The Article That Sparked a Storm of Reactions!
Nearly 30 years ago, Walter Pories and his colleagues published a landmark article with the provocative title: “Who Would Have Thought It? An Operation Proves to be the Most Effective Therapy for Adult-Onset Diabetes Mellitus” (1). The operation in question? Gastric bypass. That publication became a turning point in the evolution of bariatric and metabolic surgery, sparking what would later be recognized as the diabetes remission revolution.
Dr. Pories came to be regarded as the father of metabolic surgery, as he was the first to observe that gastric bypass—not originally intended for diabetes, but for morbid obesity—produced rapid, complete, and long-lasting diabetes remission in patients with type 2 diabetes mellitus. His discovery laid the foundation for what would soon become a global shift in how we understand and treat diabetes remission through surgical intervention.
Published in Annals of Surgery in 1995, the article triggered intense reactions across the scientific and medical communities. In a follow-up article in the same journal in 2004, Pories wrote (2):
“We were not prepared for the observation that gastric bypass could make diabetes disappear. This is not how discoveries are supposed to happen. Usually, good news in medicine comes from the lab—through test tubes and occasionally through animal models. But truly new findings for major diseases like diabetes or cancer do not come often!”
Dramatic Diabetes Remission After Gastric Bypass
In that study, Pories and colleagues reported that among 146 patients with type 2 diabetes who underwent gastric bypass, 121 (82.9%) achieved and sustained diabetes remission, maintaining normal blood glucose, HbA1c, and insulin levels for 7 to 14 years of follow-up. Among 152 patients with insulin resistance, 150 (98.7%) maintained normal metabolic profiles after surgery—an extraordinary confirmation of the potential for surgical diabetes remission.
Beyond diabetes, gastric bypass improved or resolved a number of obesity-related comorbidities including hypertension, sleep apnea, cardiopulmonary insufficiency, arthritis, and infertility—solidifying its role as the first metabolic surgery procedure shown to directly improve multiple chronic conditions, with diabetes remission as a central outcome.
A Devastating Disease Becomes Potentially Curable
That historically significant article concluded with a bold statement:
“Type 2 diabetes mellitus is no longer an uncontrollable disease. The return to normal glucose, insulin, and HbA1c levels is now possible in the majority of morbidly obese diabetic patients undergoing gastric bypass—especially if the operation is performed within the first two years of diagnosis. The exact reason why the surgery is so effective is not fully clear, though caloric restriction appears to play a major role. There is also some evidence that changes in incretin stimulation of pancreatic islets may be involved. These studies provide new insights and opportunities for understanding diabetes and strengthen our hope that—alongside obesity control—this devastating disease may indeed be curable.”
This early recognition of surgical diabetes remission redefined what was once believed to be a progressive, irreversible condition.
And Thus Was Born… Metabolic Surgery
Following that breakthrough, a wave of studies emerged documenting not only weight loss but also sustained diabetes remission and reversal of other metabolic complications after bariatric procedures. Over time, bariatric surgery evolved into metabolic surgery, a field that now focuses as much on hormonal and metabolic modulation as on obesity itself.
Today, metabolic surgery is recognized as one of the most effective tools for achieving diabetes remission, especially when performed early in the course of the disease. The legacy of Pories’ findings continues to inspire a new generation of surgeons and scientists focused on unlocking the mechanisms behind this remarkable phenomenon—and expanding access to surgical diabetes remission worldwide.
