scholarly journals Developing Integrated Clinical Pathways for the Management of Clinically Severe Adult Obesity: a Critique of NHS England Policy

2020 ◽  
Vol 9 (4) ◽  
pp. 530-543
Author(s):  
Jonathan M. Hazlehurst ◽  
Jennifer Logue ◽  
Helen M. Parretti ◽  
Sally Abbott ◽  
Adrian Brown ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Management ◽  
Clinical Pathways ◽  
Treatment Access ◽  
Access To Treatment ◽  
Personalized Care ◽  
Prevention And Treatment ◽  
Prevalence Of Obesity ◽  
Post Bariatric Surgery ◽  
Tier 3

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. Summary 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.

scholarly journals Tier 3 multidisciplinary medical weight management improves outcome of Roux-en-Y gastric bypass surgery

2015 ◽  
Vol 97 (3) ◽  
pp. 235-237 ◽  
Author(s):  
P Patel ◽  
A Hartland ◽  
A Hollis ◽  
R Ali ◽  
A Elshaw ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Weight Management ◽  
Gastric Bypass Surgery ◽  
Management Programme ◽  
Percentage Points ◽  
Weight Management Programme ◽  
Medical Weight Management ◽  
Tier 3

Introduction In 2013 the Department of Health specified eligibility for bariatric surgery funded by the National Health Service. This included a mandatory specification that patients first complete a Tier 3 medical weight management programme. The clinical effectiveness of this recommendation has not been evaluated previously. Our bariatric centre has provided a Tier 3 programme six months prior to bariatric surgery since 2009. The aim of our retrospective study was to compare weight loss in two cohorts: Roux-en-Y gastric bypass only (RYGB only cohort) versus Tier 3 weight management followed by RYGB (Tier 3 cohort). Methods A total of 110 patients were selected for the study: 66 in the RYGB only cohort and 44 in the Tier 3 cohort. Patients in both cohorts were matched for age, sex, preoperative body mass index and pre-existing co-morbidities. The principal variable was therefore whether they undertook the weight management programme prior to RYGB. Patients from both cohorts were followed up at 6 and 12 months to assess weight loss. Results The mean weight loss at 6 months for the Tier 3 cohort was 31% (range: 18–69%, standard deviation [SD]: 0.10 percentage points) compared with 23% (range: 4–93%, SD: 0.12 percentage points) for the RYGB only cohort (p=0.0002). The mean weight loss at 12 months for the Tier 3 cohort was 34% (range: 17–51%, SD: 0.09 percentage points) compared with 27% (range: 14–48%, SD: 0.87 percentage points) in the RYGB only cohort (p=0.0037). Conclusions Our study revealed that in our matched cohorts, patients receiving Tier 3 specialist medical weight management input prior to RYGB lost significantly more weight at 6 and 12 months than RYGB only patients. This confirms the clinical efficacy of such a weight management programme prior to gastric bypass surgery and supports its inclusion in eligibility criteria for bariatric surgery.

Publicity Over Prevention, Cures Over Care

2019 ◽  
pp. 131-160
Author(s):  
Rachel Kahn Best
Keyword(s):  
Health Policy ◽  
Treatment Access ◽  
Access To Treatment ◽  
Advocacy Organizations ◽  
Corporate Influence ◽  
Prevention And Treatment ◽  
Disease Advocacy ◽  
Corporate Interests ◽  
Over Time

Focusing on diseases shapes the types of goals advocacy organizations pursue and the types of laws Congress passes. Over time, the pressure to adopt goals that fit neatly within disease categories, corporate influence, and the strategic avoidance of controversy encouraged disease advocates to prioritize awareness and research over prevention and access to treatment. This creates a health policy portfolio that subsidizes corporate interests, ignores collective risks, fails to challenge inequalities, and may actually make people less healthy by encouraging overtreatment. Yet while only a small proportion of organizations focus on prevention and treatment access, the phenomenal growth of disease advocacy means that large numbers of organizations continue to pursue the latter goals. Narrow goals outnumber broader goals but do not displace them.

Efficacy of liraglutide in weight management post bariatric surgery patients: data from an Emirati cohort

2019 ◽  
Author(s):  
Abdulla Alnuaimi ◽  
Saradalekshmi Koramannil Radha ◽  
Majid AlAmeri ◽  
Maha T Barakat ◽  
Nader Lessan
Keyword(s):  
Bariatric Surgery ◽  
Weight Management ◽  
Post Bariatric Surgery

scholarly journals Study Protocol: A Six-Session Mindfulness-Based Training to Support Weight Management in Hispanics Post Bariatric Surgery – Lessons Learned From a Pilot Study

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1284-1284
Author(s):  
Preciosa Martinez Motta ◽  
Valerie George ◽  
Adriana Campa ◽  
Agustin Castellanos
Keyword(s):  
Bariatric Surgery ◽  
Pilot Study ◽  
Weight Management ◽  
Short Form ◽  
Lessons Learned ◽  
Five Facet Mindfulness Questionnaire ◽  
Snowball Sampling ◽  
Support Weight ◽  
Hispanic Origin ◽  
Post Bariatric Surgery

Abstract Objectives Objective: To evaluate the recruitment, retention, and acceptability of a mindfulness-based group intervention to support weight management in Hispanics after bariatric surgery. Background: Mindfulness-based approaches may support improvement of problematic eating behaviors post- bariatric surgery. Such approaches have been explored with promising results in Non-Hispanic; however their impact on bariatric clients of Hispanic origin has not been investigated. The purpose of this pilot study was to evaluate the feasibility of a six-session mindfulness-based training for bariatric clients of Hispanic origin. Methods This was an intervention-one group pre/post-test pilot study. Participants were Hispanics (≥ 21 years), who had surgery 12–36 months prior to baseline. Recruitment was over a one-month period, through flyers available in a dietetics practice and through snowball sampling. Interested individuals were screened via telephone. Group training was delivered over six consecutive weeks, participants were asked to complete four questionnaires including: Perceived Stress Questionnaire, Acceptance and Committed Action-II Questionnaire, Intuitive Eating Scale-2, and Short-Form Five Facet Mindfulness Questionnaire at baseline, week six, and ten. A group exit interview was conducted on week six. Incentives and refreshments were provided at each meeting, training was free of charge. Results For recruitment in the first cohort, 60 people screened, 55 (92%) were eligible and 7 (13%) consented, meeting the recruitment objective of 7–10 participants. Out of the eligible, 42 (76%) were willing but not able at this time. There was 100% participation in all sessions and assessment visits which exceeded the adherence criteria of attendance at 4/6 sessions. Three participants were recruited from flyers, four from snowball sampling. Conclusions This pilot study was feasible; Hispanics were willing to participate, retention and adherence was at a maximum. Multiple sources for recruitment could increase the efficacy of the recruitment. Funding Sources None.

scholarly journals Prevalence of co-morbidities in a specialist weight management programme prior to bariatric surgery

2019 ◽  
Vol 19 (1) ◽  
pp. 8-13
Author(s):  
Daniel Fountain ◽  
Mohammed Al Kharaiji ◽  
Sherif Awad ◽  
David Hughes ◽  
Iskandar Idris
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Weight Management ◽  
Sleep Apnoea ◽  
East Midlands ◽  
Obstructive Sleep ◽  
Co Morbidity ◽  
Future Evaluation ◽  
Tier 3

Objective: There is limited evidence on the prevalence of patients’ obesity-related co-morbidities and the effectiveness of specialist multidisciplinary weight management (Tier 3) programmes prior to bariatric surgery. We therefore evaluate and report the prevalence of co-morbidities in patients attending a Tier 3 service within the National Health Service.Methods: This was a prospective observational study of consecutive patients who attended the Tier 3 service at the East Midlands Bariatric Metabolic Institute throughout 2017.Results: 430 patients attended the service over the study observation period. Twelve patients (2.8%) were excluded from our analysis due to incomplete data. 70.8% of patients were women, mean age at baseline was 46.4 years, mean±SD weight and body mass index at baseline were 137.8±29.2 kg and 48.0±8.6 kg/m2, respectively. The most common co-morbidities recorded at baseline were type 2 diabetes mellitus (31.1%), hypertension (31.1%), depression (26.1%), obstructive sleep apnoea (23.2%) and osteoarthritis (15.6%). Significant weight loss was observed at the 3-month and 6-month follow-up points, but not at the 9- or 12-month follow-up points. 22.5% of patients achieved weight loss of ≥5%.Conclusion: The prevalence of co-morbidities within this Tier 3 service was high. While specialised weight management services may achieve moderate weight loss through a multidisciplinary intervention, future evaluation of clinical outcomes of specialist weight services should also include co-morbidity outcomes.

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