Primum Non Nocere
Authors: Edward H. Livingston
Journal: Annals of Internal Medicine (2011)

Editorials6 September 2011Primum Non NocereEdward H. Livingston, MDEdward H. Livingston, MDFrom University of Texas Southwestern Medical Center, Dallas, TX 75235.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-5-201109060-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail To do no harm has been a guiding tenet of medicine for millennia. In this context, bariatric surgery warrants serious consideration. Bariatric operations undoubtedly induce weight loss, but at what cost? Consideration of the balance between benefits and harms calls into question the overall utility of bariatric surgery and, most important, what the appropriate end points should be.Weight loss is a good start. Bariatric procedures were devised to induce weight loss in patients who could not lose weight by modifying diet and exercise alone. The first operation was the ill-fated jejunoileal bypass, a procedure that caused substantial nutrient malabsorption ...References1. Livingston EH. Complications of bariatric surgery. Surg Clin North Am. 2005;85:853-68, vii. [PMID: 16061090] CrossrefMedlineGoogle Scholar2. The Management of Overweight and Obesity Working Group. VA/DOD Clinical Practice Guideline for Screening and Management of Overweight and Obesity. Washington, DC: U.S. Department of Veterans Affairs, Department of Defense; 2006. Accessed at www.healthquality.va.gov/obesity/obe06_final1.pdf on 20 July 2011. Google Scholar3. Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, et al; American Association of Clinical Endocrinologists. 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Obesity, metabolic syndrome, and coronary atherosclerosis [Editorial]. Circulation. 2002;105:2696-8. [PMID: 12057978] CrossrefMedlineGoogle Scholar7. Livingston EH, Ko CY. Effect of diabetes and hypertension on obesity-related mortality. Surgery. 2005;137:16-25. [PMID: 15614276] CrossrefMedlineGoogle Scholar8. Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253:484-7. [PMID: 21245741] CrossrefMedlineGoogle Scholar9. Maciejewski ML, Livingston EH, Smith VA, Kavee AL, Kahwati LC, Henderson WG, et al. Survival among high-risk patients after bariatric surgery. JAMA. 2011;305:2419-26. [PMID: 21666276] CrossrefMedlineGoogle Scholar10. Huerta S, Rogers LM, Li Z, Heber D, Liu C, Livingston EH. Vitamin A deficiency in a newborn resulting from maternal hypovitaminosis A after biliopancreatic diversion for the treatment of morbid obesity. Am J Clin Nutr. 2002;76:426-9. [PMID: 12145017] CrossrefMedlineGoogle Scholar11. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, et al; Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741-52. [PMID: 17715408] CrossrefMedlineGoogle Scholar12. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753-61. [PMID: 17715409] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Texas Southwestern Medical Center, Dallas, TX 75235.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1746.Corresponding Author: Edward H. Livingston, MD, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Room E7-126, Dallas, TX 75390-9156; e-mail, edward.[email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoWeight Loss, Cardiovascular Risk Factors, and Quality of Life After Gastric Bypass and Duodenal Switch Torgeir T. Søvik , Erlend T. Aasheim , Osama Taha , My Engström , Morten W. Fagerland , Sofia Björkman , Jon Kristinsson , Kåre I. Birkeland , Tom Mala , and Torsten Olbers Metrics Cited ByPilot Study of a New Model of Bariatric Surgery: Laparoscopic Intestinal Bipartition—Safety and Efficacy Against Metabolic DisordersReconstructive Transplantation: Program, Patient, Protocol, Policy, and Payer ConsiderationsThe rationale for a duodenal switch as the primary surgical treatment of advanced type 2 diabetes mellitus and metabolic diseaseNutritional Management of the Bariatric Surgery PatientWeight Loss, Cardiovascular Risk Factors, and Quality of Life After Gastric Bypass and Duodenal Switch: A Randomized TrialBenefits and complications of the duodenal switch/biliopancreatic diversion compared to the Roux-en-Y gastric bypassOpportunities for Cost Reduction of Medical Care: Part 3Comment on: Superior weight loss and lower HbA1c three years after duodenal switch compared to Roux-en-Y gastric bypass—a randomized controlled trialComments regarding a recent article comparing gastric bypass and duodenal switch and its questionable method and results 6 September 2011Volume 155, Issue 5Page: 329-330KeywordsBariatric surgeryBlindnessCholesterolGlucoseHypertensionObesityOverweightSurgeryWeight loss ePublished: 6 September 2011 Issue Published: 6 September 2011 CopyrightCopyright © 2011 by American College of Physicians. 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