In Reply We agree with Dr Majeed’s argument that the selection of high-risk groups for metabolic surgery should balance clinical eligibility and surgery capacity. Beyond the criteria of body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), there is no doubt that type 2 diabetes mellitus is one of the most important factors rendering additional eligibility for metabolic surgery because people with type 2 diabetes are prone to developing macrovascular and microvascular complications. However, the diabetic population, as a whole, is too broad and diverse to accommodate the current surgery capacity in most societies. Do we have any guide to screening diabetic patients for better success after metabolic surgery? It is universally accepted that metabolic surgery is an alternative choice for diabetic patients with BMI greater than 35 if their glycemic status or associated morbidities are hard to control with lifestyle modification and medical treatment.
