Bariatric surgery effective for treating obesity
News release from NETSCC, HTA
18 November 2009
Bariatric surgery is a more clinically effective intervention for treating obesity compared to non-surgical options suggests research published by the National Institute of Health Research Health Technology Assessment (NIHR HTA) programme.
‘Bariatric’ surgery is the branch of medicine concerned with the treatment of obesity. The prevalence of overweight and obesity among people in England and Wales is increasing. In the decade ending in 2005 the proportion of obese men rose by over 40% and obese women rose by almost 35%. Among children, it was up by over 50%. Serious health problems associated with obesity include type 2 diabetes, cardiovascular disease, musculoskeletal disorders, certain cancers and increased mortality. Childhood obesity is associated with a higher chance of premature death and disability in adulthood.
As people become overweight and continue to gain weight they increase their risk of developing health problems. When obese people lose weight there may be an improvement in existing weight-related health problems and a decrease in the risk of future weight-related health problems. If people have failed to lose weight by dietary and/or drug treatment they may be considered for bariatric surgery. There are several different kinds of operation that can be carried out to help obese people lose weight in conjunction with appropriate lifestyle changes. These involve making the stomach smaller, shortening/bypassing part of the intestine so that less food can be absorbed, or a combination of these approaches. However, it was not clear which one is the safest and most effective.
Researchers, led by Dr Joanna Picot, University of Southampton, systematically reviewed existing literature on the clinical and cost-effectiveness of surgery versus non-surgical interventions (diet, weight-loss drugs, or no treatment) for obesity. An economic model was developed to assess cost-effectiveness of bariatric surgery for three patient populations. These included patients with morbid obesity with a body mass index (BMI) of forty or greater, patients with moderate to severe obesity with BMI between thirty and forty who have Type 2 diabetes, and patients with moderate obesity with BMI between thirty and thirty five.
The results of the systematic review showed that surgery for adults leads to a greater reduction in weight compared to non-surgical treatments. The evidence suggests that gastric bypass (GBP) is more effective for weight loss than vertical banded gastroplasty (VGB) and adjustable gastric banding (AGB). Bariatric surgery was associated with a risk of death and serious adverse events. In the three patient populations analysed, bariatric surgery is more expensive than non-surgical treatment but delivers improved outcomes over a twenty year time period. Generally the results fell within the range considered cost-effective, except for some in the population group with BMI 30-35. No evidence on bariatric surgery in young people met the inclusion criteria for the review.
“Evidence from the studies suggests that bariatric surgery is a more effective intervention for weight loss than non-surgical treatments,” says Dr Picot.” However, there are risks associated with bariatric surgery and not everyone would be eligible for the procedure. Uncertainties remain over the long-term outcomes of bariatric surgical interventions, particularly their impact on weight-related health problems and patient quality of life. Further studies will be required.”
Following the results of this project, the HTA programme has invited new research proposals to further the study into obesity and the long-term effects of bariatric surgery. There have been a number of proposals received that will be reviewed before the end of 2009.
In addition, on 10 November 2009 the HTA programme will also be inviting research proposals in the area of obesity in a joint themed call with the Public Health Research (PHR) programme. For more information about this call, please visit http://www.hta.ac.uk/funding/themedcalls/obesity.shtml
To view and download the full report ‘The clinical-effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation’ visit http://www.hta.ac.uk/1742
Notes for editors
1. The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme commissions research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 530 issues published to date. The journal’s 2009 Impact Factor (4.197) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk
2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk
Contact details
Naomi Williams, Programme Manager (Communications)
Telephone: 02380 595 646, Email: N.E.Williams@southampton.ac.uk
Emma Sunderland, Assistant Programme Manager (Communications)
Telephone: 02380 599 094, Email: E.Sunderland@southampton.ac.uk
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