How Obesity Affects Health
Weight loss surgery isn’t just about shedding kilograms—it’s also highly effective in treating health problems caused by excess weight. Obesity is a known cause or contributing factor to many diseases. Given these risks, it’s no surprise that people with obesity tend to have shorter life spans than those at a healthy weight.
After bariatric surgery, patients typically lose between 45% and 70% of their excess body weight. This weight loss is often long-lasting and leads to major improvements in obesity-related conditions. Unlike traditional treatments—which manage each problem separately (e.g., blood pressure medicines for hypertension, insulin for diabetes, pain relievers for joint pain)—weight loss surgery addresses multiple issues at once by targeting the root cause: excess fat.
The Rising Number of People with Diabetes
Among obesity-related diseases, type 2 diabetes is especially concerning. In the Philippines, an estimated 4.7 million adults were diagnosed with diabetes as of 2024, and that number has been rising since 2003. Both genetics and lifestyle play a role.
Compared to Westerners, many Asians including Filipinos have a lower ability to secrete insulin, the hormone that lowers blood sugar. This puts them at higher risk for diabetes. When a high-fat diet and lack of exercise lead to obesity, the body’s insulin becomes less effective (a condition called insulin resistance), which then triggers diabetes.
Why Diabetes Is Dangerous
Diabetes is defined as a condition where the body doesn’t use insulin properly, leading to chronically high blood sugar. The problem is that high blood sugar alone often causes no obvious symptoms—no pain, no itching. Many people continue working and eating normally, which is why diabetes is sometimes called a “silent killer.”
If left untreated, complications can develop without warning, eventually becoming irreversible.
Complications of Diabetes
Diabetic complications fall into two main categories:
- Microvascular (small blood vessel) damage – This includes:
- Retinopathy (eye damage)
- Nephropathy (kidney damage)
- Neuropathy (nerve damage)
These are known as the three major complications of diabetes.
- Macrovascular (large blood vessel) damage – This includes:
- Ischemic heart disease (angina and heart attack)
- Cerebral infarction (stroke)
- Obstructive arteriosclerosis (hardening of the arteries)
What Good Blood Sugar Control Looks Like
Large-scale studies show that keeping hemoglobin A1c, a measure of average blood sugar over 2–3 months below 6.5% helps prevent or slow down these complications.
The standard approach to diabetes involves lifestyle changes (diet and exercise) combined with medications (oral drugs or insulin). However, many patients still struggle to achieve good control.
A 2007 study by the Japan Diabetes Data Management Study Group (JDDM)—which tracks about 75,000 patients across 72 specialized clinics—found that out of 35,404 patients, only 34.1% had their A1c below 6.5% after one year of treatment. That means nearly two-thirds (65.9%) remained at risk for complications. Among severe cases requiring both insulin and oral drugs, only 13.6% reached that target. Despite advances in diabetes drugs, medical treatment alone is often not enough.
How Weight Loss Surgery Helps Diabetes
Bariatric surgery is effective for many obesity-related conditions, but its impact on type 2 diabetes is especially striking. A large international meta-analysis found that among diabetic patients who had surgery:
- 86.0% showed significant improvement
- 76.8% achieved complete remission
Remission means no longer needing diabetes medication, with blood tests returning to normal levels.
How Does Surgery Improve Blood Sugar?
Certain procedures that bypass part of the small intestine—such as Roux-en-Y gastric bypass and sleeve bypass—are particularly effective. In many patients who required high doses of insulin or oral drugs before surgery, blood sugar stabilizes within just a few days after the operation. This happens long before any significant weight loss occurs.
This suggests that bypass surgery has a direct effect on blood sugar control, not just an indirect one through weight loss. The leading theory is that bypass surgery increases the secretion of incretins—hormones that help the pancreas release more insulin.
Our Experience with Filipino and Asian Patients
While the original data comes from Japan, the findings are highly relevant to the Philippines, where many people share similar genetic tendencies toward lower insulin secretion.
In patients with severe type 2 diabetes (those requiring insulin, with a long history of diabetes, or with low insulin production), laparoscopic sleeve bypass surgery produced remarkable results. Before surgery, average A1c was very high at 8.8%, and average fasting blood sugar was 234 mg/dL. Within a few months after surgery, both improved dramatically. Among these patients:
- 91% achieved clinical remission (no longer needing diabetes medication)
- The remaining 9% showed major improvement
Conclusion: A Growing Role for Surgery in Diabetes Care
During the 2nd Diabetes Surgery Summit last 2016, the International Diabetes Organizations recommend bariatric surgery be considered for type 2 diabetes patients with a BMI of 30 or higher (BMI of 27.5 or higher for Asians) who cannot control their condition with medical treatment alone.
Globally, surgery is becoming a more accepted treatment option for diabetes. However, in many parts of Asia—including the Philippines—awareness remains low. Many doctors and patients still view surgery only as a last resort for weight loss, not as a powerful tool for treating diabetes itself.
Because type 2 diabetes in Asians has unique characteristics compared to Westerners, treatment must be done with great care and expertise. More research and patient data from the Philippines are needed. Still, surgical approaches that work with the body’s natural insulin-producing ability are expected to become an important option for Filipino patients in the years ahead.