Bariatric treatments for adult obesity - Institute of Health Economics

Obesity rates increased with age, from 8.1% among adults aged 18 to 24 years to the peak at23.5% among individuals aged 55 to 64 years. The proportion of obesity drops among theelderly (those over 65 years of age).Albertans who are high school graduates are less likely than those who did not graduatefrom high school to be classified as obese (17.2% and 22.5%, respectively).Obesity prevalence rates were higher for married and widowed adults (over 19%) than forsingle persons (12.4%) The relationship between obesity rates and household annual income did not vary in a linearfashion. Obesity rates were lower (approximately 16%) for those in income categories of lessthan $20,000 or between $40,000 and $59,000, and higher for those with incomes between$20,000 and $39,000 (17.7%) or between $60,000 and $70,000 (19.2%). The highest obesityrate (21.6%) was observed in individuals with incomes of more than $80,000. Obesity rates were lower in the Edmonton and Calgary zones (17.7% and 14.2%,respectively) than in other health zones in the province, where the rates ranged from 20% to25%.The latest directly measured adult obesity prevalence rates for Alberta were obtained from 2004CCHS data. In 2004, the adult obesity rate for Alberta was 25.2%, with the rates for classes I, II, andIII obesity being 15.4%, 6.7%, and 3.2%, respectively.Patterns of careGiven that long-term maintenance of weight loss is difficult to achieve once an individual becomesobese, both prevention strategies (to keep more individuals from becoming obese) and bariatrictreatment strategies (to assist those diagnosed with obesity in losing excess weight and keeping it offpermanently) should be considered when addressing obesity. A comprehensive and multisectoralapproach to obesity prevention is recommended, and effective action requires addressing thecommercial, environmental, and social policy drivers of obesity. Healthy behaviours need to besupported by public health measures, such as supportive environments and effective policy changesthat promote healthy weight and prevent obesity and its related health risks and consequences.Bariatric treatment for adults with obesityEvidence-based recommendations suggest that bariatric care for adults with obesity should addressboth the medical and the psychological burdens of obesity, and include prevention of further weightgain. A weight management program based on lifestyle and behavioural modification that includesdietary changes, increased physical activity, and behavioural therapy remains the cornerstone ofeffective bariatric care for adult obesity. Realistic weight loss goals must be clearly defined with theaffected individual, and the treatment plan should be individually tailored based on age, gender,degree of obesity, individual health risks, cardiometabolic and psychobehavioural characteristics, andoutcome of previous weight loss attempts. Pharmacotherapy may be added if lifestyle andbehavioural modification alone are insufficient to achieve clinically significant weight loss. Bariatricsurgery combined with long-term lifestyle modification may be an appropriate option for adults withsevere and moderate obesity (when BMI reaches 40 kg/m 2 and even 35 kg/m 2 if it is associated withcomorbidities) who do not respond to appropriate nonsurgical approaches.The therapeutic approach to adult obesity is multifaceted and complex, particularly for severeobesity, and is based on intensive patient education and counseling about improving dietary patterns,Bariatric treatments for adult obesity 39