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Access to Bariatric Surgery and Patients With Diabetes—Reply
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In Reply: In response to the alternative criteria offered by Dr Rubino for prioritizing access to bariatric surgery in patients with diabetes, we note that our Commentary did not propose eliminating current guidelines for consideration of bariatric surgery in patients with BMI of 35 or more. We recommended that the medical and insurance communities elevate the option of bariatric surgery to that of an accepted standard of practice for patients with diabetes and extreme obesity (BMI  50).
However, our call for a BMI cutoff of 50 was intended to be pragmatic, ethical, and safe. We believe this approach is pragmatic in that it considers the availability of surgeons and centers to actually perform the additional case volume that would flow from such an approach. Based on data in our Commentary, we estimate that over a few years there would be doubling of the number of bariatric surgery cases. Conversely, Rubino's . . . [Full Text of this Article]
Jonathan Q. Purnell, MD
purnellj@ohsu.edu
Department of Medicine
Oregon Health & Science University
Portland
David R. Flum, MD, MPH
Department of Surgery
University of Washington
Seattle
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