03560591

June 24, 2025, 07:55

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The manuscript by Camille Kass and co-authors focuses on the issue of eating disorders following bariatric surgery that may be associated with physical and physiological changes, as well as various psychological phenomena related to the effects of the surgery and dietary modifications. Diagnosis and treatment of these disorders require appropriate categorization within disease classification systems, particularly the DSM-5. However, creating such a classification with the inclusion of new categories in the existing list or expanding the diagnostic criteria requires a requires the accumulation of a sufficiently large database. The presented article describes a case of eating disorder after bariatric surgery with a detailed description of symptoms and their dynamics in the course of complex therapy. Based on the data obtained and the results of literature analysis, the authors conclude that the observed disorder is the closest to avoidant/restrictive food intake disorder according to DSM-5. At the same time, the results of the patient's follow-up confirm the opinions expressed by other authors about the need to include body dysmorphia, and the loss of personal identity associated with severe weight loss, in the diagnostic criteria for ARFID. The presented article has some relevance for the development of a diagnostic system for eating disorders. However, it should be noted that the authors did not practically consider the possible influence of the patient's premorbid background (generalized anxiety disorder) and its interaction with the effects of bariatric surgery on the observed eating disorders. In general, it seems reasonable and interesting to conduct such an analysis using author’s own results and data from the literature.

First, thank you very much for your professional comments on the article published in World Journal of Clinical Cases. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Clinical Cases at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.

08215565

June 16, 2025, 14:48

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Cass K et al.'s report of the first documented case of avoidant/restrictive food intake disorder (ARFID) following Roux-en-Y gastric bypass (RYGB) surgery highlights critical diagnostic gaps in post-bariatric eating pathology assessment. This instance illustrates how ARFID, marked by the avoidance of food due to fear of adverse outcomes such as nausea, can arise independently after surgery, differing from body-image-centered disorders like anorexia nervosa. The likely reason for previous underreporting is diagnostic overshadowing, where symptoms are mistakenly attributed to expected surgical side effects, and limitations in the DSM-5-TR, which excludes patients experiencing weight-loss-related body dysmorphia but not driven by fat phobia. The patient's significant weight loss of 52.3 kg in just six months highlights the role of extreme weight suppression in inducing physiological stress, such as metabolic adaptation and hepatitis, which may exacerbate aversion to food. Additionally, voluntary vomiting, often reported by post-bariatric patients as a means of relieving discomfort rather than controlling weight, remains a challenging diagnostic issue. The current DSM-5-TR inaccurately categorizes this behavior as anorexia nervosa (AN) or bulimia, indicating a need for revised criteria for ARFID. Furthermore, body image disturbance in this population frequently stems from loose skin or identity disruption, rather than a fear of weight gain, emphasizing the importance of distinguishing this condition from AN to prevent ineffective treatments. Prospective studies are necessary for future endeavors to ascertain the prevalence of ARFID, refine the DSM criteria to differentiate behavioral motivations (such as vomiting intent), and establish integrated multidisciplinary care models. Given the widespread increase in bariatric surgeries, it is urgent to develop surgery-specific diagnostic frameworks. Clinicians must screen for ARFID in post-bariatric patients who avoid food due to fear of aversive outcomes, regardless of any concurrent body image issues or intentional vomiting.

First, thank you very much for your professional comments on the article published in World Journal of Clinical Cases. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Clinical Cases at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.