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Invited Critique |

Results of Roux-en-Y Gastric Bypass in Morbidly Obese vs Superobese Patients—Invited Critique

Jon Gould, MD
Arch Surg. 2009;144(4):318. doi:10.1001/archsurg.2009.13.
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Suter and colleagues have touched on an important issue in their study. In 2007, the American Society of Bariatric Surgeons changed its name to more accurately reflect what is accomplished with a bariatric operation. Metabolic was added to the society name to emphasize the fact that these are more than weight-loss operations. The primary objective of bariatric surgery is improved health. A formerly diabetic patient who is still obese long after undergoing bariatric surgery has had a successful, life-altering outcome regardless of the amount of weight lost. Rather than reporting surgical results in terms of percentage of EWL, the bariatric surgical community should emphasize the changes in health and quality of life that follow these operations. Some may argue that bariatric surgeons are doing that now. I would argue that we are not doing it well enough. When we discuss surgical criteria, it is BMI that receives the headline; comorbidities get honorable mention. Weight loss is the first outcome discussed in our bariatric surgery lectures, in our clinical encounters with patients, and in our published reports. It is no wonder that, despite mountains of clinical evidence touting the health benefits of bariatric surgery, it is still acceptable for insurance companies to deny benefits for “weight-loss surgery.” As these authors state in the conclusion of their article, “weight loss or residual BMI is not all that matters. . . . ”

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