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BMJ 2006; 332 doi: (Published 26 January 2006) Cite this as: BMJ 2006;332:225
  1. Alison Tonks, associate editor (

    High volume hospitals do most of the bariatric surgery in the US

    The worsening obesity epidemic in the United States has led to a proliferation of hospitals offering bariatric surgery. By 2003, 1111 or nearly a quarter of all US hospitals did bariatric surgery, three times more than in 1997.

    Credit: JAMA

    In response to concerns about the expertise and facilities available in these hospitals, researchers from Ann Arbor, Michigan, examined data from two national surveys to find out more about the hospitals. They found that in 2003 most patients (77%) had their bariatric surgery in high volume centres where staff performed more than 100 procedures a year. If anything, these hospitals looked bigger and better equipped than other US hospitals, with more operating theatres, more beds, bigger intensive care units, and more staff. Less than 10% of patients had their surgery in low volume centres performing fewer than 50 procedures a year.

    While these findings are reassuring, they fall a long way short of guaranteeing safety for the increasing number of morbidly obese patients who want a surgical solution, write the authors. They want better data on quality, and the mechanisms to improve it, from all centres offering bariatric surgery.

    Sex selection is the likeliest explanation for India's sex imbalance

    Sex selection has been illegal in India since 1994, but it's still common. Analysis of data from a detailed and representative survey of 1.1 million Indian households found that for every 1000 boys born in 1997 there were only 899 girls. In families that already had one girl the ratio was 759 girls per 1000 boys; in families with two girls, it was 719. The sex ratio was about equal among families with one or more boys. The female to male sex ratio for second children was lowest among educated urban women with a daughter (683 girls for every 1000 boys).

    The authors estimate that about half a million girls went …

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