Bariatric treatments for adult obesity - Institute of Health Economics

directly causes death. 61 To the extent that it contributes to premature death, it does so bycontributing to chronic diseases, such as diabetes, heart disease, and cancer, that generally manifestover years to decades. The causal pathway involved is lengthy and obesity is a distant, “upstream”factor.Whereas substantial attention has been paid to the role of nutritional and psychobehavioural factorsin weight management, the role played by hormonal and hereditary determinants of weight loss andweight loss maintenance has not been well studied. 46Evidence-based recommendationsAccording to evidence-based best practice guidance, the clinical decision on selecting appropriatebariatric treatment strategies is based on BMI and/or waist circumference (WC) and health risks orcomorbidity (see Table S.4). 1,2,6,7,13,18,27,108 The majority of the documents used the WHO obesityclassification based on BMI. No document has yet been found that used the Edmonton ObesityStaging System. 5Table S.4: Bariatric treatments for obese adults with different BMI, WC, and healthrisks/comorbiditiesCountry(specialtybody/agency)Canada(Obesity Canada)2006 1,3,94LifestylemodificationinterventionFirst line (dietary therapy, physicalactivity, CBT) for adults with a BMI≥ 25 kg/m 2 or WC ≥ cut-offs (seeTable S.3)Behaviouralmodificationintervention Pharmacotherapy SurgeryAdjunct to lifestyle andbehavioural modificationfor adults with a BMI 27.0to 29.9 with risk factors, ora BMI ≥ 30 who failedappropriate lifestyle andbehavioural modificationinterventionsCanada First line (dietary-lifestyle therapy, physical activity) for adults with a(CTFPHC) BMI ≥ 25; add behavioural-cognitive therapy and pharmacotherapy,2006 108 as appropriate, for adults who failed dietary-lifestyle and physicalactivityUS (ACP)2005 7UK (NICE)2006 13First line (diet, exercise, behaviouralinterventions) for adults with a BMI≥ 30 kg/m 2First line (diet, physical activity,behavioural techniques) for adultswith a BMI ≥ 25 kg/m 2 or WC ≥cut-offs (see Table S.3)Adjunct to lifestyle andbehavioural modificationfor adults who faileddiet/exerciseAdjunct to lifestyle andbehavioural modificationfor adults with a BMI ≥ 25kg/m 2 with comorbidities,or a BMI ≥ 35 kg/m 2 whofailed appropriate lifestyleand behaviouralmodification interventionLast option for adults with aBMI 35.0–39.9 kg/m 2 andserious comorbidities, or aBMI ≥ 40, who failedappropriate nonsurgical BTLast option for adults with aBMI ≥ 40 kg/m 2 , whofailed appropriatenonsurgical BTLast option for adults with aBMI ≥ 40 kg/m 2 , whofailed appropriatenonsurgical BTLast option for adults with aBMI ≥ 35 kg/m 2 andcomorbidities (that could beimproved by weight loss), ora BMI ≥ 40 kg/m 2 whofailed appropriatenonsurgical BTFirst line option forindividuals with a BMI ≥ 50kg/m 2Bariatric treatments for adult obesity 26