A Systematic Review of the Evidence for Non-surgical Weight Management for Adults with Severe Obesity: What is Cost Effective and What are the Implications for the Design of Health Services?

Jacobsen, Elisabet; Boyers, Dwayne; Manson, Paul; Avenell, Alison

doi:10.1007/s13679-022-00483-z

Cited by 9 publications

(7 citation statements)

References 43 publications

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“…Mediation models for obese patients with and without regular binge eating were reported, permitting the highlighting of differences in two distinct groups. Finally, longitudinal outcomes for a BWLI are reported, expanding the existing evidence on the effect of these interventions on obesity-related outcomes, a field currently in need of targeted research [ 64 ]. Concerning limitations, the assessment of binge eating relied on a single standardized questionnaire, whereas a systematic clinical evaluation of enrolled patients could have allowed for the inclusion of manualized diagnoses of BED.…”

Section: Discussionmentioning

confidence: 99%

Mental Health Variables Impact Weight Loss, Especially in Patients with Obesity and Binge Eating: A Mediation Model on the Role of Eating Disorder Pathology

Pruccoli,

Mack,

Klos

et al. 2023

Nutrients

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Background: Various mental health and eating behavior variables have been independently associated with predicting weight loss in individuals with obesity. This study aims to investigate a mediation model that assesses the distinct contributions of these variables in predicting weight changes in patients with obesity following an outpatient behavioral weight loss intervention (BWLI). Methods: General mental health (depression, anxiety, stress, impulsivity), eating behavior (cognitive restraint, disinhibition, hunger), eating disorder pathology, and body mass index (BMI) were assessed in a group of 297 patients with obesity at the admission of a BWLI program. BMI was re-evaluated during the final treatment session. A mediation model was employed to examine whether mental health and eating behavior variables predicted BMI changes, with eating disorder pathology serving as a mediator. The model was tested both overall and within two patient subgroups: those with regular binge eating (≥four episodes/month) and those without. Results: In the overall sample (n = 238), the relationships between depression, impulsivity, and cognitive restraint with BMI change were mediated by eating disorder pathology. In the subgroup with regular binge eating (n = 99, 41.6%), the associations between stress and disinhibition with BMI change were additionally mediated by eating disorder pathology. In the subgroup without regular binge eating, eating disorder pathology showed no mediating effect. Discussion: Multiple mental health and eating behavior variables assessed at admission predicted BMI changes, particularly when mediated by eating disorder pathology in patients with regular binge eating. A comprehensive psychopathological assessment prior to starting BWLI may help identify multiple factors affecting prognosis and treatment outcomes. Long-term follow-up studies in this field are required.

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Section: Discussionmentioning

confidence: 99%

Mental Health Variables Impact Weight Loss, Especially in Patients with Obesity and Binge Eating: A Mediation Model on the Role of Eating Disorder Pathology

Pruccoli,

Mack,

Klos

et al. 2023

Nutrients

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“…This is due in part to lower degrees of weight loss and the challenges in quantifying the multifactorial and likely long-term or lagged benefits from these therapies. 48,49 Studying the cost-effectiveness of obesity prevention is even more challenging. 50 Still, this lack of definitive cost-effectiveness data likely contributes to the low uptake of obesity science implementation in clinical settings.…”

Section: Identifying Gaps In Obesity Science: Clinician Knowledge Com...mentioning

confidence: 99%

Implementation of Obesity Science Into Clinical Practice: A Scientific Statement From the American Heart Association

Laddu,

Neeland,

Carnethon

et al. 2024

Circulation

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Obesity is a recognized public health epidemic with a prevalence that continues to increase dramatically in nearly all populations, impeding progress in reducing incidence rates of cardiovascular disease. Over the past decade, obesity science has evolved to improve knowledge of its multifactorial causes, identifying important biological causes and sociological determinants of obesity. Treatments for obesity have also continued to develop, with more evidence-based programs for lifestyle modification, new pharmacotherapies, and robust data to support bariatric surgery. Despite these advancements, there continues to be a substantial gap between the scientific evidence and the implementation of research into clinical practice for effective obesity management. Addressing barriers to obesity science implementation requires adopting feasible methodologies and targeting multiple levels (eg, clinician, community, system, policy) to facilitate the delivery of obesity-targeted therapies and maximize the effectiveness of guideline-driven care to at-need patient populations. This scientific statement (1) describes strategies shown to be effective or promising for enhancing translation and clinical application of obesity-based research; (2) identifies key gaps in the implementation of obesity science into clinical practice; and (3) provides guidance and resources for health care professionals, health care systems, and other stakeholders to promote broader implementation and uptake of obesity science for improved population-level obesity management. In addition, advances in implementation science that hold promise to bridge the know-do gap in obesity prevention and treatment are discussed. Last, this scientific statement highlights implications for health research policy and future research to improve patient care models and optimize the delivery and sustainability of equitable obesity-related care.

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“…Implementing treatment or referral mechanisms for long‐term care wherever individuals with obesity enter the healthcare system (specialty, primary, emergent, or diagnostic/procedural care)—the same model now used for other chronic diseases—is expected to lead to better clinical outcomes. 101 Because obesity care must focus on long‐term health, moreover, the field needs additional research regarding costs of optimal care for both individuals and populations affected by obesity for all treatment modalities and intensities globally.…”

Section: Recommendations and Future Directionsmentioning

confidence: 99%

Assessing the state of obesity care: Quality, access, guidelines, and standards

Kaplan,

Apovian,

Ard

et al. 2024

Obesity Science & Practice

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BackgroundAn international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence.AimsThe panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity.MethodsThe panel was held in Leesburg, Virginia in September 2019.ResultsThe panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice guidelines (CPG) to better reflect obesity’s pathophysiological basis and heterogeneity, as well as the disease’s health, sociocultural, and economic complications; effects on quality of life; need for standards for quantitative comparison of treatment benefits, risks, and costs; and the need to more effectively integrate obesity treatment guidelines into routine clinical practice and to facilitate more direct clinician participation to improve public understanding of obesity as a disease with a pathophysiological basis. The panel also recommended that professional organizations working to improve the care of people with obesity collaborate via a working group to develop an updated, patient‐focused, comprehensive CPG establishing standards of care, addressing identified needs, and providing for routine, periodic review and updating.ConclusionsUnmet needs in the definition, assessment and treatment of obesity were identified and a blueprint to address these needs developed via a clinical practice guideline that can be utilized worldwide to respond to the increasing prevalence of obesity.

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A Systematic Review of the Evidence for Non-surgical Weight Management for Adults with Severe Obesity: What is Cost Effective and What are the Implications for the Design of Health Services?

Cited by 9 publications

References 43 publications

Mental Health Variables Impact Weight Loss, Especially in Patients with Obesity and Binge Eating: A Mediation Model on the Role of Eating Disorder Pathology

Mental Health Variables Impact Weight Loss, Especially in Patients with Obesity and Binge Eating: A Mediation Model on the Role of Eating Disorder Pathology

Implementation of Obesity Science Into Clinical Practice: A Scientific Statement From the American Heart Association

Assessing the state of obesity care: Quality, access, guidelines, and standards

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