We commend Agrawal et al for their insightful and pioneering study, which provides new evidence that revisional endoscopic bariatric therapy (EBT) can significantly improve quality of life and reduce internalized weight bias. Their work rightly demonstrates that these procedures provide benefit beyond weight loss alone. To build on these findings, we suggest that future studies should address certain remaining methodological issues. These include recruiting larger and more heterogeneous cohorts to assess generalizability, using multivariable analysis to control for the confounding effects of anti-obesity medications, and implementing longitudinal assessments to determine the duration of improvements in patient-reported outcomes. Establishing a causal link between early improvements in EBT and internalized weight bias with long-term weight control will be vital to establish the therapeutic value of revisional EBT as part of a comprehensive and multi-modal treatment for obesity.
Tu et al. (Wed,) studied this question.