Metabolic surgery: present and future

Several articles in this issue of the Journal cover a broad range of the new concepts of metabolic surgery, the mechanisms that leads to sustained metabolic syndrome remission, the new surgical procedures, and the perspective of surgeons and endocrinologists. Obesity is a global health concern. Health surveys from 2005 revealed that the number of overweight and obese individuals in China were 200 million and 60 million, respectively [1] . The rising prevalence of obesity is causing a major health burden in terms of morbidity and mortality [2] . The complications of obesity and comorbidities, such as hypertension, coronary heart disease, type 2 diabetes mellitus (T2DM), hyperlipidemia, osteoarthrosis, and an increase in cancer risk, are placing growing demand on healthcare resources [3] . The metabolic surgery has been widely recommended as the only effective management for obesity and related metabolic syndromes [4] . The global total number of metabolic surgical procedures increased very quickly. In 2011, the global total number was 340,768, and surgeons was 6,705 [5] . However, there are still a lot of considerable debates over the choice of operative procedure, optimal time, duration of effects, mechanisms behind the effects, new surgical procedures, and so on. In the article titled ‘‘Recent advancement in bariatric/metabolic surgery: appraisal of clinical evidence’’ [6] , Dr. Wei-Jei Lee et al. present a comprehensive overview of the development of metabolic surgery, including the improvement of safety, the new procedures, the mechanism studies and the option of patient selection. In the article titled ‘‘The Success of Sleeve Gastrectomy in the Management of Metabolic Syndrome and Obesity’’ [7] , Dr. Asim Shabbir et al. summarize a new surgical procedure, sleeve gastrectomy(SG). The review introduces the development, mechanism, outcome, superiority and the future of the procedure. Based on the most recent basic and clinical data, the health benefits of the sleeve gastrectomy have been clearly established. Perhaps no endocrinologist, 20 years ago, could predict that an operation would cure T2DM. Several studies have demonstrated dramatic improvements in T2DM among patients with morbid obesity following a variety of gastrointestinal surgical procedures. The article ‘‘Metabolic bariatric surgery and type 2 diabetes mellitus: an endocrinologist9 s perspective’’ [8] by Dr. Kwang-Wei Tham in this issue is another testimony from the physicians. Endocrinologists have focused their attention on metabolic surgery. The diabetes patients will benefit from the medical and surgical cooperation. There is strong evidence that metabolic surgeries can cure most of the associated T2DM in morbidly obese patients. On the other hand, a dramatic remission of glucose homeostasis even before weight loss occurs has attracted interest. With the current very low morbidity and mortality of metabolic procedures, a ‘‘surgical’’ treatment of diabetes in normal weight patients seems to be a new target. Dr. Liang et al. in their article ‘‘Roux-en-Y gastric bypassfor the treatment of type 2 diabetes mellitus in Chinese patients with a BMI , 28 kg/m 2 : multi-institutional study’’ [9]