Bariatric treatments for adult obesity - Institute of Health Economics

workers and other professionals, continue to educate, counsel, and assess the patient during multipleclinic sessions before surgery. The number of preoperative sessions varies among programs and is afunction of the staff resources available to the programs.Some individuals with obesity may not be considered suitable candidates for surgery during this time,and other treatment options may be determined to be more appropriate and successful in the longterm. Adults who qualify for bariatric surgery are required to demonstrate a change in lifestyle andbehaviour before the surgery. Compliance assessment is generally based on weight stabilization, fullcommitment to attending all pre-operative clinic sessions and follow-up appointments, and fullcommitment to self-monitoring (by practicing lifestyle journaling). The support of thesemultidisciplinary teams is offered to the patient throughout pre-operative periods, as well as duringand immediately after the surgery, and may continue long-term to help the patient maintain weightloss.Additional weight management programs exist that provide only nonsurgical bariatric care for adultobesity in Alberta. As well, a number of private clinics and programs, including the Calgary WeightManagement Program (www.cwmc.ca), the Lefebre Clinic in Calgary(www.calgaryweightlossclinic.com), and the 12 locations of the Dr. Bernstein clinics(http://ab.drbdiet.com), offer medically supervised weight loss in Alberta. The non-surgical weightmanagement programs vary according to their weight loss philosophies, the components of theprograms, and the costs that individuals pay while accessing these services.Additionally, the database of the College of Physicians and Surgeons of Alberta lists over 60 generalpractitioners or family doctors that declare obesity, bariatric care, or weight management as one oftheir primary interests. There are also 15 specialists (not including bariatric surgeons) who considerobesity to be one of their primary interests.LimitationsThe present review has several limitations. The literature review was limited to reports of articles anddocuments that were written in English and published between January 2005 and June 2010.Proprietary reports were excluded. Only full-text articles were selected because abstracts provideinsufficient details to allow an accurate, unbiased assessment and comparison of the study results.The authors of the abstract-only publications were not contacted for full details of their studies.The present review only summarizes the recommendations from reports of relevant, evidence-basedclinical practice guidelines and care pathways, and does not appraise their scientific foundations.A literature search focused on program evaluation studies was not conducted.Clear answers could not be provided for some questions due to the absence of relevant data forAlberta.SummaryThe social systems and demographics review summarizes the available evidence from the scientificliterature published in Canada and worldwide (mainly in North America) and the informationobtained from Canadian databases to address the questions about the burden of adult obesity, thepopulation dynamics of affected individuals, the current patterns of care and issues related to theimplementation and provision of bariatric treatments within weight management/bariatric programs.The following sections highlight the key findings.Bariatric treatments for adult obesity 37