Which weight-loss surgery is best?

CIHR-funded researchers examine which type of surgery is healthiest and most effective for obese patients.

July 2, 2015

As the rate of severe obesity increases, more people are seeking out surgical weight-loss solutions. But there is little evidence as to which type of bariatric surgery is best. Drs. André Tchernof and Laurent Biertho explain how their CIHR-funded project could help surgeons decide which surgical approach would produce the best outcomes for a patient.


This is David Coulombe for CIHR news. The Canadian Institutes of Health Research has invested 4.5 million dollars, with the help of some partners, to improve the quality of bariatric care in Canada. One of those projects looked particularly at bariatric surgery and help people who suffer from severe obesity.

My guests today are Andre Tchernof and Laurent Biertho – the two main researchers who will look at this project.

David Coulombe: Dr. Andre Tchernof, Dr. Biertho, thanks for joining us today

Laurent Biertho: Thank you.

André Tchernof: It's a pleasure.

David: Dr. Tchernof, maybe I'll start with you. What's the goal of this important research project?

Tchernof: There has never been a study that has formally compared the three most commonly performed bariatric operations in a longitudinal trial. So the goal of the study is to compare them from the clinical and mechanistic standpoints. Some surgeries rely on reducing the amount of food that's consumed by the individual, some of them combine mechanisms of intestinal malabsorption. So they act through very different mechanisms. So we're going to do a formal comparison of those three surgeries.

David: Dr. Biertho, how do you decide which type of surgery you will perform on an obese patient?

Biertho: It's really a long discussion with each patient according to the side-effects of each surgery, the risk the patient is willing to undertake, and the benefits he is likely to expect after each surgery. So we look at the weight, but also the associated disease, like diabetes, hypertension, and the long-term benefits he can expect from each surgery.

David: Talking about diabetes, people that go through this type of surgery, their diabetes goes away. How come?

Biertho: It's really one of the questions we are trying to answer with this particular study. We know there is some restriction in the caloric intake that plays a role, but there is also a lot of different roles from hormones, changes in the gut microbiotica, for example, and changes in the eating habits, and also probably behavior.

David: And this remission, is it permanent?

Biertho: It depends on the surgery. It can go from depending also on the severity of the diabetes, it can go from 20 to 80 percent according to the type of surgery.

David: Dr. Tchernof, last question. How do you hope to improve the life of obese persons in Canada?

Tchernof: Well as you have seen, the decision of choosing one surgery or the other is a complex decision. And I think that adding more elements in terms of knowledge from the clinical and mechanistic standpoint for each of those surgeries will improve decision making in that regard.

David: Thank you very much and best of luck for your project.

Biertho: Thank you very much.

Tchernof: Thanks.

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