Gastric bypass surgery is the cure for people who have Type 2 diabetes, for Type 2 diabetes, the best medicine is weight loss. More than 1.2 billion people in the world are now officially classified as overweight, according to the World Health Organization (WHO), this is probably the most sedentary generation of people in the history of the world. India alone accounts for more than 25 million people suffering from morbid obesity.

Says Dr Shashank Shah, bariatric surgeon, "Surgery for severe obesity goes way beyond weight loss. This surgery results in complete remission or significant improvement of Type 2 diabetes and other life-threatening diseases in most patients. People generally don't think of surgery as a treatment for diabetes or high blood pressure, but it is, and we expect metabolic surgery to play an over-increasing role in managing these diseases.''

Metabolism is the process by which the body converts food to energy at the cellular level. The most common metabolic disease is Type 2 diabetes, which occurs when the body does not adequately metabolize or regulate blood sugars due to lack of insulin or the body's inability to respond to the insulin is produced. According to the latest figures there are 35.5 million people with Type 2 diabetes and the problem is on the rise. New research indicates that metabolic surgery may improve insulin resistance and secretion by mechanism independent of weight loss most likely involving changes in gastrointestinal hormones. Many patients with Type 2 diabetes experience complete remission within days of metabolic surgery, long before significant weight comes off. This has led to new thinking that metabolic surgery may be also appropriate for diabetic individuals who are of normal weight or only slightly overweight.

Diabetes mellitus Type 2 affects more than 150 million people worldwide. Although the incidence of complications of Type 2 diabetes can be reduced with tight control of hyperglycemia, current therapies do not achieve a cure.

Gastric bypass and biliopancreatic diversion seem to achieve control of diabetes as a primary and independent effect, not secondary to treatment of excess weight. Although controlled trials are needed to verify the effectiveness on non-obese individuals, gastric bypass surgery has the potential to change the current concepts of the pathophysiology of Type 2 diabetes and, possibly, the management of this disease. Patients with Type 2 diabetes have a six-fold increased risk of a first-time myocardial infarction compared with non-diabetic patients and a three to eight-fold increased risk of death.

Series with long-term follow-up show that gastric bypass and biliopancreatic diversion achieve durable normal levels of plasma glucose, plasma insulin, and glycosylated hemoglobin in 80 per cent to 100 per cent of severely obese diabetic patients, usually within days after surgery. Shah describes the effects of laparoscopic gastric bypass surgery on the development of type 2 diabetes. All patients had severe obesity (BMI 35.0 kg/m2). One year after surgery, 64 per cent patients had remission of diabetes. The prevalence of diabetes decreased from 10 to 5.6 per cent. An additional 26 per cent of patients with diabetes had an improvement in their control of diabetes.