The Harms of Obesity in Abdominoplasty: Considerations of Methodological and Social Behavioral Factors.

backgroundKlimitz et al. used the ACS-NSQIP database to conduct an observational cohort study of 1,778 cases on the impact of obesity on 30-day complications after cosmetic abdominoplasty; the study has limitations in four aspects: obesity definition, statistical model, sociodemographics, and preoperative weight-loss recommendations.

objectiveWithout introducing new data, identify the above four methodological issues based solely on the original report to provide directions for future research.

methodsRe-examined the publicly reported data and descriptions of the 1,778-case ACS-NSQIP cohort, focusing on: 1) sole use of BMI as the obesity criterion and absence of other adiposity measures; 2) unreported variable selection, multicollinearity, and interaction terms in the logistic regression; 3) omission of certain social determinants from the model; 4) absence of records on weight-loss history, weight stability, or effectiveness of weight-reduction programs.

resultsTheir findings highlight that obesity is an independent risk factor for certain complications, offering valuable insights for clinical practice, yet the four limitations may overestimate the effect or mask heterogeneity, finer risk stratification, sensitivity analyses across BMI thresholds, social determinants, and structured weight-loss trials are lacking.

conclusionFuture work should retain large sample size and rigorous statistics while adopting multidimensional obesity assessment, transparent modeling, inclusion of social determinants, and prospective studies documenting weight-loss processes to enable precise and equitable preoperative patient selection and counseling. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .