In Reply: In response to the alternative criteria offered by Dr Rubino for prioritizing access to bariatric surgery in patients with diabetes, we note that our Commentary did not propose eliminating current guidelines for consideration of bariatric surgery in patients with BMI of 35 or more. We recommended that the medical and insurance communities elevate the option of bariatric surgery to that of an accepted standard of practice for patients with diabetes and extreme obesity (BMI ≥50).
Purnell JQ, Flum DR. Access to Bariatric Surgery and Patients With Diabetes—Reply. JAMA. 2009;302(10):1055-1057. doi:10.1001/jama.2009.1289