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Comment & Response
May 22/29, 2018

Surgical Procedures for Patients With Severe Obesity—Reply

Author Affiliations
  • 1Kaiser Permanente Washington Health Research Institute, Seattle
  • 2Bariatric Surgery Program, Washington Permanente Medical Group, Seattle
JAMA. 2018;319(20):2137. doi:10.1001/jama.2018.4116

In Reply We agree with Dr Cohn and colleagues that all researchers should report the percentage total weight loss in studies of bariatric surgery outcomes because measures of percent excess weight loss can bias results in favor of patients with lower BMI. Percentage total weight loss is less influenced by the preoperative weight and facilitates cross-study comparisons of weight loss outcomes.1,2 As Cohn and colleagues note, the Swiss Multicenter Bypass or Sleeve Study (SM-BOSS)3 and the SLEEVEPASS study4 would have found statistically significant differences in percentage total weight loss between gastric sleeve resection and Roux-en-Y gastric bypass had they reported this outcome. However, the magnitude of the difference in percentage total weight loss between the 2 procedures at 5 years was small (the absolute differences in percentage total weight loss in the 2 studies were 3.2%3 and 3.6%4), and the clinical significance of this difference in terms of improvements in quality of life and long-term cardiometabolic outcomes is uncertain. The individual patient’s own valuation of the importance of a 3% difference in weight loss is the most important factor to consider in this setting.