Bariatric, metabolic, and diabetes surgery: what's in a name?

Ann Surg. 2014 Jan;259(1):117-22. doi: 10.1097/SLA.0b013e3182759656.


Objective: This study investigated the practical clinical consequences of offering surgery for metabolic disease and diabetes as opposed to weight loss.

Background: The terms "metabolic" and "diabetes surgery" indicate a surgical approach whose primary intent is the control of metabolic alterations/hyperglycemia in contrast to "bariatric surgery," conceived as a mere weight-reduction therapy.

Methods: A "metabolic surgery" program distinct from the "bariatric surgery" program was recently established at a tertiary US academic medical center. The 2 programs differ in their stated goals but offer the same procedures and use identical eligibility criteria for patients with morbid obesity. Demographics, clinical characteristics, and 30-day postoperative morbidity and mortality were assessed from a prospective database of 200 consecutive patients who underwent surgery at these units.

Results: Metabolic surgery patients were older (45.8±13.4 v 41.8±11.7, P<0.05), had a lower body mass index (42.4±7.1 vs 48.6±9.5 kg/m; P<0.01), and a higher prevalence of being of the male sex (42% vs 26%, P<0.05), having diabetes (62% vs 35%; P<0.01), hypertension (68% vs 52%; P<0.05), dyslipidemia (48% vs 31%; P<0.05), and cardiovascular disease (14% vs 5%; P<0.05). Diabetes was more severe among metabolic surgery patients (higher glycated hemoglobin levels; greater percentage of insulin use). There was no mortality, and there were no differences in perioperative complications.

Conclusions: Offering surgery to treat metabolic disease or diabetes rather than as a mere weight-reduction therapy changes demographical and clinical characteristics of surgical candidates. This has important and practical ramifications for clinical care and support consideration of metabolic/diabetes surgery as a novel practice distinct from traditional bariatric surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Bariatric Surgery*
  • Comorbidity
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / surgery*
  • Female
  • Humans
  • Male
  • Metabolic Diseases / epidemiology
  • Metabolic Diseases / surgery*
  • Middle Aged
  • Names
  • Obesity / epidemiology
  • Obesity / surgery*