Minimizing unnecessary surgery for thyroid nodules.

n engl j med 367;8 nejm.org august 23, 2012 765 in 1987, the participants were followed for up to 15 years. Type 2 diabetes was significantly less likely to develop in participants who underwent a bariatric procedure that was current in that era (banding, vertical banded gastroplasty, or gastric bypass) than in controls. Two additional observations are also worth highlighting: baseline BMI did not appear to influence the effect of bariatric surgery, and the various surgical procedures that were performed appeared to be equally effective, although the study was not statistically powered to detect differences among the procedures. The long-term findings of the SOS study are both provocative and exciting — especially the findings that suggest that bariatric surgery may prevent the conversion of abnormalities in glucose metabolism to frank diabetes. However, it remains impractical and unjustified to contemplate the performance of bariatric surgery in the millions of eligible obese adults. And to be certain, the authors do not suggest such an approach. Rather, the current study should provide an impetus to develop a more complete understanding of the mechanisms by which the various bariatric procedures exert their beneficial effects. Such understanding will be important because it will enable the identification of the persons who are the most appropriate candidates for surgery. The cause of type 2 diabetes is multifactorial, and this long-term study shows that surgery did not prevent the development of diabetes in all patients. Furthermore, it is possible that interventions that are even less invasive may accomplish the very desirable goal of decreasing the incidence of type 2 diabetes and its attendant complications.