Bariatric surgery history: altered anatomy, altered expectations

Posting this under the heading it deserves: Bariatric surgery history: altered anatomy, altered expectations Everything below is what sits behind that.

Asking about bariatric surgery history directly, because I have read four threads on it and each answered a slightly different question.

The version I want answered is the narrow one: given the method stated below, is the result within what anyone else has seen? I am not asking what it means yet.

Method, numbers and the two assumptions I am aware of making are below. If the assumptions are wrong that is more useful to me than agreement.

One caution on bariatric surgery history: everything above assumes the underlying documentation is what it claims to be. That assumption is doing real work and is rarely stated.

Gastroparesis: pre-existing severe delayed gastric emptying can worsen with compounds that slow it further. Discussion with a clinician is prudent if this history exists.

I read post #2 twice before replying, because I had assumed the opposite.

Whatever the answer on bariatric surgery history turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, invite the correction.

Building on post #4 rather than restating it.

Genetic and ancestry-related differences in response are asked about regularly and the published evidence is thin enough that the honest answer is short.

That is one dataset and I would not build a rule on it.

This settles it for me, at least until somebody posts a reason it should not.

I have been on both sides of the bariatric surgery history argument in this category within eighteen months, which should tell you how strong the evidence for either side is.

Bariatric surgery history is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.

On post #7 — agreed on the reasoning, with one qualification.

Dedicated trials in under-studied populations are the only real remedy and several are ongoing, which is worth saying rather than speculating.

Where I would look next, rather than where I would stop.

Post #9 put the caveat in the right place and I want to underline it.

Medullary thyroid carcinoma history: an absolute contraindication because of the preclinical findings in rodent toxicology. The history (personal or family, especially multiple endocrine neoplasia type 2) is an important screening question.

That has held every time I have looked, which is not the same as always.

Building on post #9 rather than restating it.

Practical note on bariatric surgery history: write down what you expect before you look. The number of times I have found what I went looking for is higher than chance would allow.

I keep a log for bariatric surgery history specifically because my memory of it turned out to be systematically wrong in one direction. Six weeks of notes cost nothing and settled it.

The most useful contribution here is usually a citation to whichever published document comes closest, with a plain statement of how far it is from the question.