PICO Question: Bariatric Surgery As the obesity rate continues to be an issue of great concern in America, the question arises as to the best ways to reduce the BMIs of individuals already suffering from the condition, as well as how to enact preventative means. Although the ideal is for people to never become obese at all, the fact remains that there is a need to develop proactive measures to facilitate weight reduction. For most patients, modifications in diet and exercise is recommended but, as even people who have attempted casual weight loss know, deploying such techniques in an effective and consistent fashion is far easier said than done.

PICO Question

The PICO question for the purpose of this study is, from the perspective of a family nurse practitioner, when treating patients with type 2 diabetes and obesity, can bariatric surgery be more effective than standard medical therapy at increasing the probability of remission of diabetes? The patient population in question is obese females with type 2 diabetes, the intervention is bariatric surgery (or other types of weight loss surgery), the current standard medical care is that of diet and exercise, the desired outcome is weight loss and diabetes management. Surgical intervention always poses at least some risk to patients and is not something to be undertaken lightly, hence the significance of this question to nursing, particularly for practitioners who are dealing with an increasingly large population of patients suffering from obesity-related conditions.

Systematic Review One: The Benefits of Surgical Intervention

According to a systematic review of 7 randomized control trials (RCTs) involving bariatric patients conducted by Colquitt (et al. 2014), all studies found benefits for surgery in terms of weight loss combined with non-surgical control groups. Improvements included health-related quality of life outcomes and control of...

No deaths occurred during any of the studies and serious adverse events ranged from 0-37% in the group which experienced the surgical intervention versus 0-25% in the groups which eschewed surgical intervention. This was deemed to be a statistically significant difference. Across the studies which kept track of such data, 2%- 13% of participants required reoperations. The authors noted, however, that adverse effects across all of the studies were poorly reported in general. Most studies only followed up with patients for a year or two. Three of the studies found gastric bypass to foster greater weight loss versus with laparoscopic adjustable gastric banding, suggesting the more intensive intervention was beneficial for patients.
Overall, the authors concluded, based upon the study, that for patients that meet current criteria regarding the BMI for bariatric surgery, the surgery fosters more positive health outcomes than dieting and exercise alone. There was limited data on patients whose body mass indexes fell outside of such criteria, though. The authors concluded that recommending a bariatric intervention would be warranted, weighing the potential risk factors against the benefits of both weight loss and quality of life improvement but also cautioned that the quality of evidence within all the RCTs was relatively weak. It should also be noted that although the focus of the PICO study is upon female obese patients with diabetes, the Colquitt (et al. 2014) study focused upon both male and female patients in the randomized control studies chronicled in the review.

Systematic Review Two: Surgical Intervention for Younger Patients

Surgical intervention is often only prescribed for older patients, after other options for weight loss have been repeatedly exercised. But there is an argument for earlier intervention, given the extent to which diet and exercise habits are established earlier in…