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Letters to the Editor

BARIATRIC BIAS?

The article concerning Medicare coverage of bariatric care ("MedicareEyes Coverage of Bariatric Care," January 2005) is illustrated with apicture of a lap band. In the same issue, another article ("BariatricSurgery Puts Patients at Risk for Peripheral Neuropathies") alsofeatures a picture of an adjustable lap band.

My concern is that you are representing the adjustable lap band as theprimary form of bariatric surgery. As a bariatric surgeon myself, I find thatrather alarming. I feel very strongly that patients should understand the prosand cons of every option when it comes to bariatric surgery—whether itis a gastric bypass, a lap band, or a duodenal switch procedure.

Although you didn't highlight one bariatric procedure over another withinthe context of these articles, the choice of illustrating them with images ofonly one procedure may promote a bias.

Steven C. Simper, MD

Rocky Mountain Associated Physicians

Salt Lake City, Utah

DOC News regrets the oversight. We in no way intended to suggest,however subliminally, that lap banding is the primary surgical option forobese patients with diabetes. Physicians should weigh the costs and benefitsof every bariatric procedure with their patients.

WHAT'S IN A NAME?

I looked at DOC News for the first time (February 2005) anddiscovered that Irl Hirsch is the editor-in-chief. Anything by Dr. Hirsch isworth reading. I am hooked.

William Cushard, MD

Clinical Professor of Internal Medicine

University of California Davis Medical Center

Sacramento, Calif.

WORD TO THE WISE

Your article on sudden-death risk associated with waist size("Measure for Measure," February 2005) seems to have confusedcircumference with diameter. The article used the term"circumference"; however, Empana and colleagues actually measuredthe sagittal abdominal diameter, that is, the direct dimension from the frontto back of the trunk.

Numerous publications have already documented that waist circumference isassociated with cardiovascular and metabolic risk. Fewer articles havereported on the utility of measuring the diameter. Like Empana, they generallyhave found that the diameter provides a strong association with adverseoutcomes. Perhaps this improved predictive power is because the abdominaldiameter is better correlated than the abdominal circumference with theintra-abdominal (visceral) fat volume, at least when both are measured onsubjects in the supine posture.

Henry S. Kahn, MD

National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention

Atlanta, Ga.

Due to an editing mistake, the term "circumference" wassubstituted for "diameter." We regret the error.

Footnotes

Your comments and feedback are always welcome. Send email todocnews{at}diabetes.org.Comments may be edited for clarity and length.

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