Guidelines fall short on bariatric surgery

In reply: I appreciate the opportunity to respond to McCallum's defence of the National Health and Medical Research Council (NHMRC) guideline development process, and appreciate the revisions that were made to the current version. With my general practice background, I understand that the 656-page systematic review will not be considered in clinical practice, but I do know that the text within the guidelines will. And unfortunately that text did not reflect either the established literature or the systematic review. I found the text regarding bariatric surgery flawed throughout, with issues not restricted to nutritional support. There were multiple statements with no evidence base, which of course means they could not be referenced, and two statements where cited references did not support the statement made.

I strongly suggest that the NHMRC carefully reviews its process as described in the letter above. There is limited value in this rigorous process if it delivers a flawed and potentially dangerous outcome. The expert multidisciplinary committee clearly lacked specific expertise in bariatric surgery, and the consultation phase failed to seek appropriate expert advice.