1
[4] Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999 –2004. JAMA 2006;295:1549 –55. [5] Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body mass index and mortality in a prospective cohort of US adults. N Engl J Med 1999;341:1097–105. [6] Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res 1998;6;97–106. [7] Mokdad AH, Marks JS, Stroup DF, Gerberdin JL. Actual causes of death in the United States, 2000. JAMA 2004;291:1238 – 45; Erratum in JAMA 2005;293:293– 4, 298. [8] Galuska DA, Will JC, Serdula MK, Ford ES. Are healthcare profession- als advising obese patients to lose weight? JAMA 1999;282:1576 –78. [9] Yan LL, Daviglus ML, Liu K, et al. Midlife body mass index and hospitalization and mortality in older age. JAMA 2006;295:190 – 8. [10] Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724 –37. [11] Steinbrook R. Surgery for severe obesity. N Engl J Med 2004;350:1075–9. [12] Bardia A, Holtan S, Slezak JM, Thompson W. Diagnosis of obesity by primary care physicians and impact on obesity management. Mayo Clin Proc 2007;82:927–32. [13] Buchwald H. Consensus conference statement— bariatric surgery for morbid obesity: health implications for patients, health professionals and third-party payers. Surg Obes Relat Dis 2005;1:371– 81. [14] Consensus Development Conference Panel. NIH conference: gastroin- testinal surgery for severe obesity. Ann Intern Med 1991;115:956 – 61. [15] Consensus Development Conference Panel. Clinical guidelines on the iden- tification, evaluation and treatment of overweight and obesity in adults. Bethesda: National Heart, Lung and Blood Institute; 1998. Available from: www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm. Accessed 2008. [16] Cope MB, Allison DB. Obesity: person and population. Obesity 2006;14(suppl 4):156S–9S. [17] De Maria E. Bariatric surgery for morbid obesity. N Engl J Med 2007;357:2176 – 83. [18] Collazo-Clavell ML, Clark MM, McAlpine DE, Jensen MD. Assess- ment and preparation of patients for bariatric surgery. Mayo Clin Proc 2006;81(suppl 10):S11–7. [19] McTigue KM, Harris R, Hemphill B, et al. Screening and interven- tions for obesity in adults: summary of the evidence for the U.S. preventive services task force. Ann Intern Med 2003;139:933– 49. [20] Snow V, Barry P, Fitterman N, et al. Pharmacologic and surgical man- agement of obesity in primary care: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2005;142:525–31. [21] Sjostrom L, Londroos A-K, Peltonen M, et al. Lifestyle, diabetes and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683–93. [22] Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gas- trectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc 2006;20:859 – 63. [23] Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrec- tomy in the high-risk patient. Obes Surg 2006;16:1445–9. [24] Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 2005;15:1469 –75. [25] Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with du- odenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg 2006;16:1138 – 44. [26] Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357:753– 61. [27] Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L. Obesity in adulthood and its consequences for life ex- pectancy: a life-tale analysis. Ann Intern Med 2003;138:24 –32. [28] Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357:741–52. [29] Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008:299:316 –23. [30] Abid A, Galuska D, Khan LK, Gillespie C, Ford ES, Serdula MK. Are healthcare professionals advising obese patients to lose weight? A trend analysis. Medscape Gen Med 2005;7:10. [31] Ruser CB, Sanders L, Brescia GR, et al. Brief report: identification and management of overweight and obesity by internal medicine residents. J Gen Intern Med 2005;20:1139 – 41. [32] Stafford RS, Farhat JH, Misra B, Schoenfeld DA. National patterns of physician activities related to obesity management. Arch Fam Med 2000;9:631– 8. [33] Stafford RS, Farhat JH, Misra B, Schoenfeld DA. National patterns of physician activities related to obesity management. Arch Fam Med 2000;9:631– 8. [34] Scott JG, Cohen D, DiCicco-Bloom B, et al. Speaking of weight: how patients and primary care clinicians initiate weight loss counseling. Prev Med 2004;38:819 –27. [35] Kushner RF. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med 1995;24:546 –52. [36] Huang J, Yu H, Marin E, et al. Physician’s weight loss counseling in two public hospital primary care clinics. Acad Med 2004;79:156 – 61 [37] Blixen CE, Singh A, Thacker H. Values and beliefs about obesity and weight reduction among African American and Caucasian women. J Transcult Nurs 2006;17:290 –7. [38] Perlman SE, Reinhold RB, Nadzam GS. How do family practitioners per- ceive surgery for the morbidly obese? Surg Obes Relat Dis 2007;3:428 –33. Editorial comment Comment on: Perceived barriers to bariatric surgery among morbidly obese patients Access to care has become one of the critical aspects of the dialogue on healthcare. The authors discuss the perceived bar- riers to metabolic surgery in a small cohort of patients in a metropolitan area. The critical issue, however, is access to comprehensive obesity management. Bariatric surgeons have delivered care of a high caliber and relief of obesity-related co-morbidities. Even if we were able to double the number of patients undergoing metabolic surgery from 1 to 2/1000, we would still be left with the remainder of the 7% fraction of the U.S. population with a BMI 40 kg/m 2 who are not receiving definitive management of their obesity. We should continue to maintain a leadership position in advocating for comprehen- sive treatment and prevention of obesity. Disclosures Dr. Murr is a consultant for Covidien, Endocore, and Elsevier. Michel M. Murr, M.D. Tampa General Hospital, University of South Florida Tampa, Florida 21 M. M. Murr / Surgery for Obesity and Related Diseases 6 (2010) 21

Comment on: Perceived barriers to bariatric surgery among morbidly obese patients

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21M. M. Murr / Surgery for Obesity and Related Diseases 6 (2010) 21

[4] Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, FlegalKM. Prevalence of overweight and obesity in the United States,1999–2004. JAMA 2006;295:1549–55.

[5] Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Bodymass index and mortality in a prospective cohort of US adults. N EnglJ Med 1999;341:1097–105.

[6] Wolf AM, Colditz GA. Current estimates of the economic cost ofobesity in the United States. Obes Res 1998;6;97–106.

[7] Mokdad AH, Marks JS, Stroup DF, Gerberdin JL. Actual causes ofdeath in the United States, 2000. JAMA 2004;291:1238–45; Erratumin JAMA 2005;293:293–4, 298.

[8] Galuska DA, Will JC, Serdula MK, Ford ES. Are healthcare profession-als advising obese patients to lose weight? JAMA 1999;282:1576–78.

[9] Yan LL, Daviglus ML, Liu K, et al. Midlife body mass index andhospitalization and mortality in older age. JAMA 2006;295:190–8.

10] Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: asystematic review and meta-analysis. JAMA 2004;292:1724–37.

11] Steinbrook R. Surgery for severe obesity. N Engl J Med 2004;350:1075–9.12] Bardia A, Holtan S, Slezak JM, Thompson W. Diagnosis of obesity

by primary care physicians and impact on obesity management. MayoClin Proc 2007;82:927–32.

13] Buchwald H. Consensus conference statement—bariatric surgery formorbid obesity: health implications for patients, health professionalsand third-party payers. Surg Obes Relat Dis 2005;1:371–81.

14] Consensus Development Conference Panel. NIH conference: gastroin-testinal surgery for severe obesity. Ann Intern Med 1991;115:956–61.

15] Consensus Development Conference Panel. Clinical guidelines on the iden-tification, evaluation and treatment of overweight and obesity in adults.Bethesda: National Heart, Lung and Blood Institute; 1998. Available from:www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm. Accessed 2008.

16] Cope MB, Allison DB. Obesity: person and population. Obesity2006;14(suppl 4):156S–9S.

17] De Maria E. Bariatric surgery for morbid obesity. N Engl J Med2007;357:2176–83.

18] Collazo-Clavell ML, Clark MM, McAlpine DE, Jensen MD. Assess-ment and preparation of patients for bariatric surgery. Mayo Clin Proc2006;81(suppl 10):S11–7.

19] McTigue KM, Harris R, Hemphill B, et al. Screening and interven-tions for obesity in adults: summary of the evidence for the U.S.preventive services task force. Ann Intern Med 2003;139:933–49.

20] Snow V, Barry P, Fitterman N, et al. Pharmacologic and surgical man-agement of obesity in primary care: a clinical practice guideline from theAmerican College of Physicians. Ann Intern Med 2005;142:525–31.

21] Sjostrom L, Londroos A-K, Peltonen M, et al. Lifestyle, diabetes andcardiovascular risk factors 10 years after bariatric surgery. N Engl

obese pat

.S. population with a BMI �40 kg/m2 who are not receiving

dms

D

22] Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gas-trectomy as an initial weight-loss procedure for high-risk patientswith morbid obesity. Surg Endosc 2006;20:859–63.

23] Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrec-tomy in the high-risk patient. Obes Surg 2006;16:1445–9.

24] Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleevegastrectomy (LSG) at 1 year in morbidly obese Korean patients. ObesSurg 2005;15:1469–75.

25] Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopicsleeve gastrectomy (first stage of biliopancreatic diversion with du-odenal switch) on co-morbidities in super-obese high-risk patients.Obes Surg 2006;16:1138–44.

26] Adams TD, Gress RE, Smith SC, et al. Long-term mortality aftergastric bypass surgery. N Engl J Med 2007;357:753–61.

27] Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A,Bonneux L. Obesity in adulthood and its consequences for life ex-pectancy: a life-tale analysis. Ann Intern Med 2003;138:24–32.

28] Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery onmortality in Swedish obese subjects. N Engl J Med 2007;357:741–52.

29] Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric bandingand conventional therapy for type 2 diabetes: a randomized controlledtrial. JAMA 2008:299:316–23.

30] Abid A, Galuska D, Khan LK, Gillespie C, Ford ES, Serdula MK.Are healthcare professionals advising obese patients to lose weight?A trend analysis. Medscape Gen Med 2005;7:10.

31] Ruser CB, Sanders L, Brescia GR, et al. Brief report: identificationand management of overweight and obesity by internal medicineresidents. J Gen Intern Med 2005;20:1139–41.

32] Stafford RS, Farhat JH, Misra B, Schoenfeld DA. National patterns ofphysician activities related to obesity management. Arch Fam Med2000;9:631–8.

33] Stafford RS, Farhat JH, Misra B, Schoenfeld DA. National patterns ofphysician activities related to obesity management. Arch Fam Med2000;9:631–8.

34] Scott JG, Cohen D, DiCicco-Bloom B, et al. Speaking of weight: howpatients and primary care clinicians initiate weight loss counseling.Prev Med 2004;38:819–27.

35] Kushner RF. Barriers to providing nutrition counseling by physicians:a survey of primary care practitioners. Prev Med 1995;24:546–52.

36] Huang J, Yu H, Marin E, et al. Physician’s weight loss counseling intwo public hospital primary care clinics. Acad Med 2004;79:156–61

37] Blixen CE, Singh A, Thacker H. Values and beliefs about obesity andweight reduction among African American and Caucasian women. JTranscult Nurs 2006;17:290–7.

38] Perlman SE, Reinhold RB, Nadzam GS. How do family practitioners per-

J Med 2004;351:2683–93. ceive surgery for the morbidly obese? Surg Obes Relat Dis 2007;3:428–33.

Editorial comment

Comment on: Perceived barriers to bariatric surgery among morbidly

ients

Access to care has become one of the critical aspects of theialogue on healthcare. The authors discuss the perceived bar-iers to metabolic surgery in a small cohort of patients in aetropolitan area. The critical issue, however, is access to

omprehensive obesity management. Bariatric surgeons haveelivered care of a high caliber and relief of obesity-relatedo-morbidities. Even if we were able to double the number ofatients undergoing metabolic surgery from 1 to 2/1000, weould still be left with the remainder of the 7% fraction of the

efinitive management of their obesity. We should continue toaintain a leadership position in advocating for comprehen-

ive treatment and prevention of obesity.

isclosures

Dr. Murr is a consultant for Covidien, Endocore, and Elsevier.

Michel M. Murr, M.D.Tampa General Hospital, University of South Florida

Tampa, Florida