John Morton, MD, the association's secretary-treasurer and the Stanford University School of Medicine's director of Quality Surgery and Surgical Sub-specialties, added that because the two groups were not strictly matched by BMI, it may be that the comparison group was essentially healthier to begin with.
He also suggested that the reasons bariatric surgery patients have surgery represents "pent up demand" for procedures they may have wanted to have, but weren't appropriate for previously because of their unhealthy weight, "but now that obstacle is removed."
"We know obesity is a leading public health problem this country, but here, when we have something that actually works, and is safe, it's being attacked for not providing cost savings when there's no similar criteria for any other disease. There's bias we feel has come into play."
Clifford Ko, MD, director of the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP), also had a criticism: "No study is perfect but they should at least address the limitations more appropriately. All studies should."
In a related editorial, Edward H. Livingston, MD, JAMA deputy editor, wrote that the study suggests "weight loss operations should be offered to highly selected patients," those with a complication of obesity "that is known to dramatically improve with weight loss surgery.
Examples include diabetes and osteoarthritis. These operations should not be done for body mass index as an exclusive indication," and, he added, only patients "with demonstrated compliance to medical and dietary treatment" should be offered the procedure.
Weiner says the seven BlueCross Blue Shield plans provided data for 18 million people, some 29,800 of whom had bariatric surgery and qualified for inclusion.