As described by authors, obesity is increasing in prevalence all over the world and is associated with increasing need for spine fusion surgery. Many authors have reported that increase in body mass index is associated with increased operative time and increased postoperative complications, which has supported the role for weight loss preoperatively before fusion surgery [2,3]. This article put forth stir question about role of bariatric surgery for weight loss before fusion surgery in morbidly obese patients. Bariatric surgeries have been associated with hypo-proteinemia and various mineral deficiency, frequency of which varies on basis of procedure done on patients [4]. Nutritional deficiency is more common in malabsorptive surgery methods adopted than compared to restrictive procedures; bariatric surgery procedure done should also be intricately considered while planning for giving nutritional supplementation [4,5].

In the context of complications associated with being morbidly obese, bariatric surgery has proven to be a safe modality and is frequently safer for patients than remaining obese. The author has shown the results associated with bariatric surgery to be disappointing compared to the non–weight loss group, which can lead to the conclusion, with conviction, that it is not a good option even for morbidly obese patients. The author has considered massive weight loss as a criterion and does not provide definitive documentation of bariatric surgery, with no mention of the type of bariatric procedure performed. As different procedures have different frequencies of associated complications such as nutritional deficiencies, this could be one of the variable factors altering the outcome [4].

Finally, the author might have obtained data pertaining to the details of previous surgery by reviewing pre-anesthetic check-up documents, as these usually contain such information. If the availability of pre-anesthetic check-up documents to the operating team is restricted or limited, then the patient’s file containing physical examination records might include a mention of a previous surgical scar. Apart from these methodological constraints, the most important concern and restraint was the lack of information about preoperative micronutrient deficiency and whether the patient was on supplements or not. Deficiency of certain nutrients might be present preoperatively and could worsen after surgery [6]. Correction of these factors and parameters could have resulted in a different outcome with a more realistic picture of the effect of prior bariatric surgery in morbidly obese patients. I would agree with the author that the timing of surgery for spinal fusion after bariatric surgery might have been one of the reasons, but without knowing the nutritional status of the patient—especially micronutrients that serve as cofactors in numerous cellular processes—commenting on the outcomes might have too little impact and seem somewhat immature.