Obesity and Diabetes: Twin Threats to Health – Laparoscopic or Robotic Bariatric Surgery as the Gold Standard

Director Chen Hongbing's Team from the Department of Gastrointestinal Surgery, Gansu Wuwei Cancer Hospital​

Harms of Obesity

​​First, it causes dyslipidemia.​​ Individuals with abdominal obesity are particularly more prone to hypercholesterolemia, hypertriglyceridemia, and hypertension than the general population. They also exhibit abnormally elevated levels of low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL), while high-density lipoprotein (HDL) levels are reduced.

​​Second, it increases the risk of cerebrovascular disease.​​ Obese people are more susceptible to hypertension, dyslipidemia, and diabetes. For those with obesity combined with these conditions, cerebral atherosclerosis is more likely to develop. Under the stress of hypertension, this can trigger the rupture of blood vessels, leading to life-threatening cerebral hemorrhage.

​​Third, it raises the likelihood of hypertension.​​ Obesity is closely associated with hypertension—obese individuals have a 50% higher risk of developing hypertension than non-obese people. Those with moderate obesity face over 5 times the hypertension risk of normal-weight individuals and more than twice the risk of those with mild obesity.

​​Fourth, it exacerbates cardiac workload.​​ Obese individuals have a 4-fold higher incidence of angina pectoris and sudden cardiac death. Excess weight definitely strains the heart and causes damage. Due to excessive fat storage in the blood, total blood volume increases significantly, forcing the heart to contract with greater force. When the heart is overwhelmed, overt heart failure can easily occur.

Fifth, it leads to fatty liver disease.​​ Approximately half of obese individuals have fatty liver disease. The liver is responsible for synthesizing triglycerides, but it has limited extra space to store them. In obese people, the balance between triglyceride synthesis and transport is disrupted: they consume more fatty acids, prompting the liver to produce excess triglycerides. These accumulate in the liver, eventually causing fatty liver disease.

​​Sixth, it increases the risk of diabetes.​​ Obesity is a major risk factor for diabetes—80% of patients with type 2 diabetes are obese. Moreover, the longer an individual has struggled with obesity, the higher their likelihood of developing diabetes.

​​Seventh, obese individuals are more susceptible to cancer.​​ Obese women face a higher risk of endometrial cancer and postmenopausal breast cancer, while obese men are more prone to prostate cancer. Regardless of gender, obesity elevates the risk of colorectal cancer (affecting both colon and rectum). The severity of obesity directly correlates with a higher prevalence of these cancers.

​​Eighth, it causes osteoarticular (bone and joint) diseases.​​ Key conditions linked to obesity include osteoarthritis, diabetic osteoarticular disease, and gouty osteoarticular disease. Among these, osteoarthritis is the most common and damaging—it primarily affects the knees but can also impact the hips, fingers, and other joints.

​Harms of Diabetes​​

First, the most common and harmful complication of diabetes is cardiovascular disease. Diabetic patients have a 2- to 4-fold increased risk of developing cardiocerebrovascular diseases, with coronary heart disease being the most prevalent complication.

Second, diabetic nephropathy is another severely harmful complication and one of the most serious microvascular complications. It primarily stems from renal arteriosclerosis caused by chronic hyperglycemia. Over time, it can lead to massive proteinuria, and in advanced stages, renal failure.

Third, diabetic retinopathy: Metabolic byproducts from high blood glucose damage the normal capillaries in the retina, causing microvascular lesions and retinal hemorrhage. Early symptoms include vision loss and hemorrhagic spots. Severe cases may result in extensive retinal bleeding and even permanent blindness.

Fourth, diabetic neuropathy: The most common type is peripheral neuropathy, which causes numbness, pain, and burning sensations in the limbs. In later stages, patients lose sensation, to the point of not feeling burns or injuries.

Fifth, peripheral vascular disease and diabetic foot: These are caused by a combination of peripheral vascular and nerve damage. Patients may experience necrosis of the extremities, leading to amputation, or even death from severe infections.

Sixth, some obese diabetic patients experience sexual dysfunction, which can be restored after laparoscopic bariatric surgery and weight loss.

Relationship Between Obesity and Diabetes

A large waistline in obese individuals signals excess body fat, which predisposes them to ​​insulin resistance​​—meaning obesity is a major risk factor for diabetes. Obesity and diabetes are like twin brothers; their combined harm is greater than the sum of their parts (1+1>2), demanding early attention and proactive management.

Surgical Treatment for Obesity and Diabetes with Laparoscopic or Robotic Bariatric Surgery

Decades of surgical practice have proven that ​​laparoscopic bariatric surgery​​ is the gold standard for treating both obesity and diabetes. With advances in medical technology, surgical intervention has emerged as the optimal treatment for diabetic patients with obesity. In recent years, laparoscopic minimally invasive surgery has been recognized by the global medical community as the gold standard for curingdiabetes.

In 1995, an academic paper titled "Who Would Have Thought Surgery Could Be the Best Treatment for Type 2 Diabetes?"was published in the ​​Annals of Surgery​​ (a top U.S. surgical journal). Since then, bariatric surgery has skyrocketed in popularity and remains a go-to solution for obesity and diabetes. Practice confirms: laparoscopic or robotic bariatric surgery is the gold standard for managing both conditions.

Introduction to the Department of Gastrointestinal Surgery

The Department of Gastrointestinal Surgery is a ​​Gansu Provincial Key Clinical Specialty​​ and a demonstration unit for ​​NOSES (Natural Orifice Specimen Extraction Surgery)​​—a minimally invasive technique for radical resection of gastric and colorectal cancer without abdominal incisions—using laparoscopic and robotic approaches.

Located in the ​​Heavy Ion Campus​​ of Gansu Wuwei Cancer Hospital (affiliated with Wuwei Academy of Medical Sciences), the department focuses on gastrointestinal tumor diagnosis and treatment. Its core expertise includes:

•Standardized ​​D2 radical gastrectomy​​ (for gastric cancer) and ​​D3 radical colectomy​​ (for colorectal cancer);

•Laparoscopic/robotic D2 radical gastrectomy and D3 radical colectomy;

•Preoperative ​​neoadjuvant therapy​​, ​​conversion therapy​​, and postoperative ​​adjuvant therapy​​;

•Comprehensive treatment, immunotherapy, targeted therapy, and ​​multidisciplinary team (MDT) care​​ for advanced tumors.

These efforts have significantly improved the ​​5-year cure rate and survival rate​​ of tumor patients. Additionally, the department performs extended combined organ resections and complex major tumor surgeries, enhancing its reputation as a leading center for gastrointestinal oncology.

Currently, the department has 1 Chief Physician (Chen Hongbing, Director of the Department and Level 2 Chief Physician in General Surgery), 1 Deputy Chief Physician, 2 Master's Degree holders, and 4 Attending Physicians and junior physicians. The team has received advanced training in hospitals across Beijing, Shanghai, Guangzhou, Zhejiang, Fujian, Xi'an, and other regions, boasting rich experience in the diagnosis and treatment of gastrointestinal tumors. With strong research capabilities, exquisite techniques, and precise and standardized surgical and treatment approaches, standardized diagnosis and treatment of gastrointestinal tumors are achieved here. Since February 2023, the department has been the first among prefecture-level hospitals in our province to perform robot-assisted radical gastrectomy with D2 lymph node dissection for gastric cancer and radical resection of colorectal cancer with D3 lymph node dissection. It is also the first in China to conduct NOSES (Natural Orifice Specimen Extraction Surgery) for radical resection of colorectal cancer using domestically produced surgical robots, enabling patients to access the most advanced domestic diagnostic and treatment technologies without leaving their hometowns. This has propelled leapfrog development in the department's diagnosis and treatment capabilities. The Department of Gastrointestinal Surgery of our hospital ranks at the advanced domestic level and leading position in our city for tumor diagnosis and treatment. It is among the earliest departments in our province to perform laparoscopic and robotic radical resection of gastrointestinal tumors, and among the earliest in China to perform laparoscopic and robotic radical resection of colorectal cancer without abdominal incisions (i.e., NOSES surgery).

Department members have authored and presented over 50 papers, completed 7 scientific research projects at the departmental, provincial, and municipal levels, and won 1 first prize, 3 second prizes for municipal scientific and technological progress, and 2 third prizes for provincial scientific and technological progress. They have also published 2 medical monographs. Additionally, the department completed 1 research project funded by the National Health Commission (concluded in 2022 with a grant of 100,000 yuan) and currently leads 1 key R&D project in our city: "Clinical Application Research of Domestic Tumai Surgical Robot-Assisted Radical NOSES Surgery for Colorectal Cancer" (supported by a 100,000 yuan research grant).

Chen Hongbing

Director of the Department of Gastrointestinal Surgery, Gansu Wuwei Academy of Medical Sciences Oncology Hospital; Level 2 Chief Physician

● Leader of Provincial Key Discipline

● Director of both the Department of Gastrointestinal Surgery and the Medical Affairs Department of Wuwei Oncology Hospital

● Member of the Expert Group of Gansu Provincial Quality Control Center for General Surgery

● Expert receiving the allowance for senior professional and technical talents in Gansu Province

● Deputy Director of the Colorectal Cancer Professional Committee of Gansu Anti-Cancer Association

● Vice President of Gansu Branch of China Colorectal Cancer MDT Alliance

● Executive Director of China Rectal Cancer Anal Preservation Alliance

● Deputy Director of Longyuan Gastroenterology Alliance of the Oncology Gastroenterology Professional Committee of the Chinese Anti-Cancer Association

● Vice President of the First Gansu Provincial Medical Doctor Association Oncology Physicians Branch

● Executive Member of the Colorectal Cancer Professional Committee of Gansu Alliance of China Anti-Cancer Alliance

● Deputy Director of the Medical Robotics Branch of Gansu Medical Doctor Association

● Member of the Weight Loss and Metabolic Diseases Professional Committee of Gansu Medical Doctor Association

● Deputy Director of the General Surgery Professional Committee of Wuwei City

Specializes in: Standardized D2 radical gastrectomy for gastric cancer; standardized D3 radical resection for colorectal cancer. Twelve years ago, he took the lead in performing standardized laparoscopic and robotic radical resections for gastric cancer and colorectal cancer, laparoscopic anal preservation surgery for low rectal cancer (ISR, Bacon surgery), and laparoscopic/robotic radical NOSES surgery for colorectal cancer in hospitals across our province and city. He has completed 6 scientific research projects, won 3 second prizes for municipal scientific and technological progress, and 2 third prizes for provincial scientific and technological progress. In 2022, he completed 1 project funded by the National Health Commission; in 2023, he presided over 1 key R&D plan project in Wuwei City.

Preliminary Review: Zhang Jie  

Final Review: Ma Shuqian