Thank you very much for your interest in our study. We have continued to offer obese endometrial cancer survivors bariatric referrals, and, at this time, of 156 women approached, only 2 have actually gone through with bariatric surgery. Those 2 women have had profound and sustained weight loss, on average losing 61 lb with almost 1 year of follow-up from the time bariatric referrals were offered. Unfortunately, they are the minority. We agree that bariatric surgical referrals are effective and should be offered to every woman who is a candidate. However, we also emphasize that cancer survivorship is different for each woman; one surgery does not fit all.

The cases we included in our series were low- to intermediate-risk endometrial cancers. The reason we chose that group of women is that their risk of recurrence and death from their cancer was low, but their risk of morbidity and mortality from obesity-related conditions was considerable. We would emphasize that a bariatric referral may be ineffective and even harmful in women experiencing toxicity from therapy or who have high-risk endometrial cancer based on advanced stage or aggressive histology. Women with high-risk endometrial cancer have a high likelihood of recurrence. Given their risk for cancer recurrence and cancer-related mortality, they may not see the benefits of a surgical procedure. An additional surgical procedure may only expose them to excess morbidity.

Furthermore, while we agree the biologic plausibility is compelling, until we have better data confirming that bariatric surgery can help endometrial cancer regress, we caution against recommending it as a standard therapy for endometrial cancer. We anxiously await the arrival of more informative studies on the matter. Surgical referrals are underutilized and consideration of a surgical referral should be a standard part of the care of an obese endometrial cancer survivor. However, in lieu of surgery, it is critical that providers remain enthusiastic in their efforts and maintain a variety of tools and approaches to help women achieve a healthier lifestyle, even if that just means weight maintenance or slower weight gain.