The article by Lassailly et al1 reported on 1540 patients who had undergone a bariatric surgery procedure that included 1489 cases in whom intraoperative liver biopsies were obtained. Surprisingly, histologic nonalcoholic steatohepatitis (NASH) was diagnosed in only 115 of the 1489 cases (7.7%). In the Discussion, this unusually low rate of disease is given only sparse attention. In addressing limitations of the study the authors state that, “the prevalence of NASH was lower than in other studies, but this could be explained by the absence of any selection of enrolled patients among surgical candidates.” This is not an adequate explanation for results that are significantly discrepant from other published studies of liver biopsy data from patients with extreme obesity undergoing bariatric surgery procedures.