Evidence-based medicine reports on obesity surgery: a critique

Abstract

OBJECTIVE:To evaluate evidence in recent authoritative 'Evidence-Based Medicine' (EBM) reports on surgery for severe obesity. METHODS: Focused review of Index Medicus citations and authors' own databases of publications on surgery for obesity, . RESULTS: EBM criteria for assessment of strength of evidence requiring randomized controlled studies (RCTs) in these reports are inappropriate for evaluating invasive treatments such as surgery, which have robust physiological effects, are difficult to reverse and may have more serious side effects than the drug studies for which the criteria were promulgated. Flaws in these reports include omissions of important studies demonstrating improvements in comorbidity, factual errors in descriptions of operations and faulty analyses of outcomes of laparoscopic approaches. There are misinterpretations of cited papers, and inclusion of obsolete operations as well as a study generated during the 'learning curve' of an avowed complex procedure. CONCLUSION: EBM analyses of surgical modalities affecting access to care require relevant evaluation criteria, true peer review and expert consultation. Authors' claims of objectivity by invoking use of evidence-based criteria applicable to drug treatment and other easily reversible forms of therapy are questionable. Decisions based on flawed EBM reports may adversely affect access to care for millions of severely obese patients.

Persistent Correlation of Ghrelin Plasma Levels with Body Mass Index Both in Stable Weight Conditions and during Gastric-bypass-induced Weight Loss

“…Our bariatric population disclosed a marked decrease in BMI in agreement with the majority of LRYGBP prospective studies [3,22,23]. One would expect the massive decrease in BMI achieved with these surgeries to trigger an elevation in ghrelin levels.…”

“…All current bariatric surgeries result in weight loss of large magnitude, correction of comorbidities, and excellent short-and long-term outcomes [3,22,23]. Together with the spectacular weight loss seen in bariatric surgery, endocrine changes take place, particularly after laparoscopic RYGBP (LRYGB).…”

Ten-year changes in health-related quality of life after biliopancreatic diversion with duodenal switch

“…In addition we used well-validated HRQL instruments (both generic and obesity-specific) that allowed us to compare the results with population norms and the SOS study. Lack of a control group could be considered a limitation, but we believe that prospective, long-term cohort studies with careful monitoring of the patients is an appropriate design [32].…”

Health-related quality of life after bariatric surgery: a systematic review of prospective long-term studies

“…First, as no long-term RCTs were identified, we had to rely on information from prospective cohort studies [34] . Second, only seven published studies were included in this review, and the total sample size was relatively small (N=1113).…”