A weighty debate

The first debate at ICE/ECE 2012 - This house believes that metabolic (bariatric) surgery should be offered to every diabetic with a BMI over 30 - was sure to spark some interesting discussion.

With the global type 2 diabetes burden at epidemic proportions, and growing, the need for a safe and effective way of addressing the main contributing factor – obesity – is vast. Bariatric surgery is a radical but effective treatment that has the surprising effect of curing diabetes in 90-95% of patients who maintain the weight loss. Should it therefore be offered to all obese type 2 diabetes patients?

At the outset of the debate the audience voted overwhelmingly ‘no’ (83%). Arguing for the motion was Geltrude Mingrone, M.D. (Rome, Italy), who pointed to the three randomised controlled trials on bariatric surgery as a demonstration of the supremacy of bariatric surgery in effecting remission of diabetes. Edoardo Mannucci, M.D. (Florence, Italy), used the same three studies to demonstrate the comparative lack of research conducted on bariatric surgery in comparison to that required for approval of any drug, likening the current evidence base to that of a phase IIa trial.

The audience asked how the protagonists thought patients might vote, how an appropriate control for the surgery would be constituted, and how one could resource wide-scale provision of the surgery. Interestingly the final vote was almost exactly 50/50: clearly it is an area for further discussion.

Debate 1: This house believes that metabolic (bariatric) surgery should be offered to every diabetic with a BMI over 30, took place in the Main Hall at ICE/ECE 2012, 11:30-12:30, Sunday 6 May 2012, Florence, Italy. The Chair was Professor Valdis Pirags (Latvia).