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Comment & Response
June 12, 2019

Concerning Greater Social Contexts in Bariatric Surgery Availability and Telomere Length Outcomes—Reply

Author Affiliations
  • 1Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
  • 2Stanford University School of Medicine, Stanford, California
  • 3Department of Urology, UCSF School of Medicine, University of California, San Francisco
JAMA Surg. Published online June 12, 2019. doi:10.1001/jamasurg.2019.1727

In Reply We appreciate the relevant and insightful commentary provided by Shah and Shah in their letter regarding our article.1 The authors are correct in their assessment of the association of social determinants with health status, including weight, stress, and socioeconomic status. Our study patient population is generally representative of the bariatric surgery population by age, sex, and weight parameters. This study population is also representative of the diverse ethnic representation present in the San Francisco Bay Area, as we have cited.2 While we do have patient zip code data that could be used for income status, this is a broad assessment not appropriate for individual-level analysis. Education is a key parameter that should be measured in the future, and we appreciate the authors’ suggestion.

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