Bariatric treatments for adult obesity - Institute of Health Economics

UK (NHS)2006 27UK (SIGN)2010 2,18Europe (EASOOMTF) 2008 6First line (diet, physical activity, behavioural advice) for adults with aBMI ≥ 30 kg/m 2 , or a BMI ≥ 2 kg/m 2 8 with co-morbidities; addpharmacotherapy in adults aged 18 to 75, if indicated, according toCPG by NICEFirst line (dietary interventions,physical activity, behaviouralinterventions) for adults with aBMI ≥ 25 kg/m 2 or WC ≥ cutoffs(see Table S.3)First line (dietary interventions,physical activity, cognitivebehavioural interventions) foradults with a BMI ≥ 25 kg/m 2or WC ≥ cut-offs (see TableS.3)Adjunct to lifestyle andbehavioural modification foradults with a BMI ≥ 28 kg/m 2and co-morbidities, or a BMI ≥30 kg/m 2 who failed appropriatelifestyle and behaviouralmodification interventionAdjunct to lifestyle andbehavioural modification foradults with a BMI ≥ 27 kg/m 2and co-morbidities, or a BMI ≥30 kg/m 2 who failed appropriatelifestyle and behaviouralmodification interventionLast option for adults with aBMI ≥ 35 kg/m 2 andcomorbidities, or a BMI ≥40 kg/m 2 who failedappropriate nonsurgical BTLast option for adults with aBMI ≥ 35 kg/m 2 and severecomorbidities (expected toimprove significantly withweight reduction) whocompleted structured WMprogram and failedappropriate nonsurgical BTLast option for adults (aged18 to 60) with a BMI 35.0–39.9 kg/m 2 andcomorbidities (expected tobe improved by weightloss), or a BMI ≥ 40 kg/m 2who failed appropriatenonsurgical BTAbbreviations: ACP = American College of Physicians; BMI = body mass index (kg/m 2 ); BT = bariatric treatment(s); CBT =cognitive-bahaviour therapy; CPG = Clinical Practice Guidelines; CTFPHC = The Canadian Task Force on Preventive Health Care;EASO OMTF = Obesity Management Task Force of the European Association for the Study of Obesity; NICE = National Institutefor Health and Clinical Excellence; NHS = National Health Service; SIGN = Scottish Intercollegiate Guidelines Network; UK =United Kingdom; US = United States of America; WC = waist circumference; WM = weight managementAccording to the reviewed CPGs: 1,2,6,7,13,27,108Lifestyle and behavioural modification should be considered as the first line of treatment forall adults with obesity to achieve clinically important weight loss and reduce obesity-relatedhealth risks, suggesting that all structured weight management programs should includedietary change, physical activity, and behavioural components.o The goal of a dietary intervention is to create a deficit of 500 to 1000 kcal per day toachieve a gradual weight loss of one to two pounds per week, over a 3- to 6-monthperiod. Further weight loss should be considered after a period of weightmaintenance. When choosing from various dietary strategies, individualization (basedon age, preference and taste, obesity level and health risk category, and the presenceof other comorbid disease) is recommended to increase compliance and the chancesof success.o Individuals consulting about weight management should be encouraged to reducesedentary behaviour (such as television viewing and computer use) and to graduallyincorporate 30 to 60 minutes of moderate physical activity per day on most days ofthe week. As with dietary interventions, physical activity and exercise should beindividually tailored to obesity level, age, and the presence of health risks andcomorbidities.o Individuals willing to participate in weight management programs should beprovided with education and with cognitive and behavioural techniques as adjunctsto dietary therapy and physical activity.Bariatric treatments for adult obesity 27