Bariatric treatments for adult obesity - Institute of Health Economics

approximately 3 to 5 kilograms. For people with a BMI of 35 kg/m 2 or greater, surgical therapyleads to substantial reductions in weight of 20 kilograms or more.Both counseling-based and drug-based maintenance interventions were helpful in retaining weightloss. Reduction of 5% to 7% of body weight is associated with lower incidences of diabetes, reducedblood pressure, and improved dyslipidemia. Greater weight loss has been linked with greaterimprovements in glycemic control and lipids in limited surgical outcomes data.In terms of adverse events, potential harms of counseling-based interventions were not reported.Sibutramine is sometimes associated with increased blood pressure (mean increase of 0 to 3.5mmHg) and orlistat causes gastrointestinal distress in 15% to 37% of patients taking the drug.Surgical procedures lead to peri-operative mortality in less than 1% of patients, and over a 5-yearperiod up to 25% of patients require a reoperation.Clinical Practice Guidelines/Position StatementsSeveral clinical practice guidelines addressed the potential role of various bariatric treatmentstrategies for patients with obesity. Clinical decision on selecting appropriate treatment strategies isbased on BMI and/or waist circumference, risk factors and comorbidities (see Table S.4 in S-section). The majority of the documents used the WHO BMI obesity classification. No documentwas found that used the Edmonton Obesity Staging System. 55Table T.9 presents an algorithm of treatment interventions based on patients’ gender, BMI, waistcircumference, and comorbidities.Table T.9: European clinical practice guidelines, 2008 4BMI (kg/m 2 )Men < 94Women < 80Waist circumference (cm)Men ≥ 94Women ≥ 80Comorbidities25 to 29.9 L L L D30.0 to 34.9 L L D L D35 to 39.9 L D L D L D S≥ 40 L D S L D S L D SAbbreviations: L = life style interventions (dietary therapy and physical exercise); D = drugs; S = surgeryDiscussionAssessment limitationsThe T-section of this report suffers from several methodological limitations.First, this report only included systematic reviews/HTAs of RCTs as the primary source of evidencefor the safety and efficacy of bariatric treatment strategies. RCTs published after the search dates(2005 for dietary therapy/exercise, 2003 for behavioural therapy, 2008 for pharmacotherapy, and2009 for surgery) of the most recent reviews were not searched due to time constraints. However,most of the included systematic reviews/HTAs were published within the last 5 years. For example,the CADTH review on bariatric surgeries was conducted in 2010, which limited the possibility thatmore recent studies on newer surgical procedures (for example, sleeve gastrectomy) were missed.Bariatric treatments for adult obesity 94