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Effects of Obesity Surgery on the Metabolic Syndrome—Invited Critique

Effects of Obesity Surgery on the Metabolic Syndrome—Invited Critique 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. There are many unanswered questions that would help put some of the authors' comments in perspective—in particular, their recommendation that "obesity surgery, therefore, should be highly recommended for the treatment of morbidly obese patients with the [metabolic syndrome]." For example: Because the risk of developing the metabolic syndrome appears to vary by ethnicity, can one assume that the authors' findings are broadly applicable to all patient populations? Can one assume that any operation "cures" the metabolic syndrome and decreases the risk of developing type 2 diabetes mellitus or significant coronary atherosclerosis if the duration of the follow-up is limited to 1 year? and The pharmacological treatment regimens of the patients before and after surgery are not reported. Can one evaluate the efficacy of bariatric operations if this information is not explicitly presented for review? The authors' data are promising, but much more research is needed before we subject patients who do not meet currently established criteria to bariatric surgical procedures. Back to top Article Information Correspondence: Dr Jacobs, Department of Surgery, Duke University Medical Center, DUMC 3704, Durham, NC 27710 (jacob060@mc.duke.edu). References 1. Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135:48-58. PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Effects of Obesity Surgery on the Metabolic Syndrome—Invited Critique

Archives of Surgery , Volume 139 (10) – Oct 1, 2004

Effects of Obesity Surgery on the Metabolic Syndrome—Invited Critique

Abstract

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...
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References (1)

Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.139.10.1093
Publisher site
See Article on Publisher Site

Abstract

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. There are many unanswered questions that would help put some of the authors' comments in perspective—in particular, their recommendation that "obesity surgery, therefore, should be highly recommended for the treatment of morbidly obese patients with the [metabolic syndrome]." For example: Because the risk of developing the metabolic syndrome appears to vary by ethnicity, can one assume that the authors' findings are broadly applicable to all patient populations? Can one assume that any operation "cures" the metabolic syndrome and decreases the risk of developing type 2 diabetes mellitus or significant coronary atherosclerosis if the duration of the follow-up is limited to 1 year? and The pharmacological treatment regimens of the patients before and after surgery are not reported. Can one evaluate the efficacy of bariatric operations if this information is not explicitly presented for review? The authors' data are promising, but much more research is needed before we subject patients who do not meet currently established criteria to bariatric surgical procedures. Back to top Article Information Correspondence: Dr Jacobs, Department of Surgery, Duke University Medical Center, DUMC 3704, Durham, NC 27710 (jacob060@mc.duke.edu). References 1. Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135:48-58. PubMedGoogle ScholarCrossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Oct 1, 2004

Keywords: obesity,metabolic syndrome x,surgical procedures, operative

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