Comment on: Cohen et al. Effects of Gastric Bypass Surgery in Patients With Type 2 Diabetes and Only Mild Obesity. Diabetes Care 2012;35:1420–1428

Cohen et al. (1) are to be commended for their observational study of 30 patients with longstanding diabetes and BMI 30–35 kg/m2 who were followed for 6 years after laparoscopic Roux-en-Y gastric bypass (LRYGB). The study appropriately challenges using threshold levels to determine indications for treatment based on a continuous variable, BMI (size), which in itself is not a measure of any disease (unlike blood pressure, fasting plasma glucose, or triglycerides).Several items require clarification:1. National Institutes of Health Consensus Development Conferences such as the Gastrointestinal Surgery for Severe Obesity conference in 1991 do not “bound” or “set limits” for treatments: they provide recommendations based on presented evidence. However, third- …