Bariatric treatments for adult obesity - Institute of Health Economics

EXECUTIVE SUMMARYSocial and System DemographicsAdult obesity has emerged as a chronic medical condition characterized by an accumulation ofexcess body fat caused by a long-term energy imbalance that mainly results from complexinteractions of biological, environmental, and behavioural factors. In practice, it is defined accordingto body mass index (BMI), categorized as follows:BMI Range Type of Obesity Obesity Class30 kg/m 2 to 34.9 kg/m 2 mild obesity Class I obesity35 kg/m 2 to 39.9 kg/m 2 moderate obesity Class II obesity40 kg/m 2 or greater severe/extreme/morbid obesity Class III obesityAdult obesity is associated with multiple organ-specific and psychosocial consequences that mayresult in reduced quality of life and increased morbidity and premature mortality. The most seriousadverse health risks and consequences are associated with severe (class III) obesity.In Canada, as in other countries, the prevalence of obesity during the past 30 years has increasedprogressively within all demographic groups and continues to rise. This increase is influenced bynumerous individual-level and environmental factors.Among Alberta’s 2007 population of adults (aged 18 years and over), 17.7% were classified as obese,with 12.5% in class I, 3.7% in class II, and 1.5% in class III. These rates were based on self-reporteddata from the 2007 Canadian Community Health Survey (CCHS). They are considerably lower thanthe latest available directly measured rates from the 2004 CCHS data, where the measured adultobesity rate was 25.2% and the rates for classes I, II, and III obesity were 15.4%, 6.7%, and 3.2%,respectively.According to evidence-based recommendations, when addressing adult obesity, both preventionstrategies (to keep more individuals from becoming obese) and bariatric therapy (to assist thosediagnosed with obesity in managing their weight problems) should be considered. A comprehensiveand multisectoral approach to adult obesity prevention is recommended. Lifestyle and behaviouralmodification, based on intensive patient education and counseling, is recommended as an essentialpart of effective adult obesity management. Pharmacotherapy may be added if lifestyle andbehavioural modification interventions alone are insufficient. For severe and moderate obesity (BMI≥ 40 kg/m 2 and BMI ≥ 35 kg/m 2 with comorbidities) refractory to appropriate non-surgicaltreatments, bariatric surgery may be an appropriate option when combined with long-term lifestylemodifications.Bariatric treatment options should be stratified according to BMI and waist circumferencemeasurements, the presence of associated health risks and consequences, readiness for change andwillingness to comply with an individualized treatment plan, and failure of previous bariatrictreatments. Key components of quality bariatric care include:appropriate selection of patients for each treatment strategy;the availability of a multidisciplinary team that includes dedicated and appropriately trainedand credentialed personnel;Bariatric treatments for adult obesity – March 2012ii