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  1. Mayer, Jennifer E. MS, RD
  2. Dwyer, Johanna T. DSc, RD


This article explores the risks and benefits of 2 therapies for adults with severe or morbid obesity and type 2 diabetes: bariatric surgery (with special attention to the Roux-en-Y gastric bypass) or conventional medical therapy, which relies on nutrition, physical activity, lifestyle changes, and hypoglycemic medication. The Roux-en-Y gastric bypass remains the most advantageous surgically in terms of glycemic control and weight loss, with lesser adverse effects on nutrient absorption and non-weight related quality of life. Although bariatric surgery may be useful to varying degrees for achieving glycemic control and potential diabetes remission, patients still must adhere to elements of conventional medical therapy if gains in glycemic control are to continue postoperatively.