Reader Response: Association of Amount of Weight Lost After Bariatric Surgery With Intracranial Pressure in Women With Idiopathic Intracranial Hypertension

Mollan et al. report that bariatric surgery was superior to community weight management (CWM) regarding weight lost, intracranial pressure (ICP) reduction, disease remission, and quality of life in women with idiopathic intracranial hypertension (IIH).^1,2 They recommend for clinicians to have low thresholds of referral for bariatric surgery.¹

However, surgery did not have a greater effect on papilledema grade, visual function, or headache disability than CWM.³ More specifically, there was no difference in visual acuity, contrast sensitivity, perimetric mean deviation, or optic nerve and the retinal nerve fiber layer. Given that loss of vision is the most severe complication in IIH, and headache is the principal symptom, not highlighting these supplementary data in either the initial or follow-up paper seems to be a crucial omission. In particular, defining disease remission only in opening pressure or ICP reduction could be misleading.

In addition, although physical functioning and general health seemed to improve more in the surgery arm of the study (though we note no correction for multiple comparisons), this was not the case in emotional wellbeing, anxiety and depression, social functioning, or pain. Bariatric surgery, despite its potential risks, does have proven long-term health benefits.⁴ However, its role in IIH treatment remains far from clear.