LAUSR

In a recent article, Cummings and Cohen (1) compared glycemic outcomes after bariatric surgery in patients with BMI ≥35 or <35 kg/m2, concluding that there was no clear difference in outcomes between these BMI thresholds. To strengthen their argument, they discussed possible weight-independent effects of bariatric surgery on glycemic outcomes. Their article correctly recognized the 35 kg/m2 threshold used as an indication for bariatric surgery, based on a 1991 National Institutes of Health Consensus Statement (2), as arbitrary and probably not suitable for Asian patients, and it discussed the fact that initial BMI does not predict outcome in larger cohorts. However, many points discussed in the article should be analyzed with caution, given the limited number of less obese patients with long-term follow-up after metabolic surgery and the few existing comparisons of BMI extremes. Additionally, many studies have demonstrated that diabetes remission is associated with the amount of weight loss and that, …