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Obesity: The Role of Gastric Surgery-Reply

John F. Wilber, MD
JAMA. 1991;266(22):3130. doi:10.1001/jama.1991.03470220046021.
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In Reply.  —Because this article was derived from a 20-minute NIH Grand Rounds that was limited in scope, all aspects of obesity management could not be considered. I recognize, nevertheless, that gastric surgery is an important option in management of severely obese individuals.The more common morbidity of liver disease, renal stones, and polyarthritis, which represent a major group of difficulties for patients undergoing jejunoileal bypass, is infrequent in individuals with gastric bypass. However, long-term results of this procedure have been somewhat disappointing, and patients have tended to regain the weight they have lost.1Second, although gastric surgery has clearly superseded jejunoileal bypass and will produce significant weight loss, patients after 3 years remain substantially overweight and may experience symptomatic biliary disease. Because of these problems, the American Academy of Clinical Nutrition has recommended that gastric procedures should be done only in patients (1) who are 100% in excess


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