Getting What the Guidelines Stated Matters.

beneficial compensatory response to altered systemic metabolic changes in obesity needs further evaluation. Our results also confirm those obtained for skeletal muscle, with reversal of systemic and muscle metabolic derangements only 9 months after BS (3). The improvement in life-style habits may have also contributed to the late reduction in cardiac steatosis. Compared with usual care, BS is the most effective treatment for severe obesity, and the longterm results regarding reduction of cardiovascular mortality have been well established. To the best of our knowledge, this study is the first to show a significant improvement in all types of ectopic fat depots, even cardiac steatosis, long-term after BS. Whether these improvements participate in the reduction of cardiovascular risk and mortality in obese patients needs to be confirmed.