Going Back to School - Annals of Internal Medicine: Fresh Look Blog


Wednesday, December 21, 2022

Going Back to School

Earlier today during a meeting on curriculum development, I said, “I wish I could go back to medical school.” “Come on Fatima; you don’t mean that.” I guess that’s true. I could do without the exams and the stress of it all, but I wish I could go back and see all of the surgeries my future primary care patients would receive so I could be better prepared to understand their experience. The truth about primary care is that the longitudinal relationships we build with our patients lead to comfort, familiarity, and mutual care and respect. When they go through things in their health that are outside of the primary care office, patients still look to us for information and guidance because of that comfort and mutual respect. When I don’t know something, I am honest. I don’t know the intricacies of some of the procedures they may undergo. As a primary care provider, I often discuss surgical intervention for weight management. In my experience, most of the time when I discuss surgical options, I’m met with resistance and fear. Surgery is a scary prospect for anyone, and I can’t go into detailed nuance about surgical procedures. However, I can speak to evidence. Seeberg and colleagues’ study (1) helps provide that evidence for me and thus increases the honesty with which I can recommend surgery for weight management.

In the article, the authors state:

Bariatric surgery effectively promotes weight loss and substantially reduces hepatic steatosis in most patients. However, to aid clinical decision making, identifying the most appropriate bariatric procedure concerning both clearance of liver fat and reversal of fibrosis is important. Observational studies have reported improvement of NAFLD [nonalcoholic fatty liver disease] after bariatric surgery, but whether any procedure is superior to others remains unknown (1).


When presenting different options for weight management, I need to know facts. I need to know options and I need to know what works effectively for the individual needs and goals of a patient. Weight loss can be curative of some medical conditions, but how do we gauge what procedures? This article doesn’t fully answer that question in terms of NAFLD, but it does tell us that any surgical intervention will improve fatty liver. For a primary care physician, having these studies in their back pocket can help guide decisions for patients and make surgery seem less scary.


  1. Seeberg KA, Borgeraas H, Hofsø D, et al. Gastric bypass versus sleeve gastrectomy in type 2 diabetes: effects on hepatic steatosis and fibrosis. A randomized controlled trial. Ann Intern Med. 2022;175:74-83. [PMID: 34843380] doi:10.7326/M21-1962

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