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Weight Loss and Outcomes in Wait-listed, Medically Managed, and Surgically Treated Patients Enrolled in a Population-based Bariatric Program: Prospective Cohort Study

Padwal, Raj S. MD, MSc*,†; Rueda-Clausen, Christian F. MD, PhD*,†; Sharma, Arya M. MD, PhD*,†; Agborsangaya, Calypse B. MSc*,†; Klarenbach, Scott MD, MSc*; Birch, Dan W. MD; Karmali, Shahzeer MD; McCargar, Linda§; Majumdar, Sumit R. MD, MPH*,†

doi: 10.1097/MLR.0000000000000070
Original Articles

Background: Multidisciplinary bariatric care is increasingly being delivered in Canada within publicly funded regional programs. Demand is high, wait lists are long, and clinical effectiveness is unknown.

Objective: To examine the “real-world” outcomes associated with a publicly funded, population-based regional bariatric (medical and surgical) program.

Research Design: Prospective observational cohort.

Subjects: Five hundred consecutive patients (150 wait-listed, 200 medically treated, 150 surgically treated) from the Edmonton Weight Wise program were enrolled.

Measures: The primary outcome was weight change (kg). Between-group changes were analyzed using multivariable regression adjusted for age, sex, and baseline weight and “last-observation-carried-forward” was used for missing data. Subjects transitioning between groups (wait-list to medical or medical to surgery) were censored when crossing over.

Results: At baseline, mean age was 43.7±9.6 years, mean body mass index was 47.9±8.1 kg/m2, and 88% were female. A total of 412 subjects (82%) completed 2-year follow-up and 143 (29%) subjects crossed over to the next treatment phase. Absolute and relative (% of baseline) mean weight reductions were 1.5±8.5 kg (0.9±6.1%) for wait-listed, 4.1±11.6 kg (2.8±8.1%) for medically treated, and 22.0±19.7 kg (16.3±13.5%) for surgically treated (P<0.001) subjects. For surgery, weight reductions were 7.0±9.7 kg (5.8±7.9%) with banding, 21.4±16.0 kg (16.4±11.6%) with sleeve gastrectomy, and 36.6±19.5 kg (26.1±12.2%) with gastric bypass (P<0.001). Rates of hypertension, diabetes, and dyslipidemia decreased to a significantly greater degree with surgery than medical management (P<0.001) and stayed the same or increased in wait-listed subjects.

Conclusions: Population-based bariatric care, particularly bariatric surgery, was clinically effective. Weight and cardiometabolic risk was relatively stable wait-listed patients receiving “usual care.”

*Department of Medicine, University of Alberta

Alberta Diabetes Institute

Department of Surgery and CAMIS (Center for the Advancement of Minimally Invasive Surgery), Royal Alexandra Hospital

§Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.lww-medicalcare.com.

APPLES is funded by the Canadian Institutes of Health Research (CIHR) Grant Number 86642. R.S.P., S.R.M., SK., and A.M.S. are supported by an alternative funding plan from the Government of Alberta and the University of Alberta. S.R.M. and S.K. are supported by Alberta Innovates Health Solutions (AI-HS). A.M.S. is supported by an Alberta Health Services Chair in Obesity Research and Management.

Trial registration: Clinicaltrials.gov NCT00850356.

D.W.B. has received honoraria for advisory boards, teaching and research from Ethicon Endo-Surgery Inc., a Johnson and Johnson company. S.R.M. holds the Endowed Chair in Patient Health Management at the University of Alberta. C.F.R-C. is a CIHR and AI-HS Clinical Research Fellow. The remaining authors declare no conflict of interest.

Reprints: Raj S. Padwal, MD, MSc, 5-134 Clinical Sciences Building,11350 - 83rd Ave, Edmonton, AB, Canada T6G2G3. E-mail: rpadwal@ualberta.ca.

© 2014 by Lippincott Williams & Wilkins.