A JAMA Surgery article confirms that metabolic bariatric surgery (MBS) is more effective than medication for the treatment of type II diabetes and obesity in people with a BMI of less than 35. A 5-year study showed a 96.2% effectiveness rate in the surgical group compared to 83.6% in the medication group, and a 5-year follow-up confirmed the long-lasting efficacy of surgery in the treatment of diabetes and obesity. Moreover, bypass surgery is more effective for type 2 diabetes (46.9% for bariatric surgery and 16.7% for sleeve gastrectomy); the two surgeries have similar results for obesity. Dr. Blackstone, a member of the American Obesity Society, was invited to comment on the future of metabolic bariatric surgery. He argued that a prospective study from 3 years ago showed similar results, with MBS surgery having similar efficacy in alleviating diabetes and obesity. A 6- and 20-year follow-up of patients with a BMI over 35 showed MBS surgery to be similar in terms of durability. Likewise, MBS surgery is just as effective for other metabolic syndromes, and improving quality of life through bariatric surgery is not an ineffective intervention. The question now is: should metabolic bariatric surgery be replicated on a larger scale? There are many difficulties in promoting it; the cost of the procedure, the complication profile, the lack of bariatric surgery professionals, the lack of financial reimbursement, the problem of weight regain, and the bias of clinicians and patients against the procedure all remain to be addressed. It is difficult to change these issues in a short period of time. But based on the fact that the number of patients will increase in the future, finding an effective solution is imminent. Above: gastric bypass surgery In addition to surgery, many people use behavioral therapy. This method is easily accepted by patients, but it is not effective and is prone to rebound. This is because weight rebound is related to the genes of obesity patients. Otherwise, it would be impossible to explain why some people always need to diet to lose weight while other similar people are always so thin! ABOVE: Sleeve Gastrectomy The medical community now has a two-pronged approach to improving both patient behavior and the effectiveness of medications. The authors believe that efforts to reverse obesity should be neither limited in scope nor scale, with further expansion of the various modalities of treatment, and that other solutions need to be sought and tested as well. This is because long-term solutions to obesity are yet to be discovered. In patients with obesity-induced type 2 diabetes, lowering body weight can provide glycemic relief. However, for diabetics with a BMI of 27.5-32, weight loss alone will not achieve good glycemic effects, and surgical remodeling of the gastric structure is still needed to reduce weight and improve the microbiota, which can achieve significant glycemic effects. Some people may ask: If gastric bypass surgery can modify the structure of the stomach, why can’t type 2 diabetic patients with normal weight undergo the surgery? The reason is that this surgery will make the patient’s weight drop significantly, if in order to treat diabetes instead of malnutrition, will not it be more than worth it? If the patient’s quality of life does not improve after the surgery, then such a surgery might as well not be done.