Bariatric treatments for adult obesity - Institute of Health Economics

programs using lifestyle and behaviour modification interventions as well as pharmacotherapytypically produce a 5% to 10% reduction in initial weight at 1 year. 1,42,53,55,57These weight loss outcomes may help improve the health and psychosocial status of individuals withmild to moderate obesity without related comorbidity, but probably have little effect on the healthstatus and well being of those with extreme morbidity. 1,2,13,17,39,40,53-55,57,62,74,78,79,82,83 Severely obeseindividuals typically respond poorly to non-surgical bariatric treatments in terms of achievingclinically significant weight loss.Bariatric surgerySurgical treatment of obesity, or bariatric surgery, has emerged as the preferred option for suitablecandidates with moderate to severe obesity who are refractory to non-surgical bariatric treatments:to facilitate significant and sustained weight loss;to resolve or improve associated morbidity; to improve QoL. 1,2,6,7,13-15,17,24,27,35,39,40,42,46,50,53-58,68,69,78,82,83,91,120-123Bariatric surgery is based on restricting food intake or on reducing nutrient absorption. Variousprocedures have been developed to alter the anatomic and physiologic function of the stomach tomeet therapeutic goals.Based on their mechanism of action, the available procedures can be broadly categorized into:restrictive procedures (such as adjustable gastric banding);malabsorptive procedures (such as biliopancreatic diversion); hybrid procedures that combine restrictive and malabsorptive procedures (such as Roux-en-Y gastric bypass).Each of these procedures can be performed using either an open approach or a laparoscopicapproach.Candidates must meet specific criteria and must be motivated and fully informed. 1,2,6,7,13,15,17,24,27,35,39,40,42,46,50,53-58,68,69,78,82,83,91,120Age and weight criteria for bariatric surgery candidacy have widened in parallelwith the growing prevalence of severe obesity in the elderly and the rapid increase in the prevalenceof extremely severe obesity (BMI ≥ 50 kg/m 2 ). 14,15,56,78,82,83,120,122,123Psychosocial factors of those who undertook bariatric surgery and obtained a poor weight outcomehave been studied. 39,40,53-55,57,58,115 In many cases of noncompliance with the rigours of the postoperativeregime, the presence of psychological distress or of environmental stressors emerged,which interfered with the adaptability of the patients. As a consequence, there has been a tendencyin clinical practice to screen out patients with significant psychological or psychiatric disturbances.Typically cited contraindications include active substance abuse, active psychosis, bulimia nervosa,and severe uncontrolled depression. 55 However, there is no consensus that these disturbances arenegative indicators for surgery, especially if adequate management is provided. 39,40,53-55,57,58Bariatric surgery does not lead to equal results for every patient and several studies have suggestedthat the resulting anatomic and physiological changes may have an adverse affect onQoL. 14,15,39,40,53,54,57,71,122,124 After bariatric surgery patients struggle to adhere to the rigours of the postoperativeregimens and may suffer from various nutritional deficiencies, psychological battles withBariatric treatments for adult obesity 22