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Chalmers KA, Cousins SE, Blazeby JM. Randomized controlled trials comparing gastric bypass, gastric band, and sleeve gastrectomy: A systematic review examining validity and applicability to wider clinical practice. Obes Rev 2024; 25:e13718. [PMID: 38346786 DOI: 10.1111/obr.13718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 04/18/2024]
Abstract
Consideration of how applicable the results of surgical trials are to clinical practice is important to inform decision-making. Randomized controlled trials comparing at least two surgical interventions (of gastric bypass, gastric band, and sleeve gastrectomy) for severe and complex obesity were examined using the PRagmatic Explanatory Continuum Indicator Summary-2 tool, to consider how applicable the trial results are to clinical practice, and the Risk of Bias 2 tool, to examine validity. MEDLINE, Embase, and CENTRAL databases were searched for studies published between November 2013 and June 2021, and 15 were identified. Using the PRagmatic Explanatory Continuum Indicator Summary-2 tool, three were classified as pragmatic, with good applicability to clinical practice. Ten had more explanatory domains but did include some pragmatic characteristics, and two were predominantly explanatory. This was due to some trial design features that would not be considered applicable to the wider clinical setting, including being single-centered, having prescribed intervention delivery methods, and intensive follow-up regimens. Only two trials had low risk of bias, of which one was considered pragmatic. Three had high risk of bias. Overall, few trials in bariatric surgery are pragmatic with low risk of bias. Well-designed pragmatic trials are needed to inform practice and reduce research waste.
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Affiliation(s)
- Katy A Chalmers
- National Institute of Health and Care Research (NIHR) Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Sian E Cousins
- National Institute of Health and Care Research (NIHR) Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Jane M Blazeby
- National Institute of Health and Care Research (NIHR) Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Surgical Innovation Theme and the Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
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2
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Shikwambana MM, Fourie JV. Supporting a Tsonga learner living with Bardet-Biedl syndrome, a rare complex disability. Afr J Disabil 2023; 12:1181. [PMID: 38204908 PMCID: PMC10777427 DOI: 10.4102/ajod.v12i0.1181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/30/2023] [Indexed: 01/12/2024] Open
Abstract
Background Bardet-Biedl syndrome (BBS) is a rare, systemic, hereditary disorder characterised by obesity, polydactyly, visual and auditory impairment, and cognitive disability. Providing quality education in appropriate schools for children who present with such complex chronic conditions is challenging. Objectives This study explored the dimensions of psycho-educational support needs for a child with BBS in South Africa to contribute to the improvement of early detection and holistic interventions. Method A descriptive in-depth qualitative case study of Gezani, an adolescent Tsonga boy diagnosed with BBS, was undertaken. Semi-structured interviews were conducted with his parents and teachers to ascertain the boy's psycho-educational support needs. Medical reports provided information on the complexities and prognosis of the syndrome. Observations in the classroom corroborated the learner's symptoms and behaviours. Results Thematic content analysis revealed the key areas of support needs. Gezani's cognitive disability required a modified, slow-paced curriculum. His visual impairment required mobility orientation training and learning Braille. His emotional needs were supported with psychotherapy to maintain a sense of well-being. Medical monitoring was recommended with interventions for walking and managing his diet and weight. Speech therapy supported his communication skills. Conclusion Learners with multiple disabilities require carefully planned, individualised psycho-educational support programmes addressing their unique needs and delays with targeted remedial interventions in appropriate special needs schools. Contribution This study informs educators about BBS and provides multi-faceted, holistic support. The Department of Basic Education could bring special schools and national policies in tighter alignment for learners presenting with complex disabilities.
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Affiliation(s)
- Mfungana M Shikwambana
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg, South Africa
| | - Jean V Fourie
- Department of Educational Psychology, Faculty of Education, University of Johannesburg, Johannesburg, South Africa
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3
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Rees M, Collins CE, Majellano EC, McDonald VM. Healthcare Professionals' Perspectives of Nonsurgical Care of Older Inpatients with Class II or III Obesity and Comorbidities: A Qualitative Study. J Multidiscip Healthc 2023; 16:3339-3355. [PMID: 38024134 PMCID: PMC10640832 DOI: 10.2147/jmdh.s421520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Older people with Class II or III obesity and comorbidities experience complex care needs with frequent hospital admissions. In 2019/20 the National Health Service in England reported a 17% increase in hospital admissions of patients with obesity compared to 2018/19. Gaps in care for this population have been identified. Purpose The purpose of this study was to understand the experiences and perspectives of healthcare professionals delivering non-surgical care to older people with Classes II or III obesity admitted to a tertiary care hospital. Methods Healthcare professionals delivering non-surgical care to older people admitted with Class II or III obesity with comorbidities were recruited from an Australian tertiary referral hospital. Qualitative semi-structured interviews were conducted with 24 healthcare professionals from seven disciplines between August and December 2019. The interviews were audio-recorded, transcribed, and reviewed by participants for accuracy. Thematic inductive data analysis was deductively mapped to the Theoretical Domains Framework (TDF). Results Four major themes of Barriers, Facilitators, Current Practice, and Recommendations and 11 subthemes were identified and mapped to nine domains in the TDF. The Barriers subtheme identified perceived patient related factors, health system issues, and provider issues, while the Facilitators subtheme included a patient centred approach, knowledge, and resources in the subacute setting. The major Current Practice theme explored factors influencing clinical management, and the Recommendations subthemes included engaging patients, access to quality care, education and support, and obesity as a chronic disease. Conclusion This novel application of the TDF provided broad insights related to the barriers and facilitators in delivering non-surgical care to this hospital population, from the perspective of healthcare professionals. Understanding how these barriers interact can provide strategies to influence behaviour change and assist in the development of a holistic multidisciplinary model of care.
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Affiliation(s)
- Merridie Rees
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Clare E Collins
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Eleanor C Majellano
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Medical and Interventional Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Vanessa M McDonald
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- Medical and Interventional Services, Hunter New England Local Health District, Newcastle, NSW, Australia
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4
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Mendes C, Carvalho M, Oliveira L, Rodrigues LM, Gregório J. Nurse-led intervention for the management of bariatric surgery patients: A systematic review. Obes Rev 2023; 24:e13614. [PMID: 37607837 DOI: 10.1111/obr.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/16/2023] [Accepted: 06/24/2023] [Indexed: 08/24/2023]
Abstract
The prevalence of obesity has become a global health concern, and severe obesity is associated with various chronic diseases and decreased quality of life. Bariatric surgery has shown success in treating obesity. Nevertheless, some patients experience weight regain and unsatisfactory outcomes. Multidisciplinary interventions have been shown to improve postoperative outcomes. Case managers, often specialized nurses, play a crucial role in patient support and coordination of care. However, the diverse design of case-managing interventions hinders the assessment of their success. Thus, the aim of this review is to identify the most successful structural characteristics of case-managing interventions, with or without the support of e-Health, in the process of perioperative management of bariatric surgery patients. A systematic literature review was conducted following the PRISMA guidelines. PubMed, MEDLINE, EBSCOhost, and CINAHL databases were searched for relevant studies published in the last 10 years. Eligible studies included randomized controlled trials, controlled clinical studies, case studies, or observational studies that evaluated perioperative care in bariatric surgery. The PICO framework was used to frame the search strategy. The initial search yielded 225 articles, of which 10 studies met the inclusion criteria. Nurse-led case-managing interventions with a multidisciplinary approach showed positive results in weight loss, physical activity, and quality of life. Patient-centered care models were found to promote adherence to treatment and patient satisfaction. E-Health technologies improved quality of life but not weight loss. The duration of behavioral interventions and the long-term outcomes after surgery remained unclear. Nurse-led case-management interventions, with a focus on behavioral change and multidisciplinary approaches, show promise in improving outcomes in bariatric surgery patients. Patient-centered care models and longer term interventions may contribute to sustained weight loss and better postoperative outcomes. Further research is needed to determine the optimal duration of interventions and the long-term effects on weight maintenance.
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Affiliation(s)
- Cláudia Mendes
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal
- CRI.COM-Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
- Escuela de Doctorado, Programa de Ciencias de la Salud, Universidade de Alcalá, Madrid, Spain
| | - Manuel Carvalho
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal
- CRI.COM-Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
| | - Leandro Oliveira
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - Luís Monteiro Rodrigues
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - João Gregório
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
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Watkins R, Swancutt D, Alexander M, Moghadam S, Perry S, Dean S, Sheaff R, Pinkney J, Tarrant M, Lloyd J. A Qualitative Exploration of Patient and Staff Experiences of the Receipt and Delivery of Specialist Weight Management Services in the UK. THE PATIENT 2023; 16:625-640. [PMID: 37572233 PMCID: PMC10570191 DOI: 10.1007/s40271-023-00644-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Addressing the increasing prevalence of obesity is a global public health priority. Severe obesity (body mass index > 40) reduces life expectancy, due to its association with people developing complications (e.g. diabetes, cancer, cardiovascular disease), and greatly impairs quality of life. The National Health Service (NHS) in the UK provides specialist weight management services (SWMS) for people with severe obesity, but key uncertainties remain around patient access to and engagement with weight management services, as well as pathways beyond the service. METHODS In this multiple methods study, using online forum data and semi-structured interviews, stakeholders' experiences of delivering and receiving SWMS were explored. Using the web search engine Google with keywords and web address (URL) identifiers, relevant public online platforms were sourced with snowball sampling and search strings used to identify threads related to people's experiences of accessing SWMS (n = 57). Interviews were conducted with 24 participants (nine patients, 15 staff), and data from all sources were analysed thematically using the framework approach. RESULTS Six themes related to access to and engagement with SWMS emerged during data analysis: (1) making the first move, (2) uncertainty and confusion, (3) resource issues, (4) respect and understanding, (5) mode of delivery, and (6) desire for ongoing support. CONCLUSION There is a mixed and varied picture of SWMS provision across the UK. The service offered is based on local clinical decision making and available resources, resulting in a range of patient experiences and perspectives. Whilst service capacity issues and patient anxiety were seen as barriers to accessing care, peer support and positive clinical and group interactions (connectedness between individuals) were considered to increase engagement.
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Affiliation(s)
- Ross Watkins
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Dawn Swancutt
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
- University of Plymouth, Plymouth, PL4 8AA, Devon, UK.
| | - Mia Alexander
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Shokraneh Moghadam
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Steve Perry
- Independent Consultant (Patient Adviser), Plymouth, UK
| | - Sarah Dean
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Rod Sheaff
- University of Plymouth, Plymouth, PL4 8AA, Devon, UK
| | | | - Mark Tarrant
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Jenny Lloyd
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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6
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Coulman KD, Margelyte R, Jones T, Blazeby JM, Macleod J, Owen-Smith A, Parretti H, Welbourn R, Redaniel MT, Judge A. Access to publicly funded weight management services in England using routine data from primary and secondary care (2007-2020): An observational cohort study. PLoS Med 2023; 20:e1004282. [PMID: 37769031 PMCID: PMC10538857 DOI: 10.1371/journal.pmed.1004282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Adults living with overweight/obesity are eligible for publicly funded weight management (WM) programmes according to national guidance. People with the most severe and complex obesity are eligible for bariatric surgery. Primary care plays a key role in identifying overweight/obesity and referring to WM interventions. This study aimed to (1) describe the primary care population in England who (a) are referred for WM interventions and (b) undergo bariatric surgery and (2) determine the patient and GP practice characteristics associated with both. METHODS AND FINDINGS An observational cohort study was undertaken using routinely collected primary care data in England from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. During the study period (January 2007 to June 2020), 1,811,587 adults met the inclusion criteria of a recording of overweight/obesity in primary care, of which 54.62% were female and 20.10% aged 45 to 54. Only 56,783 (3.13%) were referred to WM, and 3,701 (1.09% of those with severe and complex obesity) underwent bariatric surgery. Multivariable Poisson regression examined the associations of demographic, clinical, and regional characteristics on the likelihood of WM referral and bariatric surgery. Higher body mass index (BMI) and practice region had the strongest associations with both outcomes. People with BMI ≥40 kg/m2 were more than 6 times as likely to be referred for WM (10.05% of individuals) than BMI 25.0 to 29.9 kg/m2 (1.34%) (rate ratio (RR) 6.19, 95% confidence interval (CI) [5.99,6.40], p < 0.001). They were more than 5 times as likely to undergo bariatric surgery (3.98%) than BMI 35.0 to 40.0 kg/m2 with a comorbidity (0.53%) (RR 5.52, 95% CI [5.07,6.02], p < 0.001). Patients from practices in the West Midlands were the most likely to have a WM referral (5.40%) (RR 2.17, 95% CI [2.10,2.24], p < 0.001, compared with the North West, 2.89%), and practices from the East of England least likely (1.04%) (RR 0.43, 95% CI [0.41,0.46], p < 0.001, compared with North West). Patients from practices in London were the most likely to undergo bariatric surgery (2.15%), and practices in the North West the least likely (0.68%) (RR 3.29, 95% CI [2.88,3.76], p < 0.001, London compared with North West). Longer duration since diagnosis with severe and complex obesity (e.g., 1.67% of individuals diagnosed in 2007 versus 0.34% in 2015, RR 0.20, 95% CI [0.12,0.32], p < 0.001), and increasing comorbidities (e.g., 2.26% of individuals with 6+ comorbidities versus 1.39% with none (RR 8.79, 95% CI [7.16,10.79], p < 0.001) were also strongly associated with bariatric surgery. The main limitation is the reliance on overweight/obesity being recorded within primary care records to identify the study population. CONCLUSIONS Between 2007 and 2020, a very small percentage of the primary care population eligible for WM referral or bariatric surgery according to national guidance received either. Higher BMI and GP practice region had the strongest associations with both. Regional inequalities may reflect differences in commissioning and provision of WM services across the country. Multi-stakeholder qualitative research is ongoing to understand the barriers to accessing WM services and potential solutions. Together with population-wide prevention strategies, improved access to WM interventions is needed to reduce obesity levels.
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Affiliation(s)
- Karen D. Coulman
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Ruta Margelyte
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Tim Jones
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - John Macleod
- National Institute for Health Research Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Amanda Owen-Smith
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Helen Parretti
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard Welbourn
- Department of Upper GI and Bariatric Surgery, Somerset NHS Foundation Trust, Taunton, United Kingdom
| | - Maria Theresa Redaniel
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Andy Judge
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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8
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Bolckmans R, Askari A, Currie A, Ahmed AR, Batterham RL, Byrne J, Hopkins J, Khan OA, Mahawar K, Miras AD, Pring CM, Small PK, Welbourn R. Clinical characteristics of patients undergoing primary bariatric surgery in the United Kingdom based on the National Bariatric Surgery Registry. Clin Obes 2023; 13:e12585. [PMID: 36807508 DOI: 10.1111/cob.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/23/2023]
Abstract
Baseline demographic characteristics and operations undertaken for patients having bariatric surgery in the United Kingdom are largely unknown. This study aimed to describe the profile of patients having primary bariatric surgery in the National Health Service (NHS) or by self-pay, and associated operations performed for both pathways. The National Bariatric Surgery Registry dataset for 5 years between January 2015 and December 2019 was used. 34 580 patients underwent primary bariatric surgery, of which 75.9% were NHS patients. Mean patient age and initial body mass index were significantly higher for NHS compared to self-pay patients (mean age 45.8 ± 11.3 [SD] vs. 43.0 ± 12.0 years and initial body mass index 48.0 ± 7.9 vs. 42.9 ± 7.3 kg/m2 , p < .001). NHS patients were more likely to have obesity-related complications compared to self-pay patients: prevalence of Type 2 diabetes mellitus 27.7% versus 8.3%, hypertension 37.1% versus 20.1%, obstructive sleep apnoea 27.4% versus 8.9%, severely impaired functional status 19.3% versus 13.9%, musculoskeletal pain 32.5% versus 20.1% and being on medication for depression 31.0% versus 25.9%, respectively (all p < .001). Gastric bypass was the most commonly performed primary NHS bariatric operation 57.2%, but sleeve gastrectomy predominated in self-pay patients 48.7% (both p < .001). In contrast to self-pay patients, NHS patients are receiving bariatric surgery only once they are older and at a much more advanced stage of obesity-related disease complications.
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Affiliation(s)
- Roel Bolckmans
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | | | - Andrew Currie
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - James Byrne
- University Hospital Southampton, Southampton, UK
| | - James Hopkins
- Department of Bariatric and Metabolic Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Omar A Khan
- Population Health Research Institute, St George's Hospital, University of London, London, UK
- Department Upper Gastrointestinal and Bariatric Surgery, St George's Hospital, London, UK
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Alexander Dimitri Miras
- School of Medicine, Ulster University, Belfast, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Chris M Pring
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Sussex (St Richard's Hospital), Chichester, UK
| | - Peter K Small
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
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9
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Currie A, Bolckmans R, Askari A, Byrne J, Ahmed AR, Batterham RL, Mahawar K, Miras AD, Pring CM, Small PK, Welbourn R. Bariatric-metabolic surgery for NHS patients with type 2 diabetes in the United Kingdom National Bariatric Surgery Registry. Diabet Med 2023; 40:e15041. [PMID: 36648127 DOI: 10.1111/dme.15041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/07/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023]
Abstract
AIM Bariatric-metabolic surgery is approved by the National Institute of Health and Care Excellence (NICE) for people with severe obesity and type 2 diabetes (T2DM) (including class 1 obesity after 2014). This study analysed baseline characteristics, disease severity and operations undertaken in people with obesity and T2DM undergoing bariatric-metabolic surgery in the UK National Health Service (NHS) compared to those without T2DM. METHODS Baseline characteristics, trends over time and operations undertaken were analysed for people undergoing primary bariatric-metabolic surgery in the NHS using the National Bariatric Surgical Registry (NBSR) for 11 years from 2009 to 2019. Clinical practice before and after the publication of the NICE guidance (2014) was examined. Multivariate logistic regression was used to determine associations with T2DM status and the procedure undertaken. RESULTS 14,948/51,715 (28.9%) participants had T2DM, with 10,626 (71.1%) on oral hypoglycaemics, 4322 (28.9%) on insulin/other injectables, and with T2DM diagnosed 10+ years before surgery in 3876 (25.9%). Participants with T2DM, compared to those without T2DM, were associated with older age (p < 0.001), male sex (p < 0.001), poorer functional status (p < 0.001), dyslipidaemia (OR: 3.58 (CI: 3.39-3.79); p < 0.001), hypertension (OR: 2.32 (2.19-2.45); p < 0.001) and liver disease (OR: 1.73 (1.58-1.90); p < 0.001), but no difference in body mass index was noted. Fewer people receiving bariatric-metabolic surgery after 2015 had T2DM (p < 0.001), although a very small percentage increase of those with class I obesity and T2DM was noted. Gastric bypass was the commonest operation overall. T2DM status was associated with selection for gastric bypass compared to sleeve gastrectomy (p < 0.001). CONCLUSION NHS bariatric-metabolic surgery is used for people with T2DM much later in the disease process when it is less effective. National guidance on bariatric-metabolic surgery and data from multiple RCTs have had little impact on clinical practice.
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Affiliation(s)
- Andrew Currie
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Roel Bolckmans
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Alan Askari
- Department of Bariatric Surgery, Bedfordshire Hospitals NHS Trust, Luton, UK
| | - James Byrne
- Department of Upper GI and Bariatric Surgery, University Hospital Southampton, Southampton, UK
| | - Ahmed R Ahmed
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Alexander Dimitri Miras
- School of Medicine, Ulster University, Ulster, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Chris M Pring
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Sussex (St Richard's Hospital), Chichester, UK
| | - Peter K Small
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
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Amaro Santos C, Cinza AM, Laranjeira Â, Amaro M, Carvalho M, Martins S, Bravo J, Raimundo A. The impact of exercise on prevention of sarcopenia after bariatric surgery: The study protocol of the EXPOBAR randomized controlled trial. Contemp Clin Trials Commun 2022; 31:101048. [PMID: 36568444 PMCID: PMC9768230 DOI: 10.1016/j.conctc.2022.101048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Bariatric surgery is one of the treatments for severe obesity, with proven efficacy in reducing weight and diseases associated with obesity. Weight loss associated with bariatric surgery is greatly associated with a significant reduction of skeletal muscle and bone mineral mass, which leads us to induce that after bariatric surgery, patients incur an increased risk of sarcopenia. The need for prophylactic programs that prevent sarcopenia in bariatric surgery patients seems to be one of the crucial points for the long-term surgical success of bariatric and metabolic surgery. The aim of this randomized clinical trial will be to study the effects of a 16-week supervised exercise intervention program on the prevention of sarcopenia, in patients undergoing bariatric surgery. As a secondary purpose, it is also intended to characterize metabolic risk factors, physical fitness, and quality of life in post-bariatric surgery patients. Method A total of 45 patients on the waiting list for bariatric surgery and who have subsequently perfurgery, will be include on EXPOBAR (EXercise POst BARiatric) and randomized into 2 groups, experimental and control. The intervention starts one month after surgery, for a total of 16 weeks. Parameters of body composition, metabolic risk, quality of life, physical activity, physical fitness, and sedentary behavior will be determined. For each participant, outcomes are measured at five different time points: before the surgery, before the exercise program, after the exercise program, six and twelve months after de exercise program. Results This study will provide the effects of a physical exercise on sarcopenia, in patients after bariatric surgery. Trial registration The trial was registered at Clinicaltrials.gov NCT03497546.
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Affiliation(s)
- Cláudia Amaro Santos
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal,CRI.COM - Bariatric Integrated Surgical Responsibility and Metabolic Diseases Center, Évora, Portugal,CHRC - Comprehensive Health Research Centre, Universidade de Évora, Évora, Portugal,Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Portugal,Corresponding author. CHRC - Comprehensive Health Research Centre - Universidade deÉvora, Évora, Portugal.
| | - Ana Margarida Cinza
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal,CRI.COM - Bariatric Integrated Surgical Responsibility and Metabolic Diseases Center, Évora, Portugal
| | - Ânia Laranjeira
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal,CRI.COM - Bariatric Integrated Surgical Responsibility and Metabolic Diseases Center, Évora, Portugal
| | - Margarida Amaro
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal,CRI.COM - Bariatric Integrated Surgical Responsibility and Metabolic Diseases Center, Évora, Portugal
| | - Manuel Carvalho
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal,CRI.COM - Bariatric Integrated Surgical Responsibility and Metabolic Diseases Center, Évora, Portugal
| | - Sandra Martins
- Faculty of Social Sciences and Technology, European University, Lisbon, Portugal
| | - Jorge Bravo
- CHRC - Comprehensive Health Research Centre, Universidade de Évora, Évora, Portugal,Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Portugal
| | - Armando Raimundo
- CHRC - Comprehensive Health Research Centre, Universidade de Évora, Évora, Portugal,Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Portugal
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11
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Billing-Bullen G, Nielsen D, Wham C, Kruger R. Enablers and barriers to prevent weight-regain post bariatric surgery - A qualitative enquiry. Eat Behav 2022; 47:101677. [PMID: 36252389 DOI: 10.1016/j.eatbeh.2022.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Weight-regain is commonly experienced after bariatric surgery. This qualitative enquiry aimed to explore participants' self-reported enablers and barriers to prevent future weight-regain post-surgery. METHODS Eligible adults were recruited at 12-months post-bariatric-surgery at Counties Manukau, Auckland. Participants were invited to attend data collection at their 18-month group nutrition-education session, and to participate in a focus group at 21-months post-surgery. Thematic analysis was used to evaluate patient experiences. RESULTS Participants (n = 28) were mostly female (73.2 %), New Zealand European (41.5 %), and had gastric sleeve surgery (92.3 %). Five key themes emerged from the analysis: A Life Changing Health Journey - participants experienced a decrease in obesity-related comorbidities and a subsequent decrease in medications. Weight change and food intolerances impacted quality of life. Challenge of managing a New Healthy Lifestyle - financial stress, buying healthier foods and social events were new challenges, often centred on food. Changing Eating Behavior - all participants struggled managing eating behaviors. Mindset Changes - post-surgery most participants had a positive mindset, increased confidence, and feelings of happiness. However, many struggled with mindset around weight and food. A need for On-going Support - most felt under-supported and expressed a need for longer, specific follow-up care. CONCLUSION Post-surgery group education sessions provided participants with increased support from both health professionals and peers on the same journey, to overcome struggles such as binge eating or identifying new coping strategies. Findings provide important insights into the challenges patients with bariatric surgery face and key learnings to develop specific supports for future care practices.
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Affiliation(s)
- Gypsy Billing-Bullen
- School of Sport, Exercise and Nutrition, Massey University, Private Bag 102 904, Auckland 0745, New Zealand
| | - Deirdre Nielsen
- Counties Manukau Health, Middlemore Hospital, Hospital Road, Auckland, Auckland, 0745, New Zealand
| | - Carol Wham
- School of Sport, Exercise and Nutrition, Massey University, Private Bag 102 904, Auckland 0745, New Zealand.
| | - Rozanne Kruger
- School of Sport, Exercise and Nutrition, Massey University, Private Bag 102 904, Auckland 0745, New Zealand.
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12
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Mears R, Leadbetter S, Candler T, Sutton H, Sharp D, Shield JPH. Cross-sectional survey of child weight management service provision by acute NHS trusts across England in 2020/2021. BMJ Open 2022; 12:e061971. [PMID: 36356995 PMCID: PMC9670955 DOI: 10.1136/bmjopen-2022-061971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE With one in five children in England living with obesity, we mapped the geographical distribution and format of child weight management services provided by acute National Health Service (NHS) trusts across England, to identify breadth of service provision. DESIGN A cross-sectional survey. SETTING The survey was sent to acute NHS trusts (n=148) in England in 2020, via a freedom of information request. PARTICIPANTS Responses were received from 139 of 148 (94%) acute NHS trusts, between March 2020 to March 2021. OUTCOME MEASURES The survey asked each acute NHS trust whether they provide a weight management service for children living with obesity. For those trusts providing a service, data were collected on eligibility criteria, funding source, personnel involved, number of new patients seen per year, intervention duration, follow-up length and outcome measures. Service characteristics were reported using descriptive statistics. Service provision was analysed in the context of ethnicity and Index of Multiple Deprivation score of the trust catchment area. RESULTS From the 139 survey respondents, 23% stated that they provided a weight management service for children living with obesity. There were inequalities in the proportion of acute NHS trusts providing a service across the different regions of England, ranging from 4% (Midlands) to 36% (London). For trusts providing a service, there was variability in the number of new cases seen per year, eligibility criteria, funding source, intervention format and outcome measures collected. A multidisciplinary approach was not routinely provided, with only 41% of services reporting ≥3 different staff disciplines. CONCLUSION In 2020/2021, there were geographical inequalities in weight management service provision by acute NHS trusts for children living with obesity. Services provided lacked standardisation, did not routinely offer children multidisciplinary care and were insufficient in size to meet need.
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Affiliation(s)
- Ruth Mears
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Exercise Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Sofia Leadbetter
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Toby Candler
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Hannah Sutton
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Deborah Sharp
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julian P H Shield
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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13
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Tully L, Arthurs N, Wyse C, Browne S, Case L, McCrea L, O’Connell JM, O’Gorman CS, Smith SM, Walsh A, Ward F, O’Malley G. Guidelines for treating child and adolescent obesity: A systematic review. Front Nutr 2022; 9:902865. [PMID: 36313105 PMCID: PMC9597370 DOI: 10.3389/fnut.2022.902865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Obesity is a chronic disease that compromises the physical and mental health of an increasing proportion of children globally. In high-income countries, prevalence of paediatric obesity is increasing faster in those from marginalised populations such as low-income households, suggesting the disease as one that is largely systemic. Appropriate treatment should be prioritised in these settings to prevent the development of complications and co-morbidities and manage those that already exist. An array of clinical practice guidelines are available for managing overweight and obesity in children and adolescents, but no systematic review has yet compared their quality or synthesised their recommendations. We aimed to narratively review clinical practice guidelines published in English for treating child and adolescent obesity, to identify the highest quality guidelines, and assess similarities, conflicts, and gaps in recommendations. We systematically searched academic databases and grey literature for guidelines published. We used the AGREE II tool to assess the quality, and identified nine high quality guidelines for inclusion in a narrative review of recommendations. Guidelines predominantly recommended the delivery of multi-component behaviour-change interventions aimed at improving nutrition and physical activity. Treatment outcomes were generally focussed on weight, with less emphasis on managing complications or improving quality-of-life. There was no evidence-based consensus on the best mode of delivery, setting, or treatment format. The guidelines rarely included recommendations for addressing the practical or social barriers to behaviour change, such as cooking skills or supervised physical activity. There is insufficient evidence to evaluate pharmaceutical and surgical interventions in children, and these were generally not recommended. It should be noted that this review addressed documents published in English only, and therefore the included guidelines were applicable predominantly to high-resource settings.
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Affiliation(s)
- Louise Tully
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh Arthurs
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland,W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Cathy Wyse
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Browne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Lucinda Case
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Lois McCrea
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Jean M. O’Connell
- St. Columcille’s Hospital Weight Management Service, St.Vincent’s University Hospital, Dublin, Ireland
| | - Clodagh S. O’Gorman
- School of Medicine, University of Limerick, Limerick, Ireland,Department of Paediatrics, University Hospital Limerick, Limerick, Ireland
| | - Susan M. Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Aisling Walsh
- Department of Epidemiology, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Ward
- Department of Clinical Nutrition and Dietetics, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Grace O’Malley
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland,W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland,*Correspondence: Grace O’Malley,
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14
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Visual Analysis of Nutrient Deficiency and Treatment Protocols in Bariatric Surgery Based on VOSviewer. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8228831. [PMID: 36017385 PMCID: PMC9398804 DOI: 10.1155/2022/8228831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 12/01/2022]
Abstract
Objective To analyze the global literature on nutritional deficiencies in bariatric surgery (BS) since January 1, 1985, and to discuss the current status of research, research hotspots, and new development trend and treatment of nutritional deficiency in bariatric surgery. It provides ideas and basis for promoting the development of bariatric surgery and new alternative therapy or treatment protocols. Methods The Web of Science (WOS) database core collection was used as the data source, and VOSviewer 1.6.17 software was used to search the literature on the topic of “nutritional deficiencies in bariatric surgery.” The number of published literature, the distribution of authors, institutions, and countries, keyword cooccurrences, and journal cocitations were visualized and analyzed. Results A total of 1015 relevant publications was obtained after searching and screening, and the overall trend of literature published was on the rise. The most published countries, institutions, and authors were USA, University of Sao Paulo, Ramalho, Andrea; Obesity Surgery has been the most frequently cited journal (7943 citations), and the top 10 journals had high impact factors. Keyword cooccurrence analysis showed that “bariatric surgery” and “nutritional deficiencies” are the hot topics of research in this field. Conclusion There is an urgent need for bariatric surgery issuing institutions and authors to strengthen cross-institutional, cross-team, and multicenter and multidisciplinary cooperation, to promote and facilitate the exchange and cooperation in the field of bariatric surgery between developed countries in Europe and America and developing countries in Asia, Africa, and Latin America, to draw the attention of developing countries to the health problems caused by obesity, and to encourage and support the development of developing countries in this field. Bariatric surgery, obesity, weight loss, Y-type gastric bypass, gastric bypass, and nutritional deficiency are the hot research topics in the field of nutritional deficiency in bariatric surgery, and metabolic surgery, single anastomosis gastric bypass, micronutrient supplementation, micronutrient deficiency, intestinal microbiology, and guidelines are the new trends in this field.
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Abstract
Purpose of Review Obesity-associated difficult asthma continues to be a substantial problem and, despite a move to address treatable traits affecting asthma morbidity and mortality, it remains poorly understood with limited phenotype-specific treatments. The complex association between asthma, obesity, and inflammation is highlighted and recent advances in treatment options explored. Recent Findings Obesity negatively impacts asthma outcomes and has a causal link in the pathogenesis of adult-onset asthma. Imbalance in the adipose organ found in obesity favours a pro-inflammatory state both systemically and in airways. Obesity may impact currently available asthma biomarkers, and obesity-associated asthma specific biomarkers are needed. Whilst surgical weight loss interventions are associated with improvements in asthma control and quality of life, evidence for pragmatic conservative options are sparse. Innovative approaches tackling obesity-mediated airway inflammation may provide novel therapies. Summary The immunopathological mechanisms underlying obesity-associated asthma require further research that may lead to novel therapeutic options for this disease. However, weight loss appears to be effective in improving asthma in this cohort and focus is also needed on non-surgical treatments applicable in the real-world setting.
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Affiliation(s)
- Varun Sharma
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. .,Glasgow Royal Infirmary, Glasgow, UK.
| | - Douglas C Cowan
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. .,Glasgow Royal Infirmary, Glasgow, UK.
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Rhynehart A, Dunlevy C, Hayes K, O'Connell J, O'Shea D, O'Malley E. The Association of Physical Function Measures With Frailty, Falls History, and Metabolic Syndrome in a Population With Complex Obesity. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:716392. [PMID: 36188769 PMCID: PMC9397832 DOI: 10.3389/fresc.2021.716392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022]
Abstract
Background: Frailty, falls and metabolic syndrome are known to be associated with poorer physical function. This study builds on available research by further investigating the relationship between physical function measures, including those comprising frailty, with metabolic syndrome (MetS) and falls, in the context of complex obesity. Methods: Participants were recruited from the national Level 3 weight management service in Ireland. A retrospective audit of data gathered at initial assessment was performed. Data included past medical history, blood tests, blood pressure measurement, anthropometrics, falls history, self-reported physical activity levels (PALs) and physical function measures, including hand grip strength (HGS), “timed up and go” (TUG), functional reach (FR), sit to stand (STS) and gait speed. A modified version of the Fried Frailty Index was employed. Results: Of the 713 participants, 65.1% (n = 464) were female and 34.9% (n = 249) were male with a mean age of 44.2 (±11.7) years and body mass index (BMI) of 50.6 kg/m2 (±8.2). Frailty was identified in 3.4% (n = 24), falls in 28.8% (n = 205) and MetS in 55.1% (n = 393). Frailty was associated with older age (53.8 ± 14.3 vs. 43.9 ± 11.5 years), poorer PALs (27.29 ± 46.3 vs. 101.1 ± 147.4 min/wk), reduced grip strength (17.7 ± 4.6 vs. 34.2 ± 11.0 Kg) longer STS (21.7 ± 6.6 vs. 13.7 ± 5.7 s), shorter functional reach (29.7 ± 7.9 vs. 37.9 ± 8.2 cm) and slower gait speed (0.6 ± 0.2 vs. 1.1 ± 0.5 m/s). Those reporting a falls history had a reduced FR (35.8 ± 8.9 vs. 38.3 ± 7.8 cm) and slower STS (15.4 ± 8.0 vs. 13.3 ± 4.7 s). Participants with MetS had lower PALs (83.2 ± 128.2 vs. 119.2 ± 157.6) and gait speed (1.1 ± 0.3 vs. 1.2 ± 0.7 m/s). There was no difference in BMI between fallers and non-fallers (51.34 ± 8.44 vs. 50.33 ± 8.13 Kg/m2, p = 0.138), nor between those with or without MetS. Significant associations were found between BMI and all physical function measures except the TUAG. Conclusion: The associations between frailty, falls and MetS and their combined impact on physical function in people living with obesity demonstrates the need for appropriate screening. Utilising grip strength and gait speed to identify frailty in those with obesity and metabolic syndrome could help target therapies aimed at improving strength, physical function and ultimately quality of life.
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Affiliation(s)
- Amanda Rhynehart
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
- *Correspondence: Amanda Rhynehart ;
| | - Colin Dunlevy
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
| | - Katie Hayes
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
| | - Jean O'Connell
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
- Obesity Research Group, St Vincent's University Hospital, Dublin, Ireland
| | - Donal O'Shea
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
- Obesity Research Group, St Vincent's University Hospital, Dublin, Ireland
| | - Emer O'Malley
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
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Coelho C, Crane J, Agius R, McGowan B. The Bariatric-Metabolic Physician's Role in Managing Clinically Severe Obesity. Curr Obes Rep 2021; 10:263-273. [PMID: 33964008 PMCID: PMC8106360 DOI: 10.1007/s13679-021-00435-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to outline the obesity physician's role in managing patients with severe obesity with a particular emphasis on bariatric surgery candidates. RECENT FINDINGS Obesity is a chronic, relapsing and progressive disease. Scoring systems that evaluate the severity of obesity based on the clinical assessment, rather than the Body Mass Index, are a valuable tool. The clinical assessment should explore the underlying contributors for weight gain and screen for obesity-related complications. Bariatric surgery remains the most effective management approach for severe and complex obesity. Nevertheless, pharmacotherapy and other non-surgical approaches play an important role. The bariatric-metabolic physician's role is paramount in delivering effective care to patients with obesity. The multiple complications of patients with clinically severe obesity highlight the complexity of their management and reinforce the need for adequate assessment and long-term follow-up to ensure optimal clinical outcomes.
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Affiliation(s)
- Claudia Coelho
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Crane
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rachel Agius
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta
| | - Barbara McGowan
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- Diabetes and Nutritional Sciences, King's College London, London, UK.
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18
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Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes. Obes Surg 2021; 31:4528-4541. [PMID: 34363144 PMCID: PMC8346344 DOI: 10.1007/s11695-021-05643-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 12/11/2022]
Abstract
Background Metabolic surgery is part of a well-established treatment intensification strategy for obesity and its related comorbidities including type 2 diabetes (T2DM). Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) are the most commonly performed metabolic surgeries worldwide, but comparative efficacy is uncertain. This study employed network meta-analysis to compare weight loss, T2DM remission and perioperative complications in adults between RYGB, SG and OAGB. Methods MEDLINE, EMBASE, trial registries were searched for randomised trials comparing RYGB, SG and OAGB. Study outcomes were excess weight loss (at 1, 2 and 3–5 years), trial-defined T2DM remission at any time point and perioperative complications. Results Twenty randomised controlled trials were included involving 1803 patients investigating the three metabolic surgical interventions. RYGB was the index for comparison. The excess weight loss (EWL) demonstrated minor differences at 1 and 2 years, but no differences between interventions at 3–5 years. T2DM remission was more likely to occur with either RYGB or OAGB when compared to SG. Perioperative complications were higher with RYGB when compared to either SG or OAGB. Two-way analysis of EWL and T2DM remission against the risk of perioperative complications demonstrated OAGB was the most positive on this assessment at all time points. Conclusion OAGB offers comparable metabolic control through weight loss and T2DM remission to RYGB and SG whilst minimising perioperative complications. Registration number: CRD42020199779 (https:// www.crd.york.ac.uk/PROSPERO) Graphical abstract ![]()
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Welbourn R, Hollyman M, Kinsman R, Dixon J, Cohen R, Morton J, Ghaferi A, Higa K, Ottosson J, Pattou F, Al-Sabah S, Anvari M, Himpens J, Liem R, Våge V, Walton P, Brown W, Kow L. Bariatric-Metabolic Surgery Utilisation in Patients With and Without Diabetes: Data from the IFSO Global Registry 2015-2018. Obes Surg 2021; 31:2391-2400. [PMID: 33638756 PMCID: PMC8113173 DOI: 10.1007/s11695-021-05280-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Comparative international practice of patients undergoing bariatric-metabolic surgery for type 2 diabetes mellitus (T2DM) is unknown. We aimed to ascertain baseline age, sex, body mass index (BMI) and types of operations performed for patients with T2DM submitted to the IFSO Global Registry. MATERIALS AND METHODS Cross-sectional analysis of patients having primary surgery in 2015-2018 for countries with ≥90% T2DM data completion and ≥ 1000 submitted records. RESULTS Fifteen countries including 11 national registries met the inclusion criteria. The rate of T2DM was 24.2% (99,537 of 411,581 patients, country range 12.0-55.1%) and 77.1% of all patients were women. In every country, patients with T2DM were older than those without T2DM (overall mean age 49.2 [SD 11.4] years vs 41.8 [11.9] years, all p < 0.001). Men were more likely to have T2DM than women, odds ratio (OR) 1.68 (95% CI 1.65-1.71), p < 0.001. Men showed higher rates of T2DM for BMI <35 kg/m2 compared to BMI ≥35.0 kg/m2, OR 2.76 (2.52-3.03), p < 0.001. This was not seen in women, OR 0.78 (0.73-0.83), p < 0.001. Sleeve gastrectomy was the commonest operation overall, but less frequent for patients with T2DM, patients with T2DM 54.9% vs without T2DM 65.8%, OR 0.63 (0.63-0.64), p < 0.001. Twelve out of 15 countries had higher proportions of gastric bypass compared to non-bypass operations for T2DM, OR 1.70 (1.67-1.72), p < 0.001. CONCLUSION Patients with T2DM had different characteristics to those without T2DM. Older men were more likely to have T2DM, with higher rates of BMI <35 kg/m2 and increased likelihood of food rerouting operations.
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Affiliation(s)
- Richard Welbourn
- Department Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK.
| | - Marianne Hollyman
- Department Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Robin Kinsman
- Dendrite Clinical Systems Ltd., Henley-on-Thames, Oxfordshire, RG9 1AY, UK
| | - John Dixon
- Iverson Health Innovation Research Institute, Swinburne University, Melbourne, Australia
| | - Ricardo Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - John Morton
- Division Chief, Bariatric and Minimally Invasive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Amir Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | | | - Salman Al-Sabah
- Al-Amiri Hospital Kuwait, Royale Hyatt Hospital, Kuwait City, Kuwait
| | - Merhan Anvari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Ronald Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Bergen, Norway
| | - Peter Walton
- Dendrite Clinical Systems Ltd., Henley-on-Thames, Oxfordshire, RG9 1AY, UK
| | - Wendy Brown
- Centre of Obesity Research and Education, Monash University, Melbourne, Australia
| | - Lilian Kow
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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20
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Abstract
PURPOSE OF REVIEW Bariatric surgery is an effective treatment option for severe and complex obesity; however, those who undergo such surgery need access to nutritional monitoring and vitamin and mineral supplementation to avoid the development of nutritional deficiencies. RECENT FINDINGS The British Obesity and Metabolic Surgery Society and the American Society for Metabolic and Bariatric Surgery have recently updated their recommendations on preoperative and postoperative nutritional monitoring and supplementation. There is a growing interest in the more malabsorptive procedures that are associated with an increased risk of nutritional deficiencies. Nutritional monitoring and prevention of nutritional deficiencies are discussed.Long-term follow-up that includes annual nutritional monitoring and access to a dietetic annual review is recommended; however, in the United Kingdom, many bariatric surgery centres are only commissioned to provide 2 years of follow-up, after which care is transferred to the general practitioner. Consideration should be given to developing shared care models for aftercare and also for the aftercare of malabsorptive procedures to remain with specialist centres. SUMMARY Bariatric surgery is a safe and effective treatment option for severe and complex obesity. It is essential that patients have access to lifelong nutritional monitoring adjustment of vitamin and mineral supplements to prevent nutritional issues.
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21
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Hazlehurst JM, Logue J, Parretti HM, Abbott S, Brown A, Pournaras DJ, Tahrani AA. Developing Integrated Clinical Pathways for the Management of Clinically Severe Adult Obesity: a Critique of NHS England Policy. Curr Obes Rep 2020; 9:530-543. [PMID: 33180307 PMCID: PMC7695647 DOI: 10.1007/s13679-020-00416-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE OF THE REVIEW Pathways for obesity prevention and treatment are well documented, yet the prevalence of obesity is rising, and access to treatment (including bariatric surgery) is limited. This review seeks to assess the current integrated clinical pathway for obesity management in England and determine the major challenges. RECENT FINDINGS Evidence for tier 2 (community-based lifestyle intervention) and tier 3 (specialist weight management services) is limited, and how it facilitates care and improve outcomes in tier 4 remains uncertain. Treatment access, rigidity in pathways, uncertain treatment outcomes and weight stigma seems to be major barriers to improved care. More emphasis must be placed on access to effective treatments, treatment flexibility, addressing stigma and ensuring treatment efficacy including long-term health outcomes. Prevention and treatment should both receive significant focus though should be considered to be largely separate pathways. A simplified system for weight management is needed to allow flexibility and the delivery of personalized care including post-bariatric surgery care for those who need it.
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Affiliation(s)
- Jonathan M Hazlehurst
- Institute of Metabolism and Systems Research, The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jennifer Logue
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Sally Abbott
- Institute of Metabolism and Systems Research, The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Department of Bariatric Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Adrian Brown
- Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Dimitri J Pournaras
- Department of Upper GI Surgery, Southmead Hospital, Bristol, UK
- Bristol Weight Management and Bariatric Service, Southmead Hospital, Bristol, UK
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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22
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O'Kane M, Parretti HM, Pinkney J, Welbourn R, Hughes CA, Mok J, Walker N, Thomas D, Devin J, Coulman KD, Pinnock G, Batterham RL, Mahawar KK, Sharma M, Blakemore AI, McMillan I, Barth JH. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update. Obes Rev 2020; 21:e13087. [PMID: 32743907 PMCID: PMC7583474 DOI: 10.1111/obr.13087] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/21/2020] [Accepted: 05/31/2020] [Indexed: 02/06/2023]
Abstract
Bariatric surgery is recognized as the most clinically and cost-effective treatment for people with severe and complex obesity. Many people presenting for surgery have pre-existing low vitamin and mineral concentrations. The incidence of these may increase after bariatric surgery as all procedures potentially cause clinically significant micronutrient deficiencies. Therefore, preparation for surgery and long-term nutritional monitoring and follow-up are essential components of bariatric surgical care. These guidelines update the 2014 British Obesity and Metabolic Surgery Society nutritional guidelines. Since the 2014 guidelines, the working group has been expanded to include healthcare professionals working in specialist and non-specialist care as well as patient representatives. In addition, in these updated guidelines, the current evidence has been systematically reviewed for adults and adolescents undergoing the following procedures: adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch. Using methods based on Scottish Intercollegiate Guidelines Network methodology, the levels of evidence and recommendations have been graded. These guidelines are comprehensive, encompassing preoperative and postoperative biochemical monitoring, vitamin and mineral supplementation and correction of nutrition deficiencies before, and following bariatric surgery, and make recommendations for safe clinical practice in the U.K. setting.
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Affiliation(s)
- Mary O'Kane
- Dietetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Jonathan Pinkney
- Faculty of Health and Human Sciences, Peninsula Schools of Medicine and Dentistry, Plymouth, UK.,Department of Endocrinology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Richard Welbourn
- Department of Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Carly A Hughes
- Norwich Medical School, University of East Anglia, Norwich, UK.,Fakenham Weight Management Service, Fakenham Medical Practice, Fakenham, UK
| | - Jessica Mok
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
| | - Nerissa Walker
- School of Biosciences, Sutton Bonington Campus, University of Nottingham, Nottingham, UK
| | - Denise Thomas
- Department of Nutrition and Dietetics, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Jennifer Devin
- Specialist Weight Management Service, Betsi Cadwaladr University Health Board, Wales, UK
| | - Karen D Coulman
- Population Health Sciences, Bristol Medical School. University of Bristol, Bristol, UK.,Obesity and Bariatric Surgery Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Rachel L Batterham
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, UCLH, University College London Hospital (UCLH), London, UK.,National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Kamal K Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Manisha Sharma
- Department of Clinical Biochemistry & Bariatric Surgery, Homerton University Hospital NHS Trust, London, UK
| | - Alex I Blakemore
- Department of Life Sciences, Brunel University, London, UK.,Department of Medicine, Imperial College, London, UK
| | | | - Julian H Barth
- Department of Chemical Pathology & Metabolic Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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23
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Moussa O, Zakeri R, Arhi C, O'Kane M, Snowdon-Carr V, Menon V, Mahawar K, Purkayastha S. Impact of COVID-19 on Obesity Management Services in the United Kingdom (The COMS-UK study). Obes Surg 2020; 31:904-908. [PMID: 33048286 PMCID: PMC7552587 DOI: 10.1007/s11695-020-05005-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus Disease-2019 (COVID-19) has had a severe impact on all aspects of global healthcare delivery. This study aimed to investigate the nationwide impact of the pandemic on obesity management services in the UK in a questionnaire-based survey conducted of professionals involved in the delivery. A total of 168 clinicians took the survey; the majority of which maintained their usual clinical roles and were not redeployed except physicians and nurse specialists. Nearly all (97.8%) elective bariatric surgery was cancelled, 67.3% of units cancelled all multidisciplinary meeting activity, and the majority reduced clinics (69.6%). Most respondents anticipated that the services would recommence within 1–3 months. This study found that the COVID-19 pandemic has had a severe impact on the services involved in the management of patients suffering from severe, complex obesity in the UK
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Affiliation(s)
- Osama Moussa
- Division of Surgery and Cancer, Imperial College London, London, W2 1NY, UK.
- Department of Surgery, University College London Hospital, London, UK.
| | - Roxanna Zakeri
- Department of Surgery, University College London Hospital, London, UK
| | - Chanpreet Arhi
- Department of Surgery, University Hospital Lewisham, London, UK
| | - Mary O'Kane
- Department of dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Vinod Menon
- Department of Bariatric surgery, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Kamal Mahawar
- Department of Bariatric Surgery, Royal Sunderland Hospital, Sunderland, UK
| | - Sanjay Purkayastha
- Division of Surgery and Cancer, Imperial College London, London, W2 1NY, UK
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24
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Abstract
PURPOSE OF REVIEW Bariatric surgery is the most effective treatment for severe and complex obesity; however, the risk of developing nutrient deficiencies varies based upon the type of surgery, degree of malabsorption, and level of nutrition intervention. There are numerous factors that can impact the nutrition status of a patient during their pre- and postoperative journey. We review the critical components and considerations needed in order to provide optimal nutrition care for patients with bariatric surgery. RECENT FINDINGS A dietitian, specializing in bariatric surgery, is the best equipped healthcare provider to prepare and support patients in achieving and maintaining optimal nutrition status. We present best practices for both the pre- and postoperative nutrition-related phases of a patient's journey. The dietitian specialist is integral in the assessment and ongoing nutrition care of patients with bariatric surgery. Further consideration should be given to enable access for lifelong follow-up and monitoring.
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Affiliation(s)
- Julie M Parrott
- Metabolic and Bariatric Surgery Program, Penn Medicine, Clinical Practices of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | | | | | - Mary O'Kane
- Department of nutrition and dietetics, The General Infirmary at Leeds, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK.
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25
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An analytical retrospective study to determine the prevalence of childhood obesity and assess the effectiveness of current surveillance. Prim Health Care Res Dev 2020; 21:e28. [PMID: 32792021 PMCID: PMC7443805 DOI: 10.1017/s146342362000033x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: The childhood obesity epidemic is a public health crisis. Most surveillance occurs in primary care, yet there is limited guidance for the detection and management of childhood obesity. Aims and methodology: We sought to establish the overweight and obesity prevalence in children aged 4–11 years old in a single primary care centre. Furthermore, we assessed whether appropriate weight management referrals were considered and determined the average duration since children last had their height and weight measured. Findings: We detected overweight or obesity status in 29.0% of our cohort, and only one-third (31.1%) of eligible children had evidence that appropriate weight management referral was considered. The average duration since last height and weight measurement was 20.3 months. Discussion: Childhood obesity requires an effective and inclusive solution, and in this report, we explore whether increased surveillance is necessary and how we might achieve this.
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26
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Papamargaritis D, Al-Najim W, Lim J, Crane J, Lean M, le Roux C, McGowan B, O'Shea D, Webb D, Wilding J, Davies MJ. Effectiveness and cost of integrating a pragmatic pathway for prescribing liraglutide 3.0 mg in obesity services (STRIVE study): study protocol of an open-label, real-world, randomised, controlled trial. BMJ Open 2020; 10:e034137. [PMID: 32060156 PMCID: PMC7044994 DOI: 10.1136/bmjopen-2019-034137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION In the UK and Ireland, severe and complex obesity is managed in specialist weight management services (SWMS), which provide multicomponent lifestyle interventions to support weight loss, and use of medication if available. Liraglutide 3 mg (LIRA 3 mg) is an effective weight-loss medication, but weight loss in individual patients is variable, and its efficacy has not been assessed in SWMS. This study aims to investigate whether a targeted prescribing pathway for LIRA 3 mg with multiple prespecified stopping rules could help people with severe obesity and established complications achieve ≥15% weight loss in order to determine whether this could be considered a clinically effective and cost-effective strategy for managing severe and complex obesity in SWMS. METHODS AND ANALYSIS In this 2-year, multicentre, open-label, real-world randomised controlled trial, 384 adults with severe and complex obesity (defined as body mass index ≥35 kg/m2 plus either prediabetes, type 2 diabetes, hypertension or sleep apnoea) will be randomised via a 2:1 ratio to receive either standard SWMS care (n=128) or standard SWMS care plus a targeted prescribing pathway for LIRA 3 mg with prespecified stopping rules at 16, 32 and 52 weeks (n=256).The primary outcome is to compare the proportion of participants achieving a weight loss of ≥15% at 52 weeks with a targeted prescribing pathway versus standard care. Secondary outcomes include a comparison of (1) the weight loss maintenance at 104 weeks and (2) the budget impact and cost effectiveness between the two groups in a real-world setting. ETHICS AND DISSEMINATION The Health Research Authority and the Medicines and Healthcare products Regulatory Authority in UK, the Health Products Regulatory Authority in Ireland, the North West Deanery Research Ethics Committee (UK) and the St Vincent's University Hospital European Research Ethics Committee (Ireland) have approved the study. The findings of the study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov-Identifier: NCT03036800.European Clinical Trials Database-Identifier: EudraCT Number 2017-002998-20.
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Affiliation(s)
- Dimitris Papamargaritis
- Diabetes Research Centre, Leicester General Hospital, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
| | - Werd Al-Najim
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Jonathan Lim
- Obesity and Endocrinology Clinical Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - James Crane
- Institute of Diabetes, Endocrinology and Obesity (IDEO), Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mike Lean
- Human Nutrition, University of Glasgow, Glasgow, UK
| | - Carel le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Barbara McGowan
- Institute of Diabetes, Endocrinology and Obesity (IDEO), Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Donal O'Shea
- Department of Endocrinology and Diabetes Mellitus, St Vincent's University Hospital, Dublin, Ireland
| | - David Webb
- Diabetes Research Centre, Leicester General Hospital, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
| | - John Wilding
- Obesity and Endocrinology Clinical Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
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27
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Albano G, Rowlands K, Baciadonna L, Coco GL, Cardi V. Interpersonal difficulties in obesity: A systematic review and meta-analysis to inform a rejection sensitivity-based model. Neurosci Biobehav Rev 2019; 107:846-861. [PMID: 31585134 DOI: 10.1016/j.neubiorev.2019.09.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/05/2019] [Accepted: 09/29/2019] [Indexed: 01/27/2023]
Abstract
Obesity is associated with difficulties due to stigma and loneliness. These impact negatively on individuals' quality of life and behaviour change efforts. Increased sensitivity to others' negative feedback might play a role in the maintenance of these difficulties and could be addressed in psychological interventions. We conducted a systematic review of interpersonal difficulties in individuals with obesity, across the lifespan. We investigated early interpersonal adversity (i.e. frequency of teasing/bullying), perceived interpersonal stress and quality of social life, based on a rejection sensitivity model. The databases PubMed, Web of Knowledge and AGRIS, Embase, Medline and PsychINFO were searched for published peer-reviewed journal articles (1980-June 2018). Thirty-two studies met inclusion criteria. Results from the meta-analyses (n = 16 studies) indicated that overweight/obese individuals reported more frequent experiences of teasing/bullying, greater interpersonal stress and poorer quality of social life than healthy weight individuals. Findings in the systematic review aligned to this evidence. Psychological interventions targeting increased sensitivity to negative interpersonal feedback could improve interpersonal functioning and, in turn, eating behaviours in individuals with obesity.
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Affiliation(s)
- Gaia Albano
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy.
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Luigi Baciadonna
- Queen Mary University of London, Biological and Experimental Psychology, School of Biological and Chemical Sciences, London, UK.
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy.
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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28
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Skea ZC, Aceves-Martins M, Robertson C, De Bruin M, Avenell A. Acceptability and feasibility of weight management programmes for adults with severe obesity: a qualitative systematic review. BMJ Open 2019; 9:e029473. [PMID: 31511284 PMCID: PMC6738728 DOI: 10.1136/bmjopen-2019-029473] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To improve our understanding of the acceptability of behavioural weight management programmes (WMPs) for adults with severe obesity. DESIGN A systematic review of qualitative evidence. DATA SOURCES Medline, Embase, PsycINFO, CINAHL, SCI, SSCI and CAB abstracts were searched from 1964 to May 2017. ELIGIBILITY CRITERIA Papers that contained qualitative data from adults with body mass index (BMI) ≥35 kg/m2 (and/or the views of providers involved in their care) and considered issues about weight management. DATA EXTRACTION AND SYNTHESIS Two reviewers read and systematically extracted data from the included papers which were compared, and contrasted according to emerging issues and themes. Papers were appraised for methodological rigour and theoretical relevance using Toye's proposed criteria for quality in relation to meta-ethnography. RESULTS 33 papers met our inclusion criteria from seven countries published 2007-2017. Findings were presented from a total of 644 participants and 153 programme providers. Participants described being attracted to programmes that were perceived to be novel or exciting, as well as being endorsed by their healthcare provider. The sense of belonging to a group who shared similar issues, and who had similar physiques and personalities, was particularly important and seemed to foster a strong group identity and related accountability. Group-based activities were enjoyed by many and participants preferred WMPs with more intensive support. However, some described struggling with physical activities (due to a range of physical comorbidities) and not everyone enjoyed group interaction with others (sometimes due to various mental health comorbidities). Although the mean BMI reported across the papers ranged from 36.8 to 44.7 kg/m2, no quotes from participants in any of the included papers were linked to specific detail regarding BMI status. CONCLUSIONS Although group-based interventions were favoured, people with severe obesity might be especially vulnerable to physical and mental comorbidities which could inhibit engagement with certain intervention components.
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Affiliation(s)
- Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - M De Bruin
- Health Psychology Department, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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29
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Abstract
PURPOSE OF REVIEW Rising demand for specialised "Tier 3" weight management services in England is exceeding capacity, leading many services to offer group-based care programmes. This review considers the organisation of current provision, exploring how group programmes may enhance services and how these could be scaled up for wider implementation. RECENT FINDINGS Existing group-based programmes mainly focus on providing patients with information and education about their condition. Evidence suggests that groups themselves offer therapeutic benefits beyond this, by underpinning patients' engagement with programme materials and contributing to wider health and well-being. To maximise these benefits, there is a need to attend to the group processes that emerge in treatment groups which, left unchecked, may limit or even adversely impact programme outcomes. Group-based interventions may be of benefit to patients in Tier 3 specialist weight management services, although their format is complex and reliant on facilitators' expertise.
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Affiliation(s)
- Dawn Swancutt
- Peninsula Schools of Medicine and Dentistry, Plymouth University, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK
| | - Mark Tarrant
- College of Medicine and Health , University of Exeter, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Jonathan Pinkney
- Peninsula Schools of Medicine and Dentistry, Plymouth University, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK
- University Medicine, Level 7, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth, Plymouth PL6 8DH, UK
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30
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Caterson ID, Alfadda AA, Auerbach P, Coutinho W, Cuevas A, Dicker D, Hughes C, Iwabu M, Kang J, Nawar R, Reynoso R, Rhee N, Rigas G, Salvador J, Sbraccia P, Vázquez‐Velázquez V, Halford JC. Gaps to bridge: Misalignment between perception, reality and actions in obesity. Diabetes Obes Metab 2019; 21:1914-1924. [PMID: 31032548 PMCID: PMC6767048 DOI: 10.1111/dom.13752] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/03/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
AIMS Despite increased recognition as a chronic disease, obesity remains greatly underdiagnosed and undertreated. We aimed to identify international perceptions, attitudes, behaviours and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs). MATERIALS AND METHODS An online survey was conducted in 11 countries. Participants were adults with obesity and HCPs who were primarily concerned with direct patient care. RESULTS A total of 14 502 PwO and 2785 HCPs completed the survey. Most PwO (68%) and HCPs (88%) agreed that obesity is a disease. However, 81% of PwO assumed complete responsibility for their own weight loss and only 44% of HCPs agreed that genetics were a barrier. There was a median of three (mean, six) years between the time PwO began struggling with excess weight or obesity and when they first discussed their weight with an HCP. Many PwO were concerned about the impact of excess weight on health (46%) and were motivated to lose weight (48%). Most PwO (68%) would like their HCP to initiate a conversation about weight and only 3% were offended by such a conversation. Among HCPs, belief that patients have little interest in or motivation for weight management may constitute a barrier for weight management conversations. When discussed, HCPs typically recommended lifestyle changes; however, more referrals and follow-up appointments are required. CONCLUSIONS Our international dataset reveals a need to increase understanding of obesity and improve education concerning its physiological basis and clinical management. Realization that PwO are motivated to lose weight offers an opportunity for HCPs to initiate earlier weight management conversations.
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Affiliation(s)
- Ian D. Caterson
- Boden InstituteCharles Perkins Centre, University of SydneySydneyAustralia
| | - Assim A Alfadda
- Obesity Research Center and Department of MedicineCollege of Medicine, King Saud UniversityRiyadhSaudi Arabia
| | | | - Walmir Coutinho
- Catholic University of Rio de Janeiro, State Institute of Diabetes and EndocrinologyRio de JaneiroBrazil
| | - Ada Cuevas
- Departamento de NutriciónClínica Las CondesSantiagoChile
| | - Dror Dicker
- Internal Medicine D, Hasharon Hospital Rabin Medical CenterPetah TikvaIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Carly Hughes
- Fakenham Weight Management ServiceFakenham Medical PracticeNorfolkUK
- University of East AngliaNorfolkUK
| | - Masato Iwabu
- Department of Diabetes and Metabolic DiseasesThe University of TokyoTokyoJapan
| | - Jae‐Heon Kang
- Department of Family Medicine, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Rita Nawar
- The Weight Care Clinic, Dubai Healthcare CityDubaiUnited Arab Emirates
| | | | | | - Georgia Rigas
- St George and Sutherland Clinical School, Faculty of MedicineUniversity of New South WalesSydneyAustralia
| | - Javier Salvador
- Department of Endocrinology and NutritionClínica Universidad de NavarraPamplonaSpain
- CIBER Fisiopatología de la Obesidad y NutriciónInstituto de Salud Carlos IIIMajadahondaSpain
| | - Paolo Sbraccia
- Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - Verónica Vázquez‐Velázquez
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránCiudad de MéxicoMexico
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Ramachandran D, Atlantis E, Markovic T, Hocking S, Gill T. Standard baseline data collections in obesity management clinics: A Delphi study with recommendations from an expert panel. Clin Obes 2019; 9:e12301. [PMID: 30761766 DOI: 10.1111/cob.12301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/22/2018] [Accepted: 01/08/2019] [Indexed: 02/06/2023]
Abstract
We aimed to develop an expert consensus on standardizing data collections in specialist obesity management clinics in Australia. A panel of 16 experts participated in a structured consensus-driven Delphi process to reach agreement on a minimum set of baseline patient data collections for consideration in specialist obesity services. The panel included surgeons, clinicians, allied health professionals (dietician, exercise physiologist, psychologist), a bariatric nurse and obesity researchers. We produced a recommended list of core and useful data items that should comprise the baseline patient data set. Consensus was achieved for recommended measures of demographic, anthropometric, biochemical, weight-loss history, medication, medical history and comorbidity data items using a 70% agreement threshold. In this iterative process, there was also consideration of specific data items for patients referred for bariatric surgery. We present the first expert panel consensus on recommendations for a minimum and standard set of baseline patient data collections in obesity management services in Australia. These may be relevant to other countries with similar obesity management service models. Implementation of these recommendations should facilitate data pooling for clinical audits and research collaborations across clinics seeking to improve the quality of specialist obesity care.
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Affiliation(s)
- Divya Ramachandran
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Tania Markovic
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Samantha Hocking
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Timothy Gill
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Welbourn R, Hollyman M, Kinsman R, Dixon J, Liem R, Ottosson J, Ramos A, Våge V, Al-Sabah S, Brown W, Cohen R, Walton P, Himpens J. Bariatric Surgery Worldwide: Baseline Demographic Description and One-Year Outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg 2018; 29:782-795. [DOI: 10.1007/s11695-018-3593-1] [Citation(s) in RCA: 479] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/30/2018] [Indexed: 02/06/2023]
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Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2018; 22:1-246. [PMID: 30511918 PMCID: PMC6296173 DOI: 10.3310/hta22680] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). REVIEW METHODS Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000. RESULTS A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. LIMITATIONS Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. CONCLUSIONS Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. FUTURE WORK Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. STUDY REGISTRATION This study is registered as PROSPERO CRD42016040190. FUNDING The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Atlantis E, Kormas N, Samaras K, Fahey P, Sumithran P, Glastras S, Wittert G, Fusco K, Bishay R, Markovic T, Ding L, Williams K, Caterson I, Chikani V, Dugdale P, Dixon J. Clinical Obesity Services in Public Hospitals in Australia: a position statement based on expert consensus. Clin Obes 2018; 8:203-210. [PMID: 29683555 DOI: 10.1111/cob.12249] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/07/2018] [Accepted: 03/22/2018] [Indexed: 12/16/2022]
Abstract
We aimed to describe the current state of specialist obesity services for adults with clinically severe obesity in public hospitals in Australia, and to analyse the gap in resources based on expert consensus. We conducted two surveys to collect information about current and required specialist obesity services and resources using open-ended questionnaires. Organizational level data were sought from clinician expert representatives of specialist obesity services across Australia in 2017. Fifteen of 16 representatives of current services in New South Wales (n = 8), Queensland (n = 1), Victoria (n = 2), South Australia (n = 3), and the Australian Capital Territory (n = 1) provided data. The composition of services varied substantially between hospitals, and patient access to services and effective treatments were limited by strict entry criteria (e.g. body mass index 40 kg/m2 or higher with specific complication/s), prolonged wait times, geographical location (major cities only) and out-of-pocket costs. Of these services, 47% had a multidisciplinary team (MDT), 53% had an exercise physiologist/physiotherapist, 53% had a bariatric surgeon and 33% had pharmacotherapy resources. Key gaps included staffing components of the MDT (psychologist, exercise physiologist/physiotherapist) and access to publicly funded weight loss pharmacotherapy and bariatric surgery. There was consensus on the need for significant improvements in staff, physical infrastructure, access to services, education/training in obesity medicine and targeted research funding. Based on the small number of existing, often under-resourced specialist obesity services that are located only in a few major cities, the vast majority of Australians with clinically severe obesity cannot access the specialist evidence based treatments needed.
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Affiliation(s)
- E Atlantis
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
- Capital Markets Cooperative Research Centre, Sydney, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - N Kormas
- Department of Endocrinology and Metabolism, Concord Repatriation General Hospital, Sydney, Australia
- Department of Endocrinology, Campbelltown and Camden Hospitals, Sydney, Australia
- Diabetes Obesity Metabolism Translational Research Unit, Campbelltown Hospital, Sydney, Australia
| | - K Samaras
- Department of Endocrinology, St Vincent's Hospital, Sydney, Australia
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, Australia
| | - P Fahey
- School of Science and Health, Western Sydney University, Penrith, Australia
| | - P Sumithran
- Austin Health Weight Control Clinic, Heidelberg, Australia
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Australia
| | - S Glastras
- Department of Endocrinology, Diabetes and Metabolism, Royal North Shore Hospital, St Leonards, Australia
| | - G Wittert
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - K Fusco
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - R Bishay
- Metabolic and Weight Loss Clinic, University Clinics, Western Sydney University, Blacktown Hospital, Sydney, Australia
| | - T Markovic
- Boden Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - L Ding
- Department of Endocrinology, Diabetes and Metabolism, Royal North Shore Hospital, St Leonards, Australia
- Department of Chemical Pathology, Royal North Shore Hospital, NSW Health Pathology, Sydney, Australia
| | - K Williams
- Sydney Medical School (Nepean), Sydney, Australia
- Nepean Family Obesity Services, Nepean Blue Mountains Local Health District, Sydney, Australia
| | - I Caterson
- Boden Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - V Chikani
- Department of Diabetes and Endocrinology, The Princess Alexandra Hospital, Brisbane, Australia
| | - P Dugdale
- Centre for Health Stewardship, The Australian National University, Canberra, Australia
- Chronic Disease Management Unit, Australian Capital Territory Health Directorate, Canberra, Australia
| | - J Dixon
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Australia
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Hameed S, Salem V, Tan TM, Collins A, Shah K, Scholtz S, Ahmed AR, Chahal H. Beyond Weight Loss: Establishing a Postbariatric Surgery Patient Support Group-What Do Patients Want? J Obes 2018; 2018:8419120. [PMID: 29666701 PMCID: PMC5832182 DOI: 10.1155/2018/8419120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/18/2017] [Accepted: 12/06/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE There are limited resources for long-term specialist follow-up after bariatric surgery. In selected centres, patients can access a postoperative support group, but there is no clear evidence to guide their delivery. MATERIALS AND METHODS A retrospective study of bariatric surgery patients (n = 152) who had been discharged from specialist follow-up (mean time since surgery 5.5 years), covering weight history, physical and psychosocial comorbidities, and the need for a postoperative bariatric support group. RESULTS Fifty-eight percent wanted a postbariatric surgery patient support group. This was not associated with operation type or the amount of weight lost or regained. However, those who wanted a support group were significantly more likely to be struggling to keep the weight off, to be unhappy with the way they look, or to be experiencing difficulties returning to work. CONCLUSIONS These data point to an unmet patient requirement for a postoperative support group that is independent of weight loss success. More research is required to ascertain how such a group should be delivered, but our data would suggest that supporting patients with weight loss maintenance, body image, and return to work is an important part of postoperative care, and these needs extend well beyond the immediate period of specialist follow-up.
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Affiliation(s)
- Saira Hameed
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, Hammersmith Hospital, 6th Floor Commonwealth Building, Du Cane Road, London W12 0NN, UK
| | - Victoria Salem
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, Hammersmith Hospital, 6th Floor Commonwealth Building, Du Cane Road, London W12 0NN, UK
| | - Tricia M. Tan
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, Hammersmith Hospital, 6th Floor Commonwealth Building, Du Cane Road, London W12 0NN, UK
| | - Alma Collins
- Imperial College School of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Krishna Shah
- Imperial College School of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Samantha Scholtz
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Ahmed R. Ahmed
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, St Mary's Campus, Praed Street, London W2 1NY, UK
| | - Harvinder Chahal
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, Hammersmith Hospital, 6th Floor Commonwealth Building, Du Cane Road, London W12 0NN, UK
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