”Weight loss surgery is an alternative treatment option for diabetes, but physicians need to select patients carefully according to the indications in the 2011 Expert Consensus on Surgery for Diabetes (the Consensus). Physicians should first treat the patient medically, and only choose surgery if they are unable to control their blood sugar or if they determine, on balance, that the risks of surgery are less than the risks posed by diabetes, and only with the patient’s full informed consent. Although this is a medical innovation that has been the main focus of the Cleveland Clinic, I am not optimistic about it. Because it may be “hot” abroad as well, and many new technologies that start with high expectations abroad end up failing. In addition, there are differences in patient diet and education between foreign and domestic patients, e.g., the average BMI of foreign patients with diabetes is much higher than that of domestic patients, while the situation of domestic patients is very different.” A prospective U.S. study in the October 2012 issue of Archives Surg suggests that patients may be at increased risk for substance use (drug use, alcohol use and smoking) after undergoing bariatric surgery. ”One of the intermediate and long-term complications of bariatric surgery is malnutrition and decreased immunity, which may carry an increased risk of lung tumors if the risk of smoking is increased. The organism has its own regulatory mechanisms, and it is difficult to say that the outcome is necessarily good when the east wall is torn down by surgery.” A U.S. study published online Nov. 18, 2012, in Obes Surg showed that adults with severe obesity type 2 diabetes who underwent gastric bypass achieved durable remission in most patients, but about 1 in 3 still relapsed within 5 years of initial remission. Patients should be advised that weight loss surgery alone is not entirely reliable in “curing” diabetes, according to the researchers. ”Because factors associated with the development of diabetes include not only obesity, but also genetics and progressive decline in pancreatic islet beta-cell function, it is possible for patients to remit and relapse after weight loss surgery; just as when human islet transplantation was used to treat diabetes, everyone thought it was a new hope, but five years after receiving islet transplantation, many patients were found to need insulin therapy. Moreover, this new technology has not been widely validated and has invasive and unpredictable long-term complications; in addition, the morphological structure and function of the patient’s stomach cannot be restored after complications arise, unlike drug therapy that can be stopped at any time. Therefore, there is no need to be too enthusiastic and over-hyped about the technique; non-surgical treatment can also regulate the weight and glucose metabolic status of most patients, and surgery can only be an alternative to the ineffectiveness of conservative medical treatment.” The current problem: the selection of patients is not strict Currently, the selection of patients for weight loss surgery in China is somewhat expanded, and some of the selected patients do not meet the body mass index (BMI) criteria for the indication. The “consensus” has clear indications and contraindications, but some hospitals perform surgery as long as the patient is willing, even if the patient has a BMI <28 kg/m2. Of course, some domestic and foreign institutions are trying to give surgery to diabetic patients with low BMI, but it is still only at the research stage. When we have treated some patients who visited us for complications after surgery, it is true that the patient was not given fully informed consent during the preoperative conversation and was only told that it was to treat diabetes, and only when the surgery was done did the patient learn that many other complications would arise. Moreover, the publicity of weight loss surgery on the Internet is too one-sided, which tends to make patients blindly believe in its efficacy and feel that it is once and for all. We have also initiated a clinical study on weight loss surgery and found that it was difficult to enroll patients. The reason is that before enrollment, doctors need to do a new medical treatment on the patients to validate and adjust the protocol that once failed to control the patients' blood glucose to meet the standard, and if the patients' blood glucose meets the standard after receiving the adjusted protocol, they are not recommended for surgery. We have found that many patients can have their blood glucose controlled to appropriate levels after intensive control and careful adjustment of the treatment regimen in the vast majority of cases. There are only a few cases of diabetic patients suitable for surgical treatment in most hospitals in China each year, and if a hospital does hundreds of bariatric surgeries each year it may be necessary to carefully examine whether there is a lax grasp of indications. The "consensus" lists in detail the postoperative complications, including infection, pulmonary embolism, anastomotic fistula, deep vein thrombosis, portal vein injury, and respiratory damage in the near term, and intestinal obstruction (mainly due to intestinal adhesions, intra-abdominal hernia, intussusception, etc.), dumping syndrome, malnutrition (mainly iron deficiency anemia, vitamin deficiency, calcium deficiency, etc., especially women are more vulnerable), etc. In clinical practice, the incidence of some complications even reaches 80-90%. In the case of diabetic patients with low BMI, they are not discharged from insulin or other glucose-lowering drug therapy after weight loss surgery because these patients have inherently poor pancreatic beta-cell function or no significant insulin resistance. Moreover, patients pay a price for undergoing bariatric surgery that is not necessarily better than medical medication, for example: the incidence of intestinal obstruction is 1% to 5% immediately after surgery, and nearly 10% after laparoscopic surgery, and the annual frequency of visits is reported to be >10%; there are also frequent reports in the literature of death from acute complications in certain patients during surgery; because of the severed nerves, most patients develop gastroparesis and eat slightly full Most of the patients will have gastric palsies due to the severed nerve and will show abdominal distension and abdominal pain when they are full; if the patient loses weight too quickly, gallstone disease will occur. Therefore, there is no need for the patient to take such a big risk to undergo surgery if it is not a last resort. Patients’ perseverance: withstand surgery or strictly control diet Bariatric surgery does not depend entirely on weight loss, but is directly related to dietary restrictions, because some patients have normal blood sugar before postoperative weight loss. Then, if the patient endures the surgery with the same perseverance to control the diet, it is expected that similar results can be obtained. It is true that many patients with type 2 diabetes have been seen clinically to be able to achieve blood glucose targets without medication after strict diet and weight control. Although some experts believe that the possible mechanism by which weight loss surgery works is related to gastrointestinal hormones, this is only a hypothesis and there is no definite evidence in humans. Therefore, weight loss surgery may be just another version of starvation therapy, but weight loss surgery is invasive, causes complications, and disrupts normal human physiological mechanisms, causing direct damage to the digestive system. Patients do not really need to go for weight loss surgery if they can make weight loss and control their blood sugar through medical treatment.