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Invited Critique
July 2003

Laparoscopic Roux-en-Y Gastric Bypass in the "Megaobese"—Invited Critique

Arch Surg. 2003;138(7):710. doi:10.1001/archsurg.138.7.710

This article represents the first series of bariatric surgical patients restricted to a BMI of 70 or greater. At first glance, one might wish to place this article among those that describe procedures that fall into the category "just because it can be done, should it?" This category of operations might include laparoscopic pancreaticoduodenectomy, laparoscopic hepatic resection, etc. The authors have also taken it upon themselves to coin a new term, "megaobese." At least they did not attempt to attach an eponym! In considering terms for definition of massive overweight, such as suprasuperobese or megaobese, one should understand the rationale for introduction of the well-known term superobese by Ed Mason and colleagues in 1987.1 Mason et al desired to separate superobesity from morbid obesity on the basis that the superobese usually did not achieve satisfactory weight loss following vertical banded gastroplasty. The concept of distinguishing superobesity from morbid obesity has been supported by MacLean et al,2 Sugerman et al,3 our group,4 and others. At this time, I see no justification for the additional terms megaobese and suprasuperobese. It appears that the authors have independently decided that BMI increments of 10 warrant new terminology at each successively higher level!

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