A systematic review and economic evaluation was commissioned to determine the effectiveness and cost-effectiveness of bariatric surgery for mild [class I, body mass index (BMI) 30 to 34.99] or moderate (class II, BMI 35 to 39.99) obesity.
We searched 17 electronic resources (to February 2010) and other sources. Studies meeting predefined criteria were identified, data-extracted and assessed for risk of bias using standard methodology. A model was developed to estimate cost-effectiveness.
Two RCTs were included. Evidence from both indicated a statistically significant benefit from laparoscopic adjustable banding (LAGB) compared to a non-surgical comparator for weight loss and in obesity-related comorbidity. Both interventions were associated with adverse events. LAGB costs more than non-surgical management. For people with class I or II obesity and type 2 diabetes (T2D), the incremental cost-effectiveness ratio (ICER) at 2 years is £20,159, reducing to £4,969 at 5 years and £1,634 at 20 years. Resolution of T2D makes the greatest contribution to this reduction. In people with class I obesity, the ICER is £63,156 at 2 years, £17,158 at 5 years, and £13,701 at 20 years. Cost-effectiveness results are particularly sensitive to utility gain from reduction in BMI, factors associated with poorer surgical performance and diabetes health state costs.
Bariatric surgery appears to be a clinically effective and cost-effective intervention for people with class I or II obesity who also have T2D but is less likely to be cost-effective for people with class I obesity.
[Show abstract][Hide abstract] ABSTRACT: Obesity and low back pain (LBP) are responsible for significant morbidities and financial expenditure. Numerous studies have demonstrated a positive relationship between obesity and LBP, but a concurrent investigation of causality is often omitted. Spinal clinicians routinely prescribe exercise and weight loss for obese patients with LBP, despite a paucity of literature evaluating why obesity might cause LBP or how exercise and weight loss might be suitable treatments for LBP. Etiologies have tended to focus on the biomechanical effects of obesity that lead to excessive loading and degeneration of the lumbar spine. However, recent evidence suggests that systemic inflammation associated with obesity may also be an important contributor to LBP. In this article, the latest evidence investigating the relationship between obesity and LBP is reviewed, an overview of the impact of exercise and weight loss on LBP is provided, and proposed mechanisms connecting obesity, systemic inflammation, and LBP are outlined.
[Show abstract][Hide abstract] ABSTRACT: Introduction. Moderate obesity (BMI 30-35 kg/m(2)) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m(2), 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m(2). Of the 14 patients with T2DM, 12 (86%) discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87%) showed remission and 2 (13%) improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30-35 kg/m(2). Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients.
Gastroenterology Research and Practice 12/2013; 2013:276183. DOI:10.1155/2013/276183 · 1.75 Impact Factor
A-C Paepegaey, B Dubern, A Karsenty, H Chantereau, J Aron-Wisnewsky, L Oderda, M Hadoux, A Robert-Gary, J-L Bouillot, J-M Oppert, P Tounian, C Poitou
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