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Unfortunately, despite best matching efforts, the patients and controls analysed by Booth and colleagues1 differed widely in terms of medical monitoring. Not only did controls��distilled from CPRD data��not undergo substantial obesity treatment but also they seemingly did not benefit from standard medical care. Despite these adults being obese, 27% of controls had missing values for blood pressure and 68% had missing cholesterol data, compared with 1% and 26%, respectively, of bariatric surgery patients. The frequency of missing data in the control group seems to confirm widely held beliefs that many family doctors do not view obesity as a disease and think obese people do not need treatment R428 and monitoring. Conversely, the bariatric surgery patients, who were treated by the most active means against obesity (ie, surgery), are clearly a select category of individuals who were monitored closely, rather than being broadly representative of the UK population, as claimed by Booth and colleagues.1 Indicative for the selection process is that close to 30% of bariatric surgery patients were excluded from the study because of pre-existing Everolimus price type 2 diabetes, an unusually high number compared with published data.3 Moreover, a higher proportion of surgical patients than controls were taking antihypertensives and lipid-lowering drugs, which suggests that the bariatric surgery patients were probably being monitored more carefully than controls, constituting a substantial risk for bias. Booth and colleagues did not address the mechanism by which bariatric surgery affects glucose metabolism and, hence, the incidence of de-novo type 2 diabetes. A well-recognised selleck screening library mechanism of diabetes remission is weight loss, with more weight loss leading to a higher chance of remission.4 Similarly, in people without diabetes, more weight loss probably reduces the risk of developing type 2 diabetes. This mechanism could account for why the present results show that the risk of developing diabetes in the subgroup of bariatric surgery patients that were the least obese (BMI