Gap Between Evidence and Patient Access: Policy Implications for Bariatric and Metabolic Surgery in the Treatment of Obesity and its Complications

Abstract

Despite consistently supportive evidence of clinical effectiveness and economic advantages compared with currently available non-surgical obesity treatments, patient access to bariatric and metabolic surgery (BMS) is impeded. To address this gap and better understand the relationship between value and access, the objectives of this study were twofold: (i) identify the multidimensional barriers to adoption of BMS created by clinical guidelines, public policies, and health technology assessments; and, most importantly, (ii) develop recommendations for stakeholders to improve patient access to BMS. Updated public policies focused on treatment and clinical guidelines that reflect the demonstrated advantages of BMS, patient education on safety and effectiveness, updated reimbursement policies, and additional data on long-term BMS effectiveness are needed to improve patient access.

For a Step Change to Curb the Obesity Epidemic

“…In addition, a few treatment options have been introduced, including both pharmacological and surgical approaches. Yet, as evidenced by Cecchini and Sassi [18], Baum et al [20], Chawla et al [19], and Chawla et al [21] in this issue, and others [17] elsewhere, interventions have faced and continue to face significant challenges and, to date, have failed to curb obesity. While many interventions appear to have provided some benefits, the gains have often been marginal [18,22].…”

“…As reported by Baum et al [20], Finkelstein et al [26], and Chawla et al [19], many patients face inadequate access to treatment-pharmacological and surgical-with poor health insurance coverage/ reimbursement, even in rich nations such as the USA and European countries, particularly when patients do not yet experience comorbidities. As noted by Baum et al [20] and Chawla et al [21], pharmaceutical innovation in the obesity field has been limited.…”

“…These interventions have included both prevention and treatment approaches [18]. To date most of the efforts have focused on prevention interventions, including personal responsibility and awareness (e.g., physical exercise/lifestyle interventions, counseling of individuals at risk in primary care [19]), education (e.g., school-based interventions, mass media health promotion campaigns), and environmental control efforts (e.g., food portion/intake control, worksite health promotion interventions, regulation of food advertising to children, compulsory food labeling, tax markups/price promotions) [17][18][19]. In addition, a few treatment options have been introduced, including both pharmacological and surgical approaches.…”

“…[23]. Misperception of obesity as a cosmetic or lifestyle issue, rather than a serious health problem, has been a significant hurdle to mobilizing patients, communities, and payers to embrace prevention and treatment initiatives [19,20]. Many researchers, including those in this issue, note the need for (1) more comprehensive, multi-factorial interventions [17,22,24], and (2) treatment as opposed to purely preventive approaches (to both address the needs of the already obese and the limited effectiveness of prevention) [25], as key learnings from past failed experience in obesity prevention/management.…”

“…Even clinically effective medications, which result in 5-10 % loss in body weight (the necessary threshold to achieve clinically significant improvements in most risk factors for cardiovascular disease [27,28]), have not been fully embraced by patients, as patient expectations for weight loss are generally much more ambitious, while patient adherence can be low [20]. These multiple challenges explain, in part, the underwhelming success of past interventions [19,20] and their disappointing impact on the obesity epidemic [2].…”