title: Bariatric, metabolic, and diabetes surgery: what's in a name?
abstract: 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.
authors: *Section of GI Metabolic Surgery, Department of Surgery †Section of Laparoscopic and Bariatric Surgery, Weill Cornell Medical College New York-Presbyterian Hospital, New York, NY; and ‡Catholic University of Rome, Italy.
authors: Francesco
authors: F
authors: Rubino
authors: Alpana
authors: A
authors: Shukla
authors: Alfons
authors: A
authors: Pomp
authors: Marlus
authors: M
authors: Moreira
authors: Soo Min
authors: SM
authors: Ahn
authors: Gregory
authors: G
authors: Dakin
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D009275:Names; D009765:Obesity / Q000453:epidemiology / Q000601:surgery*