Bibliographic record
Abstract
SEVERE OBESITY is associated with a large number of comorbid diseases. These start at the head (stroke, diabetic retinopathy, pseudotumor cerebri, tinnitus) and go to the toes (diabetic neuropathy, foot ulcers, venous stasis disease) and affect almost every organ in between: lungs, heart, liver, spleen, gall bladder, esophagus, intestines, colon, kidneys, bladder, ovaries, prostate, breast, kidneys, bladder, legs, etc. Many of these comorbidities can be divided into two major groups: the metabolic syndrome (also known as Syndrome X) and comorbidities secondary to an increased intra-abdominal pressure (1). Metabolic syndrome comorbidities include type 2 diabetes mellitus (T2DM), hypercholesterolemia, hypertriglyceridemia, non-alcoholic liver disease (NALD) or steatohepatitis (NASH), polycystic ovary syndrome, hypertension, and gallstones. The comorbidities associated with an increased intra-abdominal pressure include pseudotumor cerebri, obesity hypoventilation, venous stasis disease (venous thrombosis, venous stasis ulcers, pulmonary embolism), gastroesophageal reflux disease (GERD), urinary stress incontinence, abdominal hernias (inguinal, umbilical, incisional), hypertension, and the nephrotic syndrome. Other problems such as sleep apnea, diverticulitis, necrotizing pancreatitis, and musculoskeletal disorders (low back, hip, and knee pain), as well as depression and quality of life (QoL) issues are unrelated to either the metabolic syndrome or increased intra-abdominal pressure. Severe obesity also increases the risk of developing cancer (esophagus, liver, pancreas, kidney, colon, breast, uterus, ovary, prostate, leukemias, lymphomas), some of which are associated with the metabolic syndrome (e.g., breast, uterus, prostate) and some secondary to an increased intra-abdominal pressure (e.g., esophagus). Severe obesity is also associated with severe discrimination, problems with employability, and absenteeism, as well as presenteeism (limited quality and quantity of work when employed).Unfortunately, dietary management with or without pharmaceutical therapy has not been effective over the long term (three to five years) for severely obese individuals. Weight loss peaks at approximately 10% of weight, but recidivism is almost invariable. Bariatric surgery is associated with the loss of approximately one-third of pre-operative weight or two-thirds of excess weight, and this weight loss is reasonably stable over ten years, with a relatively small degree of recidivism (2-4). In 1991 the National Institutes of Health Consensus Conference supported bariatric surgery in patients with a body mass index (BMI) of 35 kg/m2 and obesity-related comorbidities or a BMI of 40 kg/m2 regardless of comorbidity status (5).The current operations for severe obesity include Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB), biliopancreatic diversion (BPD) with or without a sleeve gastrectomy (SG), and an SG by itself (figs. 1-4) (6-9).Surgically induced weight loss is associated with a significant improvement in or remission of all obesity-related comorbidities. In a study by Christou et al. there were significant improvements after RYGB in patients from Quebec, Canada, in musculoskeletal disorders, infectious complications, endocrinological problems, cardiovascular complications (myocardial infarction, peripheral vascular disease), respiratory problems (sleep apnea, obesity hypoventilation), mental problems, genitourinary problems, and, for the first time, a significant decrease in cancer care (10). In a meta-analysis with 22,094 patients, Buchwald et al. found a significant improvement in T2DM (86%), hyperlipidemia (70%), hypertension (62%), and sleep apnea (86%) following bariatric surgery (11). In that study, there was significantly more weight loss with the RYGB and BPD than with the LAGB, and these were associated with a better improvement in T2DM than the LAGB. The LAGB had the lowest mortality risk (0. …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.019 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".