Guidelines fall short on bariatric surgery

To the Editor: I am writing in relation to the concerns raised by Dixon in his critique of the Clinical practice guidelines for the management of overweight and obesity from the National Health and Medical Research Council (NHMRC).1

When developing guidelines, the NHMRC always includes a consultation phase and Dixon did not raise his concerns during this phase. When his concerns were subsequently brought to NHMRC's attention — just as the guidelines were in the process of being published — the guideline committee agreed to remove examples of nutritional complications as they were open to misinterpretation.

The revised guidelines were issued in October 2013 and Dixon was informed of the amendment. Hence the version of the guidelines cited in Dixon's article does not contain the text with which he took issue in the Journal.

Further, the guidelines are not intended for bariatric surgeons and their teams, as Dixon suggests. The guidelines are specifically targeted at primary care management of overweight and obesity. As such they note that “Individual monitoring and follow-up protocols should be determined by the appropriate specialist team or surgeon, in consultation with the primary care health professionals involved”.

The evidence base for the guidelines is documented in the accompanying 656-page systematic review, available on the NHMRC website.2

The NHMRC develops guidelines against a rigorous set of standards that include governance by an expert multidisciplinary committee, a documented evidence review process, strict conflict of interest management, and independent expert and methodological review.

An integral element is a transparent public consultation process, and the NHMRC urges all clinicians to review guidelines at this stage and respond as appropriate.