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Invited Critique
October 2004

Effects of Obesity Surgery on the Metabolic Syndrome—Invited Critique

Arch Surg. 2004;139(10):1093. doi:10.1001/archsurg.139.10.1093

Dr Lee and colleagues' report of a 1-year follow-up study of 645 patients who underwent laparoscopic vertical banded gastroplasty or gastric bypass as part of a supervised weight loss program is provocative but may be overstated. As the authors indicate, it would not be surprising if the weight loss facilitated by bariatric surgery abrogated the risk factors that characterize the metabolic syndrome. Indeed, their data (and those of Kral et al1) suggest that this is the case. Other investigations indicate that modest weight loss of 5% to 7% together with increased physical activity (150 min/wk) may be equally effective. Maintenance of the necessary weight lost is the pertinent issue—in concert with a balanced consideration of the risks and benefits of surgery vs a more conservative option.