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Obesity Weight Management and Bariatric Surgery Case Management Programs: A Review of Literature

Echols, Jennie DSN, RN

doi: 10.1097/NCM.0b013e3181b5ebeb

Purpose/objectives The proportion of Americans with clinically severe obesity has vast implications for the nation's healthcare system since this population have twice as many chronic medical conditions as people with normal weight. Through the use of review of literature, this article (a) describes the types of weight loss programs; (b) reviews the results from studies on effectiveness of bariatric surgery; and (c) identifies recommendations for obesity and bariatric surgery case management programs.

Primary practice settings Disease management companies appear to be concentrating on general weight loss strategies associated with wellness and other condition-specific disease management products, whereas larger national healthcare companies with at-risk and insurance products offer specific bariatric surgery management products. Case management programs within healthcare systems, health management organizations, and insurance companies are frequently faced with the management of individuals with morbid obesity and, increasingly, those who are requesting or have undergone bariatric surgery.

Findings/conclusions Research shows that morbid obesity is a disease that remains generally unresponsive to diet and drug therapy but appears to respond well to bariatric surgery. Research findings suggest that surgical treatment is more effective than pharmacological treatment of weight loss and the control of some comorbidities associated with obesity. The number of Americans having weight loss surgery increased by 804% between 1998 and 2004, which appears to be a driver for the recent development of obesity disease management and bariatric surgery case management programs.

Implications for case management practice Although the immaturity and lack of studies citing outcomes of obesity disease and case management programs limit the identification of best practices based on outcomes, emerging practices can be identified and recommendations for case management can be formulated. In addition to primary prevention and treatment programs for obesity, this article describes program activities in detail for the following key areas: (1) identification and engagement; (2) coaching, education, and support; (3) collaboration among treating providers; (4) preparation, management, and follow-up when bariatric surgery is indicated; (5) aggressive follow-up until personal goals are achieved; and (6) outcome measurement.

Jennie Echols, DSN, RN, is Senior Associate, Clinical Healthcare Practice at Mercer Human Resource Consulting, Atlanta, GA. She manages projects involving clinical program assessment, quality strategy, performance measurement and special studies. Dr. Echols has more than 25 years of healthcare management experience and received her doctorate in nursing from the University of Alabama in Birmingham.

Address correspondence to Jennie Echols, DSN, RN, Mercer Health and Benefits, LLC, 3560 Lenox Road, Suite 2400, Atlanta, GA 30326 (

The author has no conflict of interest.

© 2010 Lippincott Williams & Wilkins, Inc.