Response to “Weight Loss Before Bariatric Surgery and Postoperative Complications”

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We would like to comment on the letter by Quilliot and collaborators regarding our study over the effects of weight loss before bariatric study.1 The authors claim that our conclusions are in conflict with previous data demonstrating an association between weight loss and increased postoperative morbidity/mortality. To our understanding, this misinterpretation must reflect unawareness of the crucial distinction between unintentional and intentional weight loss. In none of the studies cited in the letter was unintentional, disease-associated weight loss controlled for. Thus, in patients losing weight, any underlying condition could have been expected to simultaneously influence weight and postoperative outcome.
This is in similarity to the large SOS (Swedish Obese Subjects) interventional study, in which intentional (surgical) weight loss was shown to be associated with almost 30% reduced mortality after 15 years,2 although most epidemiological studies by that time had demonstrated a relationship between (unintentional) weight loss and mortality.3–5
We appreciate that we have been given the opportunity to make this important clarification. We are, however, confident that most readers of Annals of Surgery are well aware of the difference between unintentional, disease-associated weight loss and an intervention that is aimed at, and now convincingly demonstrated to be associated with, improved outcome after bariatric surgery.
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