Bariatric treatments for adult obesity - Institute of Health Economics

• have multiple focal points and levels of intervention (that is, at national, regional, community,and individual levels);• include both policies and programs;• build links between sectors that may otherwise be viewed as independent.Although the primary goal should be to prevent obesity, it appears that a large number of adultsworldwide could benefit from comprehensive assessments to identify those who are at risk ofdeveloping obesity as well as those who are obese and at high risk for associated adverseconsequences.Screening and diagnosis of adult obesityAccording to best practice recommendations in cases of overweight and obesity, BMI and waistcircumference measurements can function both as screening and as diagnostic tests for weightoutside the normal range. 1,2,6,7,13,22,27,80,108The diagnostic protocols are composed of physical examination, laboratory tests, psychologicalassessments, and a comprehensive evaluation of medical history. 1,2,6,7,13,27,108,109 The medical evaluationentails a complete history (eating patterns, behavioural patterns, physical activity, weight history,attempts at weight loss, and obesity-related risk factors and complications) and a physicalexamination (including BMI and waist circumference measurements), as well as appropriatelaboratory and diagnostic testing. During physical examination it is recommended that the presenceand impact of obesity-related health risks and diseases be assessed.The 2006 Canadian guidelines on diagnosis and management of obesity recommend: 1measuring BMI and waist circumference in all adults to assess obesity-related health risks;conducting a a clinical evaluation of obese adults that includes a history and a generalphysical examination to exclude secondary (endocrine or syndrome-related) causes of obesityand obesity-related health risks and complications;measuring fasting plasma glucose levels and determining a lipid profile, including totalcholesterol, triglycerides, LDL cholesterol, HDL cholesterol, and calculating the ratio of totalcholesterol to HDL cholesterol (repeating these tests at regular intervals as needed issuggested);conducting a psychological assessment:o to determine the person's readiness to change behaviours;o to identify barriers to weight loss;o to screen for eating and psychiatric disorders.The guidelines reference the International Diabetes Federation (IDF) cut-off points for waistcircumference, given that these measures better reflect the ethnic diversity of Canada. 1,3,94 Using IDFcriteria, over 50% of Canadians are considered abdominally obese.Management of adult obesityEffective management of adult obesity is multifaceted and complex and involves a range of longterm,if not lifelong, bariatric strategies. 1,2,6,7,13,17,21,27,46,50,56,80,82,83,105,106 The therapeutic approach to longtermweight management requires a specially adapted bariatric treatment structure that is tailored toBariatric treatments for adult obesity 18