Bariatric treatments for adult obesity - Institute of Health Economics

Evidence from placebo-controlled clinical trials suggests that three anti-obesity drugs—orlistat,sibutramine, and rimonabant—are modestly effective in reducing weight and have different effectson cardiovascular risk. The SRs/HTAs assessed in this report did not include primary studies onhead-to-head comparisons of the three drugs; it is not clear at this time whether one particular drugis more efficacious than another.Although data from large, adequately powered, long-term RCTs are lacking, bariatric surgery appearsto be more effective than dietary therapy, with or without physical exercise, for the treatment ofsevere obesity in adults. Evidence from a small RCT also suggests that, compared to intensivemedical treatment, surgery results in significantly greater weight reduction in obese people (BMI 30to 40 kg/m 2 ) diagnosed with type 2 diabetes.Procedures that are mainly diversionary (for example, BPD) result in the greatest amounts of weightloss, hybrid procedures (for example, RYGB) are of intermediate effectiveness, and restrictiveprocedures (for example, AGB) result in the least amounts of weight loss. The choice betweenRYGB and AGB depends on trade-offs between the risk of adverse events and the need forprocedure conversion or reversals. The evidence base for sleeve gastrectomy was limited.Various patients’ characteristics and comorbidities play an important role, but these variables havenot been fully explored. The evidence base is biased and of poor quality due to short-term follow-upand high attrition rates. In addition, there is a lack of information as to how outcomes are measuredand analyzed.As obesity is a chronic disease and its etiology is complex, a comprehensive provincial weightmanagement program equipped with a multidisciplinary team, consisting of dieticians, physicaltherapists, psychologist, medical doctors/nurses, and bariatric surgeons, is necessary. Dietary therapyand physical exercise should be the cornerstone of such a program, upon which pharmacotherapyand bariatric surgery can be provided for appropriate individuals who are overweight or obese.Bariatric treatments for adult obesity 100