IN DEPTH: The great metabolic surgery debate

You know the scenario. Your patient is obese and has been for as long as you can remember. It’s a futile treadmill of diet and exercise, stacking on weight and the associated morbidities.

Almost inevitably there’s a diagnosis of type 2 diabetes mellitus (T2DM). Year by year, the weight climbs and the diabetes becomes increasingly complex and expensive to manage pharmacologically.

It’s controversial. But there is growing support for surgery as a first-line intervention for severely obese patients with T2DM, even if they have good glycaemic control, and for considering surgery in any obese patient with