Bariatric treatments for adult obesity - Institute of Health Economics

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Very-low-calorie diet (VLCD): a diet that contains less than 800 calories.Waist circumference: a measurement of the waist.Weight cycle: losing and gaining weight over and over again. It is commonly called “yo-yo” dieting(going on a diet to lose weight, going off the diet and gaining weight back again, then repeating theprocess).Weight loss: a decrease in body weight, in either voluntary or involuntary circumstances. Mostinstances of weight loss arise from the loss of body fat, but in cases of extreme or severe weight loss,protein and other substances in the body can also be depleted.Waist-to-hip ratio (WHR): a measurement that compares the size of your waist in inches to themeasurement of your hips. The risk for developing heart disease is typically indicated by the waistto-hipratio.Bariatric treatments for adult obesity – March 2012xxi
SECTION ONE: SOCIAL AND SYSTEM DEMOGRAPHICSPaula Corabian, BSc, MPH, Charles Yan, PhDMETHODOLOGY: SOCIAL SYSTEMS AND DEMOGRAPHICS (S)APPROACHThe social systems and demographics approach (SSDA) addresses the following questions:What is adult obesity (definition, progression, severity, associated co-morbidities)?What are the prevalence and incidence of adult obesity in Alberta and Canada?What is the standard of care for adult obesity in Alberta and Canada?What patient selection criteria are used for various bariatric treatments (non-surgical andsurgical) in adult Albertans and Canadians with obesity?How many adults with obesity in Alberta and Canada would benefit from appropriatebariatric treatments?What demand exists for bariatric treatments for adult obesity in Alberta and Canada?What are the utilization and the discontinuation rates of bariatric treatments in Alberta andCanada?What are the barriers to adult obesity management from the perspective of patients and theircaregivers? Do any issues exist related to acceptability, adherence/compliance, quality of life,and/or access when using appropriate bariatric treatments for adult obesity in Alberta?What are the number and distribution of programs that provide bariatric treatments withinclinical settings/facilities for adult obesity in Alberta? How many are primary, how many aresecondary, and how many are tertiary care programs?Are the available weight management programs accredited for adult obesity management inAlberta and are they all publicly funded?What are the number and the distribution of appropriately trained healthcare practitionersand support staff capable of providing bariatric treatments for adult obesity in Alberta?What barriers exist to managing adult obesity in Alberta from the perspective of healthcareproviders? Do issues exist with relation to training and accreditation, acceptability, qualitycontrol, and/or any ethical and legal matters when using appropriate bariatric treatments? What are the implications (to society, families/caregivers, and the affected individuals) forthe use of multidisciplinary programs providing bariatric treatments for adult obesity inAlberta?Search strategyTo answer the SSDA questions, the medical literature was searched to identify any relevant articlesand documents published between January 2005 and June 2010 using key health informationresources, including PubMed/MEDLINE, the Cochrane Database of Systematic Reviews, and theCentre for Reviews and Dissemination (CRD) databases (see Appendix S.A for more details).Bariatric treatments for adult obesity – March 2012 1
Page 1 and 2: Alberta STE ReportBariatric treatme
Page 3 and 4: Alberta STE ReportBariatric treatme
Page 5 and 6: EXECUTIVE SUMMARYSocial and System
Page 7 and 8: Three surgical procedures—adjusta
Page 9: Costs of Bariatric Surgery and Pote
Page 12 and 13: Regulatory status .................
Page 14 and 15: TABLES AND FIGURESSection One: Soci
Page 16 and 17: ABBREVIATIONSAll abbreviations that
Page 18 and 19: LYMmMAMDMUHCNANHLBINHSNICENIHNNHNPH
Page 20 and 21: Bariatric physician: a licensed Doc
Page 22 and 23: High-density lipoprotein (HDL): a f
Page 26 and 27: Additional Internet searches were c
Page 28 and 29: This report addresses obesity in ad
Page 30 and 31: Many systemic factors have been ide
Page 32 and 33: Severe obesity is associated with d
Page 34 and 35: eport their height and under-report
Page 36 and 37: Also using self-reported data from
Page 38 and 39: An examination of overall obesity d
Page 40 and 41: Table S.2 presents the associationa
Page 42 and 43: • have multiple focal points and
Page 45 and 46: The main problem in any weight mana
Page 47: food, and a negative body image. As
Page 50 and 51: directly causes death. 61 To the ex
Page 52 and 53: The addition of a selected pharmaco
Page 54 and 55: lack of formal training in nutritio
Page 56 and 57: slightly more likely to have prescr
Page 58 and 59: selection criteria, have facilities
Page 60 and 61: Barriers to using appropriate baria
Page 62 and 63: Overview of adult obesityOver the p
Page 64 and 65: the need for regular physical activ
Page 66 and 67: phenylpropanolamine/25. Sibutramine
Page 68 and 69: 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
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34. Gostin LO. Fast and supersized:
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69. Klarenbach S, Padwal R, Wiebe N
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105. Hill JO, Thompson H, Wyatt H.
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141. Ross R, Bradshaw AJ. The futur
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172. Arkinson J, Ji H, Fallah S, Pe
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This section will address a set of
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dietary therapy is to reduce total
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Additional benefits of exercise ove
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medications that inhibit intestinal
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Rimonabant may be considered for pa
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Long-term complications are specifi
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Devices used for bariatric surgeryH
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Description of the Included Systema
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AEs for sibutramineAs compared to a
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Evidence on Efficacy/EffectivenessW
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Table T.7: Effects of behavioural t
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SurgeryDescription of the included
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follow-up time was 3 years. Results
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group as compared to the VBG group.
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The authors identified many methodo
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The investigators pointed out that
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approximately 3 to 5 kilograms. For
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for studies with a mean age of part
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Examining whether use of any of the
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Evidence from placebo-controlled cl
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colorectal or gastroesophageal or f
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Web of ScienceISI Interface License
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AMA Clinical PracticeGuidelineswww.
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critical appraisal of the included
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APPENDIX T.B: EXCLUDED STUDIESTable
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Padwal R, Li SK, Lau DC. Long-term
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Quality subsection 1: At least MEDL
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Quality subsection 5a:Study quality
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Partially reported: The study types
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Table T.C.1: Results of quality ass
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Table T.C.1: Results of quality ass
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APPENDIX T.D: CHARACTERISTICS OF SY
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Table T.D.1: Characteristics of the
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APPENDIX T.E: EVIDENCE TABLE ON SAF
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Serious surgical complicationsSurgi
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LSGmMAMDNAnssORQoLRCTRDRRRYGBSBPTGV
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Table T.F.1-2: Weight loss - Behavi
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Table T.F.1-4: Weight loss - Surger
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Table T.F.2: Quality of life (QoL)
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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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Page 222 and 223:
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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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