All had a BMI between 30 and 39.9, with an average of 34.3 in the medical management group and 34.9 in the surgery group. They also all had type 2 diabetes.
A year later, 28 people from the surgery group and 11 people from the medical management group met the study's goals. These goals were to have an HbA1C level of below 7 percent (a measure that indicates good blood sugar control); LDL or "bad" cholesterol of less than 100 milligrams per deciliter; and systolic blood pressure (the top number) of less than 130.
Overall, those in the surgical group needed three fewer medications. They also lost significantly more of their initial body weight -- about 26 percent for the surgical group compared with 8 percent for the medical management group, the study found.
However, there were 22 serious adverse events in the surgical group compared with 15 in the medical management group. And, one person in the surgical group had a number of complications that eventually led to brain damage, which will likely be permanent.
"The risk of these surgeries is fundamentally low, but we can't make it zero. Most of the complications can be managed. But, disasters can occur, and if you're that one, any benefit of surgery is lost," Wolfe said.
Cost is another issue. A weight-loss surgery may cost $20,000 and up, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. And, insurance may or may not pay for the procedure, as there isn't yet clear evidence of a long-term benefit for people who are less obese.
"There are a whole host of contributing factors to consider. At some point, the surgery will be identified to work best in some and not so well in others. We understand this in cancer treatment, and we want to be able to do the same thing with weight loss surgery, and this is a part of the process to get there," Wolfe said.
So, what should folks with lower-level obesity and type 2 diabetes do? Wolfe said to start with making a concerted effort to lose weight and exercise regularly, and to make sure you use any diabetes medications prescribed for you exactly as your physician directs you to.
"If this doesn't work, consider surgery. If you have risk factors, like diabetes, you can appeal a negative insurance decision and ask for an exception," he suggested.
Maggard-Gibbons also suggested talking to your doctor or a bariatric surgeon about the possibility of enrolling in a clinical trial.
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Learn more about weight-loss surgery from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.
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