Bariatric treatments for adult obesity - Institute of Health Economics

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for studies with a mean age of participants of less than 45 years was a reduction in weight of 1.6kilograms in the exercise and diet group as compared to the diet alone group. The pooled effect forstudies with a mean age of participants of greater than 45 years was a reduction in weight of 1.0kilograms in the exercise and diet group as compared to the diet alone group. However, nosubgroup analysis was conducted based on the BMI cut-offs.BMIIn general, patients with a BMI less than 30 kg/m 2 were selected for lifestyle interventions,behavioural therapy, and pharmacotherapy, while patients with a BMI greater than 35 kg/m 2 (severeobesity) were considered for bariatric surgery. Some reviews included both overweight and obesepatients, but no sub-group analysis was conducted for different BMI cut-offs.Presence of comorbidityIn a review 56 of lifestyle interventions, a subgroup analysis was conducted in overweight and obesepatients with impaired glucose tolerance in the prevention of diabetes. Compared with standard care(not defined), lifestyle interventions significantly reduced body weight and cardiovascular risk factorsbut had limited impact or no impact on low-density lipoprotein and HbA1c levels.Motivation/complianceHigh drop-out rates are a major problem with obesity studies and may contribute to a substantialvariation in outcomes such as weight loss among participants. 7Patients participating in obesity clinical trials usually achieve better results than non-trial participants,as they are more motivated and receive greater supervision and encouragement. Thus, results inclinical practice will inevitably be less favourable and more variable than those in a trial setting. 7A number of factors, listed in Table T.10, have been identified that may impact clinical outcomes.Strategies that address these factors may help achiving longer-term weight loss and weightmaintenance. 71Table T.10: Factors underlying weight regain after weight lossPre-treatmentPost-treatmentOlder age Weight reduction greater than 15% to 30%High number of previous dietsHigh maximum or baseline body weightFrequent binge eating“All or nothing” thinkingLack of dietary restraintLow level of exercise and diet self-efficacyLow motivationSource: Ulen et al., 2008 71Early weight regainNot responding to early weight regainHigh levels of perceived hungerDissatisfaction with weight lossLack of dietary restraintFrequent emotional eatingFrequent binge eatingDiet high in calories, fats, and sugarsDecreased frequency and level of exerciseTelevision viewing more than two to four hours/dayBariatric treatments for adult obesity 96
In the present report, none of the included systematic reviews/HTAs specifically reported onpatient motivation and compliance with treatments. In the pharmacotherapy studies, patientseventually selected for randomization were those who complied with the treatment and lost therequired weight during the run-in phase.Gaps in evidence and future researchA number of research gaps and suggestions for future research were identified from the includedsystematic reviews/HTAs.GeneralDetermining the optimal duration of treatment.Identifying program patterns that are more effective in the long-term.Verifying the reasons for dropouts.Including outcomes such as frequency of pre-established responses to interventions.Describing the randomization and blinding processes and including intention-to-treatanalyses.Analyzing the effect of treatment assignment on health-related quality of life, with andwithout adjustment for weight change, to determine the true relationships among obesitytreatment, weight loss, and health-related quality of life.Conducting subgroup analyses by age, gender, and initial weight to explore effect sizedifferences. Investigating issues of intentionality, type of weight loss, and objective measurements ofweight changes in well-designed prospective studies, to assess the real impact of weight losson all-cause mortality in the long-term, for overweight/obese populations.Dietary therapy/physical exerciseAdapting lifestyle interventions based on the need of each patient population, taking intoconsideration different dietary and physical activity backgrounds. Examining additional outcomes to evaluate possible associations—behavioural andphysiological factors, among others—as well as to explore differences between individualsthat regained weight and those who maintained weight loss.PharmacotherapyConducting longer and more scientifically rigorous studies of antiobesity drugs that arepowered to examine endpoints such as mortality and cardiovascular morbidity.Determining the long-term effect of antiobesity drugs on health outcomes.Conducting head-to-head comparisons to determine the relative efficacy of different drugs.Examining whether combinations of drugs promote greater weight loss than use ofindividual drugs.Bariatric treatments for adult obesity 97
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Alberta STE ReportBariatric treatme
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Alberta STE ReportBariatric treatme
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EXECUTIVE SUMMARYSocial and System
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Three surgical procedures—adjusta
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Costs of Bariatric Surgery and Pote
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Regulatory status .................
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TABLES AND FIGURESSection One: Soci
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ABBREVIATIONSAll abbreviations that
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LYMmMAMDMUHCNANHLBINHSNICENIHNNHNPH
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Bariatric physician: a licensed Doc
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High-density lipoprotein (HDL): a f
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Very-low-calorie diet (VLCD): a die
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Additional Internet searches were c
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This report addresses obesity in ad
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Many systemic factors have been ide
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Severe obesity is associated with d
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eport their height and under-report
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Also using self-reported data from
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An examination of overall obesity d
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Table S.2 presents the associationa
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• have multiple focal points and
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The main problem in any weight mana
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food, and a negative body image. As
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directly causes death. 61 To the ex
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The addition of a selected pharmaco
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lack of formal training in nutritio
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slightly more likely to have prescr
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selection criteria, have facilities
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Barriers to using appropriate baria
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Overview of adult obesityOver the p
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the need for regular physical activ
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phenylpropanolamine/25. Sibutramine
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Complianceand AdherenceDemand andut
Page 70 and 71: Aetna Clinical PolicyBulletinswww.a
Page 72 and 73: Overweight 123,821 172,971 157,623
Page 74 and 75: REFERENCES1. 2006 Canadian clinical
Page 76 and 77: 34. Gostin LO. Fast and supersized:
Page 78 and 79: 69. Klarenbach S, Padwal R, Wiebe N
Page 80 and 81: 105. Hill JO, Thompson H, Wyatt H.
Page 82 and 83: 141. Ross R, Bradshaw AJ. The futur
Page 84 and 85: 172. Arkinson J, Ji H, Fallah S, Pe
Page 86 and 87: This section will address a set of
Page 88 and 89: dietary therapy is to reduce total
Page 90 and 91: Additional benefits of exercise ove
Page 92 and 93: medications that inhibit intestinal
Page 94 and 95: Rimonabant may be considered for pa
Page 96 and 97: Long-term complications are specifi
Page 98 and 99: Devices used for bariatric surgeryH
Page 100 and 101: Description of the Included Systema
Page 102 and 103: AEs for sibutramineAs compared to a
Page 104 and 105: Evidence on Efficacy/EffectivenessW
Page 106 and 107: Table T.7: Effects of behavioural t
Page 108 and 109: SurgeryDescription of the included
Page 110 and 111: follow-up time was 3 years. Results
Page 112 and 113: group as compared to the VBG group.
Page 114 and 115: The authors identified many methodo
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Page 118 and 119: approximately 3 to 5 kilograms. For
Page 122 and 123: Examining whether use of any of the
Page 124 and 125: Evidence from placebo-controlled cl
Page 126 and 127: colorectal or gastroesophageal or f
Page 128 and 129: Web of ScienceISI Interface License
Page 130 and 131: AMA Clinical PracticeGuidelineswww.
Page 132 and 133: critical appraisal of the included
Page 134 and 135: APPENDIX T.B: EXCLUDED STUDIESTable
Page 136 and 137: Padwal R, Li SK, Lau DC. Long-term
Page 138 and 139: Quality subsection 1: At least MEDL
Page 140 and 141: Quality subsection 5a:Study quality
Page 142 and 143: Partially reported: The study types
Page 144 and 145: Table T.C.1: Results of quality ass
Page 146 and 147: Table T.C.1: Results of quality ass
Page 148 and 149: APPENDIX T.D: CHARACTERISTICS OF SY
Page 150 and 151: Table T.D.1: Characteristics of the
Page 156 and 157: APPENDIX T.E: EVIDENCE TABLE ON SAF
Page 158 and 159: Serious surgical complicationsSurgi
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Page 162 and 163: Table T.F.1-2: Weight loss - Behavi
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Page 166 and 167: Table T.F.2: Quality of life (QoL)
Page 168 and 169: Curioni & Lourenco 2005 58Cholester
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Table T.F.3-3: Risk factors/comorbi
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Table T.F.3-5: Long-term effects of
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Maciejewski et al., 2005 65Avenell
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Table T.G.2: Effects of bariatric s
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Table T.G.4: Effects of bariatric s
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18. Cerulli J, Lomaestro BM, Malone
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50. Health Canada Drug Product Data
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SECTION THREE: ECONOMIC EVALUATIONC
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Definition of bariatric surgical pa
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etween surgical interventions, the
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concluded that adding orlistat to L
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Weight management program (WMP) ver
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groups. Compared with standard care
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Results from Analysis of Provincial
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DiscussionThe objectives of the eco
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surgical suites, and so on. The bud
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APPENDIX E.A: LITERATURE SEARCH SUM
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CRD Databases(DARE, HTA & NHS EED)h
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Web of ScienceISI Interface License
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NEOS Librarywww.library.ualberta.ca
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Table E.A.2: Evidence table of revi
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ResultHealth outcomesCostsMarginal
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CostsMarginal analysisThe cost anal
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Time Horizon/discount rateCurrency/
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Objectivestudy perspective: society
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S4Economic burden of obesityMean co
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15. Lacey LA, Wolf A, O'shea D, Ern
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Author Contribution StatementsPaula
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