Joint replacement surgery performed on non-obese patients is easier and associated with less risk, says Dr. Edwards. Losing weight, if needed, before surgery will make recovery faster and improve chances of success with the new joint.

Help with Other Health Problems

But pain relief and improved surgical success are not the only benefits people with OA can expect from bariatric surgery. Numerous studies have shown it can relieve many of the other problems that commonly occur in people with OA, including hypertension, high triglycerides and obstructive sleep apnea, says Dr. Edwards. But some of the most compelling research is for its effects on type-2 diabetes.

According to the Centers for Disease Control and Prevention, more than half of people with diabetes also have arthritis. Bariatric surgery has shown to be one of the most effective treatments for type-2 diabetes. In fact, two studies published earlier this year in the New England Journal of Medicine showed that for many people, gastric bypass and sleeve gastrectomy may actually reverse the disease.

In one of the two studies, researchers at the Cleveland Clinic assigned 150 volunteers with type-2 diabetes to receive one of three treatments: their standard diabetes medications, gastric bypass or sleeve gastrectomy. While half of the patients required insulin injections prior to the surgery, 12 months afterward only 4 percent who underwent gastric bypass and 8 percent who had sleeve gastrectomy were still receiving insulin injections. Similarly, most patients undergoing one of the two procedures were able to give up their oral diabetes medications.

In the second study in the same issue of the journal, researchers at the Catholic University of Rome assigned 60 type-2 diabetes patients to receive either medication or one of two bariatric surgeries – gastric bypass or bilio-pancreatic diversion, a similar surgery less commonly performed in the United States. Similar to the other study, patients undergoing bariatric surgery experienced a reversal of diabetes – for 75 percent of those who underwent gastric bypass and 95 percent who had  had bilio-pancreatic procedure blood glucose levels returned to normal.

Risks

As with any surgical procedure, bariatric surgery carries risks. Immediate risks of the surgeries are the same for all surgeries including infection, bleeding and risks from general anesthesia. As with other abdominal surgeries, bariatric surgery can result in intestinal obstructions, damage to the spleen or complications with the heart and lungs.

Longer-term risks or surgery may include ulcers of the stomach or small intestine, particularly for people who take nonsteroidal anti-inflammatory drugs; diarrhea and stomach cramps, particularly after eating certain types of foods; and deficiencies in nutrients, including vitamins, iron and calcium. 

The specific risks will vary depending on the type of surgery.

Who Needs It?

People who are interested in bariatric surgery should discuss the different options as well as risk and benefits with their doctors.

According to NIH guidelines, bariatric surgery is appropriate for people who have a BMI of at least 40 or a BMI of 35 in the presence of obesity-related health problems such as high blood pressure, sleep apnea or diabetes. However, the researchers hope their studies’ findings may encourage a change in guidelines that would lower the BMI limits for people with type-2 diabetes.