Laparoscopic gastric bypass surgery has stood the test of time, demonstrating significant and durable weight loss (vs medical management) regardless of variations in how the procedure is performed. The issue of “effectiveness” of bariatric surgery needs to include a full accounting of the benefits vs harms of the procedure. No matter the procedure, success may be defined as achieving weight loss or resolution of a specific comorbid disease (eg, diabetes). The harms are often procedure-specific, as demonstrated in this issue of JAMA Surgery. Risstad et al1 tackle a difficult problem as they attempt to identify the optimal surgical technique for “effective” weight loss in patients with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) greater than 50.
Varban OA, Dimick JB. Bariatric Surgery in Patients With Body Mass Index Greater Than 50 Technique or Timing?. JAMA Surg. Published online September 14, 2016. doi:10.1001/jamasurg.2016.2828