantly high, even though I am on medication, and my blood sugar levels are out of control; my fasting glucose is around 220 most days. I have tried diet after diet, but I just cannot seem to keep the weight off or bring my sugar down. My general practitioner mentioned metabolic surgery as an option now. I am nervous, to be honest. Is surgery worth the risks at this point?

I have heard it can improve diabetes, but is that effect permanent or only temporary? I am also concerned about possible complications because I already feel fatigued most days. Can this surgery help with both blood pressure and blood sugar? How long does the recovery take? And what happens if it does not work? Do people end up gaining the weight back? Would you like a summary of the types of metabolic surgery and how each one affects diabetes and hypertension?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

As you mentioned, your body mass index (BMI) is 40, which falls into class III obesity. Combined with uncontrolled type 2 diabetes mellitus and hypertension, this makes you a strong candidate for bariatric (weight loss) or metabolic surgery. In such cases, the risk of not opting for surgery, such as continued progression of diabetes, cardiovascular disease, or kidney damage, can outweigh the risks of surgery itself, especially when medications and lifestyle changes have not been effective. Metabolic surgery can significantly improve both blood sugar and hypertension, depending on the type of surgical procedure performed. Approximately 60 to 70 % of patients experience remission of diabetes and high blood pressure (hypertension) following surgery.

There are different types of bariatric surgeries. One is sleeve gastrectomy, where up to 80 % of the stomach is removed. This procedure is very effective for weight loss and improvement in diabetes. Another option is Roux-en-Y gastric bypass (RYGB), which creates a small stomach pouch and reroutes the small intestine to bypass part of the stomach and duodenum. This is considered the most effective for type 2 diabetes mellitus remission. A third option is the mini gastric bypass, also called the one anastomosis gastric bypass, which involves a shorter surgery and fewer complications while still being effective for weight loss and diabetes improvement.

Adjustable gastric banding is another surgical approach, but it has a high rate of long-term complications and reoperations. Biliopancreatic diversion with duodenal switch (BPD-DS) offers the highest weight loss and diabetes remission rates but also carries the highest risk of malnutrition. It requires lifelong strict vitamin and protein supplementation. Potential complications of these procedures include bleeding, infections, and anastomotic leakage (leak at the surgical connection point). The typical recovery period involves a hospital stay of about one to three days, and most patients can return to full activity within four to six weeks. Patients follow a structured eating plan, beginning with liquids, then soft foods, and eventually transitioning to regular meals over several weeks.

Most patients lose 60 to 80 percent of their excess weight and maintain long-term improvements in blood sugar levels and blood pressure. However, commitment to regular follow-up, nutritional counseling, and potentially lifelong vitamin supplementation is essential. For more information and personalized advice, you should consult a bariatric surgeon who can help determine the best surgical option for you. I hope I have answered your query. If you have more questions or need further clarification, feel free to reach out anytime. I would also appreciate your valuable positive feedback.

I hope this helps.

Thank you.