There have been multiple studies comparing “lifestyle” interventions to bariatric surgery in treating obesity and diabetes. Repeatedly the authors conclude that bariatric surgery is superior to “lifestyle” interventions.
But none of these studies have utilized very low carbohydrate diets or medically supervised fasting as a lifestyle intervention. Instead, the diets employed for the “lifestyle” intervention are typically an ADA calorie restricted low-fat diet. I find this very frustrating as a physician.
The science in this area has demonstrated that very low carbohydrate diets consistently out-perform the low fat calorie restricted diet in terms of weight loss, blood sugar control, blood pressure control and lipid profiles.
Bariatric surgery carries a mortality rate of up to 3% depending on the surgeon, hospital and other circumstances. As an anesthesiologist and pain management physician I have seen multiple complications of bariatric surgery including but not limited to multiple chronic nutritional deficiencies (malabsorption), hernias, sepsis, renal failure, rhabdomyalisis, respiratory failure requiring prolonged ventilation, multi-organ failure requiring prolonged ICU care, and death.
And although many patients have profound weight loss in the first year after bariatric surgery many patients ultimately gain back most of the weight initially lost.
We need studies that compare bariatric surgery to very low carbohydrate and paleo diets. We need studies that compare bariatric surgery to intermittent medically supervised fasting. Until those studies are performed we should not conclude that bariatric surgery is superior to lifestyle interventions, particularly given the high complication rates of this surgery and the proven effects of VLC diets and medically supervised fasting.
Here are links to videos that discuss this topic.
They are all worth watching.
I have previously discussed the issue of carbohydrate restriction, diabetes and obesity with multiple scientific references provided in previous posts.
Bob Hansen MD