ArticleThe lancet. Diabetes & endocrinology2014
Beyond BMI: the need for new guidelines governing the use of bariatric and metabolic surgery.
Article in The lancet. Diabetes & endocrinology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 2 of them syntheses that pooled it.
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Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
45 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Effectiveness of Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy on Lipid Levels in Type 2 Diabetes: a Meta-analysis.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2022Pooled it
- Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2.Diabetes care · 2016Pooled it
- Stapleless vs Stapled Gastric Bypass vs Hypocaloric Diet: a Three-Arm Randomized Controlled Trial of Body Mass Evolution with Secondary Outcomes for Telomere Length and Metabolic Syndrome Changes.Obesity surgery · 2021Trial
- Effects of Laparoscopic Roux-en-Y Gastric Bypass for Type 2 Diabetes Mellitus: Comparison of BMI > 30 and < 30 kg/mObesity surgery · 2017Trial
- Trial
- Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study.The lancet. Diabetes & endocrinology · 2015Trial
- Beyond weight loss: exploring bile acid modulations after bariatric surgery and their impact on type 2 diabetes across 5 years.Obesity (Silver Spring, Md.) · 2025Article
- A leap in the dark: Bariatric surgery for treatment of metabolic dysfunction-associated steatotic liver disease related cirrhosis: Editorial on "Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis".Clinical and molecular hepatology · 2025Article
- Beyond Insulin: Modified OAGB in Low-BMI Insulin-Resistant and Non-compliant Type 2 Diabetic Patients.Obesity surgery · 2025Article
- The Term Bariatric: Time for a Well-Deserved Retirement.Obesity surgery · 2023Article
- The role of the gastric fundus in glycemic control.Hormones (Athens, Greece) · 2023Review
- Thirty-One Years Maybe Desirable for Antique Cars But Not for Patient Care.Obesity surgery · 2023Article
- Review
- Article
- Two-year outcomes of Roux-en-Y gastric bypass vs medical treatment in type 2 diabetes with a body mass index lower than 32.5 kg/mJournal of endocrinological investigation · 2022Article
- The non-linear relationship between muscle mass and BMI calls into question the use of BMI as a major criterion for eligibility for bariatric surgery.Metabolism open · 2022Article
- Bile acids, gut microbiota and metabolic surgery.Frontiers in endocrinology · 2022Review
- Assessment of Endothelial Function in Iranian Healthy Obese Patients after Bariatric Surgery.Advanced biomedical research · 2022Article
- Weight loss dynamics following laparoscopic Roux-en-Y gastric bypass. An analysis of 10-year follow-up data.Surgical endoscopy · 2021Article
- Predictive scoring system for advanced liver fibrosis in Japanese patients with severe obesity.Surgery today · 2021Article
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Abstract
Bariatric surgery use is largely governed worldwide by a 1991 National Institutes of Health consensus statement that advocates BMI as the primary operative criterion and restricts surgery to severely obese patients. These guidelines have been enormously valuable in standardising practice, thereby facilitating accumulation of a copious database of information regarding long-term surgical benefits and risks, from vast clinical experience and research. However, the National Institutes of Health recommendations had important limitations from the outset and are now gravely outdated. They do not account for remarkable advances in minimally invasive surgical techniques or the development of entirely new procedures. In the two decades since they were crafted, we have gained far greater understanding of the dramatic, weight-independent benefits of some operations on metabolic diseases, especially type 2 diabetes, and of the inadequacy of BMI as a primary criterion for surgical selection. Furthermore, there is now a substantial and rapidly burgeoning body of level-1 evidence from randomised trials comparing surgical versus non-surgical approaches to obesity, type 2 diabetes, and other metabolic diseases, including among only mildly obese or merely overweight patients. Herein, we present arguments to impel the development of new guidelines for the use of bariatric and so-called metabolic surgery to inform clinical practice and insurance compensation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.