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Obesity Management

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1. Endoscopic placement and removal of an intra-gastric balloon (IGB) for the management of overweight and obesity in a high-risk patient

Endoscopic placement and removal of an intra-gastric balloon (IGB) for the management of overweight and obesity in a high-risk patient 1 Public Summary Document Application No. 1515 Endoscopic placement and removal of an intragastric balloon for the management of moderate obesity in patients with type 2 diabetes mellitus who have failed first-line treatments Applicant: Apollo Endosurgery Australia Date of MSAC consideration: MSAC 76 th Meeting, 1-2 August 2019 Context for decision: MSAC makes (...) Endosurgery Australia by the Department of Health. 2. MSAC’s advice to the Minister After considering the strength of the available evidence in relation to comparative safety, clinical effectiveness and cost-effectiveness, MSAC did not support public funding for endoscopic placement and removal of an IGB for the management of moderate obesity in patients with poorly controlled T2DM who have failed first-line treatments. MSAC considered that IGB had inferior safety (relative to lifestyle interventions

2019 Medical Services Advisory Committee

2. Naltrexone?bupropion for managing overweight and obesity

Naltrexone?bupropion for managing overweight and obesity Naltre Naltrex xone–bupropion for managing one–bupropion for managing o ov verweight and obesity erweight and obesity T echnology appraisal guidance Published: 12 December 2017 nice.org.uk/guidance/ta494 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guidance represent the view of NICE (...) ). Page 3 of 171 1 Recommendations Recommendations 1.1 Naltrexone–bupropion is not recommended within its marketing authorisation for managing overweight and obesity in adults alongside a reduced-calorie diet and increased physical activity. 1.2 This recommendation is not intended to affect treatment with naltrexone–bupropion that was started in the NHS before this guidance was published. Adults having treatment outside this recommendation may continue without change to the funding arrangements

2017 National Institute for Health and Clinical Excellence - Technology Appraisals

3. Obesity Prevention and Management

of the circumstances presented by the patient. Obesity Prevention and Management Patient population: Patients aged 2 years and older seen in primary care Objectives: Prevention of obesity in patients and weight management in overweight and obese patients Key points Problem. One-third or more of American adults, adolescents, and children are obese. Obesity rates have tripled in one generation, resulting in increases in associated medical comorbidities and care costs. [C]. Weight classification. BMI (body mass index (...) to meet goals. If significant obesity persists and the obesity- associated risk factors remain, consider referral to a higher level of weight management. Referrals Primary care providers should initially manage overweight and obesity. For patients who are motivated but not making progress meeting their diet and exercise goals, referrals can be helpful. Referrals may also be indicated to manage comorbidities. Common referrals are to the following: Intensive multidisciplinary obesity program

2020 University of Michigan Health System

4. Perioperative Management of Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome: A Workshop Report

Perioperative Management of Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome: A Workshop Report AMERICANTHORACICSOCIETY DOCUMENTS KnowledgeGapsinthePerioperativeManagementofAdultswith ObstructiveSleepApneaandObesityHypoventilationSyndrome An Of?cial American Thoracic Society Workshop Report Najib T. Ayas, Cheryl R. Laratta, John M. Coleman, Anthony G. Doufas, Matthias Eikermann, Peter C. Gay, Daniel J. Gottlieb, Indira Gurubhagavatula, David R. Hillman, Roop Kaw, Atul Malhotra (...) syndrome? Introduction Methods Committee Composition Workshop Structure and Literature Review Document Development Perioperative Outcomes of Patients with Sleep- disordered Breathing Screening for Obstructive Sleep Apnea in Surgical Patients Obstructive Sleep Apnea Endotypes and Potential Relevance in the Perioperative Period Role of Algorithms in the Perioperative Management of Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome Perioperative Use of Positive Airway Pressure Obesity

2018 American Thoracic Society

5. Assessing and managing children at primary health-care facilities to prevent overweight and obesity in the context of the double burden of malnutrition

no serious inconsistency no serious indirectness no serious imprecision none — — No data on this outcome IMPORTANT BMI: body mass index; CI: confidence interval; RCT: randomized controlled trial; SMD: standard mean difference. 1 National Institute for Health and Care Excellence (NICE) guidance (53) title: Weight management: lifestyle services for overweight or obese children and young people. Review 1: Effectiveness and cost effectiveness of lifestyle weight management services for children and young (...) Assessing and managing children at primary health-care facilities to prevent overweight and obesity in the context of the double burden of malnutrition Assessing and managing children at primary health-care facilities to prevent overweight and obesity in the context of the double burden of malnutrition Guideline Updates for the Integrated Management of Childhood Illness (IMCI)GUIDELINE Assessing and managing children at primary health-care facilities to prevent overweight and obesity

2017 World Health Organisation Guidelines

6. Weight management: lifestyle services for overweight or obese adults

Weight management: lifestyle services for overweight or obese adults W Weight management: lifestyle services eight management: lifestyle services for o for ov verweight or obese adults erweight or obese adults Public health guideline Published: 28 May 2014 nice.org.uk/guidance/ph53 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent (...) effectiveness 34 5 Recommendations for research 36 6 Related NICE guidance 39 Published 39 Under development 40 7 Glossary 41 Adults who are overweight or obese 41 Behaviour change techniques 41 Body mass index 42 Complex needs 42 Dietary habits 42 Lifestyle weight management programmes 42 Physical activity 43 Physical activity instructor 43 Stigma 43 Tiers of weight management services 43 Weight management: lifestyle services for overweight or obese adults (PH53) © NICE 2018. All rights reserved. Subject

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

7. Weight management: lifestyle services for overweight or obese children and young people

Weight management: lifestyle services for overweight or obese children and young people W Weight management: lifestyle services eight management: lifestyle services for o for ov verweight or obese children and erweight or obese children and y young people oung people Public health guideline Published: 23 October 2013 nice.org.uk/guidance/ph47 © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our (...) 1990 centile charts 52 Weight management: lifestyle services for overweight or obese children and young people (PH47) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 1117 References 53 8 Summary of the methods used to develop this guidance 55 Introduction 55 Guidance development 55 Key questions 55 Reviewing the evidence 56 Commissioned report 59 Cost effectiveness 59 How the PDG formulated the recommendations

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

8. Recommendations for growth monitoring, prevention and management of overweight and obesity in children and youth in primary health care 2015

. 12 The last task force guidance specifically on childhood obesity was in 1994; it focused on screening for and treatment of obesity in children, but did not address primary prevention. 13 The current guideline provides recommenda- tions for growth monitoring and prevention of overweight and obesity in healthy-weight chil- dren and adolescents aged 17 years and younger in primary care settings, and guidance for pri- mary care practitioners on the effectiveness of overweight and obesity management (...) Recommendations for growth monitoring, prevention and management of overweight and obesity in children and youth in primary health care 2015 Guidelines CMAJ ©2015 8872147 Canada Inc. or its licensors CMAJ, April 7, 2015, 187(6) 411 CME T he prevalence of obesity in Canadian children has risen dramatically from the late 1970s, more than doubling among both boys and girls. 1 Based on growth curves generated by the World Health Organization, the prevalence of overweight and obesity in Canadian

2015 CPG Infobase

9. Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care

recommen- dations are due to differences in methodology and grading of evidence, and updates in knowledge regarding management of overweight and obesity. The current task force guidance on management of overweight and obesity is consistent with inter- national guidelines and strategies (Table 2). Table 2: Summary of recommendations on prevention of weight gain in normal-weight adults and treatment of overweight and obesity in Canada and elsewhere Organization Recommendation Prevention of weight gain (...) Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care Guidelines CMAJ ©2015 8872147 Canada Inc. or its licensors CMAJ 1 T he prevalence of obesity in adults has increased worldwide and has almost dou- bled in Canada, from 14% in 1978/79 1 to 26% in 2009–2011, 2 with 2% of men and 5% of women having a body mass index (BMI) score greater than 40 (Appendix 1, available at www .cmaj.ca/lookup

2015 CPG Infobase

10. Obesity: identification, assessment and management

strategies for maintaining weight loss after such diets. NICE has a suite of guidance on obesity including the following: Weight management before, during and after pregnancy Obesity – working with local communities Body mass index and waist circumference thresholds for intervening to prevent ill health among black, Asian and other minority ethnic groups Physical activity: brief advice for adults in primary care Managing overweight and obesity among children and young people Behaviour change – individual (...) approaches Managing overweight and obesity in adults – lifestyle weight management services Maintaining a healthy weight and preventing excess weight gain among children and adults will replace section 1.1.1 in the 2006 guideline on obesity. (due to be published in February 2015) NICE has developed an obesity pathway that will link all obesity-related guidance, and a related pathway on physical activity. Obesity: identification, assessment and management (CG189) © NICE 2018. All rights reserved. Subject

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

11. Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline. Full Text available with Trip Pro

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline. Background: The purpose of this guideline is to optimize evaluation and management of patients with obesity hypoventilation syndrome (OHS).Methods: A multidisciplinary panel identified and prioritized five clinical questions. The panel performed systematic reviews of available studies (up to July 2018) and followed the Grading of Recommendations, Assessment (...) , Development, and Evaluation evidence-to-decision framework to develop recommendations. All panel members discussed and approved the recommendations.Recommendations: After considering the overall very low quality of the evidence, the panel made five conditional recommendations. We suggest that: 1) clinicians use a serum bicarbonate level <27 mmol/L to exclude the diagnosis of OHS in obese patients with sleep-disordered breathing when suspicion for OHS is not very high (<20%) but to measure arterial blood

2019 EvidenceUpdates

12. Implantation of a duodenal–jejunal bypass sleeve for managing obesity (IPG471)

Implantation of a duodenal–jejunal bypass sleeve for managing obesity (IPG471) Overview | Implantation of a duodenal–jejunal bypass sleeve for managing obesity | Guidance | NICE Implantation of a duodenal–jejunal bypass sleeve for managing obesity Interventional procedures guidance [IPG471] Published date: November 2013 Share Save Guidance The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Implantation (...) of a duodenal-jejunal bypass sleeve for managing obesity in November, 2013. January 2018: The device used in this procedure (EndoBarrier) no longer has a current CE mark. The CE mark is necessary for medical devices to be marketed in the European Union. A non CE marked device can only be used in the context of . Description Obesity is defined as a body mass index (BMI) of 30 kg/m 2 or more. It is a risk factor for comorbidities such as type 2 diabetes, coronary heart disease and hypertension. Weight loss

2013 National Institute for Health and Clinical Excellence - Interventional Procedures

13. Effects of a new intervention based on the Health at Every Size approach for the management of obesity: The "Health and Wellness in Obesity" study. Full Text available with Trip Pro

Effects of a new intervention based on the Health at Every Size approach for the management of obesity: The "Health and Wellness in Obesity" study. Health at Every Size® (HAES®) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes. This study examined multiple physiological, attitudinal, nutritional, and behavioral effects of a newly developed, intensive, interdisciplinary HAES®-based intervention in obese women. This was a prospective, seven

2018 PLoS ONE Controlled trial quality: uncertain

14. The Obesity Paradox in Kidney Disease: How to Reconcile It With Obesity Management Full Text available with Trip Pro

The Obesity Paradox in Kidney Disease: How to Reconcile It With Obesity Management Obesity, a risk factor for de novo chronic kidney disease (CKD), confers survival advantages in advanced CKD. This so-called obesity paradox is the archetype of the reverse epidemiology of cardiovascular risks, in addition to the lipid, blood pressure, adiponectin, homocysteine, and uric acid paradoxes. These paradoxical phenomena are in sharp contradistinction to the known epidemiology of cardiovascular risks (...) in the general population. In addition to advanced CKD, the obesity paradox has also been observed in heart failure, chronic obstructive lung disease, liver cirrhosis, and metastatic cancer, as well as in the elderly. These are populations in whom protein-energy wasting and inflammation are strong predictors of early death. Both larger muscle mass and higher body fat provide longevity in these patients, whereas thinner body habitus and weight loss are associated with higher mortality. Muscle mass appears

2017 Kidney international reports

15. Is reducing appetite beneficial for body weight management in the context of overweight and obesity? A systematic review and meta-analysis from clinical trials assessing body weight management after exposure to satiety enhancing and/or hunger reducing pro (Abstract)

Is reducing appetite beneficial for body weight management in the context of overweight and obesity? A systematic review and meta-analysis from clinical trials assessing body weight management after exposure to satiety enhancing and/or hunger reducing pro This review aims to investigate whether interventions that enhance satiety and/or reduce hunger lead to beneficial effects on body weight management in the context of overweight and obesity. A comprehensive review protocol was prepared before (...) are supported to improve body weight management, but studies specifically designed to demonstrate a causal link remain needed.© 2019 World Obesity Federation.

2019 Obesity Reviews

16. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Full Text available with Trip Pro

Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Obesity is a global public health threat. The transtheoretical stages of change (TTM SOC) model has long been considered a useful interventional approach in lifestyle modification programmes, but its effectiveness in producing sustainable weight loss in overweight and obese individuals has been found to vary considerably. To assess the effectiveness (...) of dietary intervention or physical activity interventions, or both, and other interventions based on the transtheoretical model (TTM) stages of change (SOC) to produce sustainable (one year and longer) weight loss in overweight and obese adults.Studies were obtained from searches of multiple electronic bibliographic databases. We searched The Cochrane Library, MEDLINE, EMBASE and PsycINFO. The date of the last search, for all databases, was 17 December 2013.Trials were included if they fulfilled

2014 Cochrane

17. Preventing obesity and helping people to manage their weight (LGB9)

Preventing obesity and helping people to manage their weight (LGB9) Preventing obesity and helping people to manage their weight | Advice | NICE Preventing obesity and helping people to manage their weight Local government briefing [LGB9] Published date: May 2013 Advice Between 2012 and 2015 we developed a series of local government briefings for a range of public health topics. We no longer have the capacity to maintain these to an acceptable standard and the information is now out of date, so

2013 National Institute for Health and Clinical Excellence - Advice

18. Cost-Effectiveness of Total Hip Arthroplasty Versus Nonoperative Management in Normal, Overweight, Obese, Severely Obese, Morbidly Obese, and Super Obese Patients: A Markov Model. (Abstract)

Cost-Effectiveness of Total Hip Arthroplasty Versus Nonoperative Management in Normal, Overweight, Obese, Severely Obese, Morbidly Obese, and Super Obese Patients: A Markov Model. We estimated the cost-effectiveness of performing total hip arthroplasty (THA) vs nonoperative management (NM) among 6 body mass index (BMI) cohorts.We constructed a state-transition Markov model to compare the cost utility of THA and NM in the 6 BMI groups over a 15-year period. Model parameters for transition (...) performed to determine the robustness of the model.Over the 15-year time period, the ICERs for THA vs NM were the following: normal weight ($6043/QALYs [quality-adjusted life years]), overweight ($5770/QALYs), obese ($5425/QALYs), severely obese ($7382/QALYs), morbidly obese ($8338/QALYs), and super obese ($16,651/QALYs). The 2 highest BMI groups had higher incremental QALYs and incremental costs. The probabilistic sensitivity analysis suggests that THA would be cost-effective in 100% of the normal

2018 Journal of Arthroplasty

19. Cost-Effectiveness of Total Knee Arthroplasty vs Nonoperative Management in Normal, Overweight, Obese, Severely Obese, Morbidly Obese, and Super-Obese Patients: A Markov Model. (Abstract)

Cost-Effectiveness of Total Knee Arthroplasty vs Nonoperative Management in Normal, Overweight, Obese, Severely Obese, Morbidly Obese, and Super-Obese Patients: A Markov Model. We estimated the cost-effectiveness of performing total knee arthroplasty (TKA) vs nonoperative management (NM) among 6 body mass index (BMI) cohorts.A Markov model was used to compare the cost-utility of TKA and NM in 6 BMI groups (nonobese [BMI 18.5-24.9], overweight [25-29.9], obese [30-34.9], severely obese [35-39.9 (...) performed to determine the robustness of the model.Over the 15-year period, the ICERs for the TKA vs NM for the different BMI categories were nonobese ($3317/quality-adjusted life years [QALYs]), overweight ($2837/QALY), obese ($2947/QALY), severely obese ($3536/QALY), morbidly obese ($5531/QALY), and super-obese ($11,878/QALY). The higher BMI groups tended to have higher incremental QALYs and also higher incremental costs. The probabilistic sensitivity analysis with an ICER threshold of $30,000/QALY

2018 Journal of Arthroplasty

20. Effectiveness of patient-centered weight management counseling in overweight and obese adults in a primary care setting: a systematic review protocol. (Abstract)

Effectiveness of patient-centered weight management counseling in overweight and obese adults in a primary care setting: a systematic review protocol. The objective of this review is to identify the effectiveness of patient-centered weight management counseling on weight and lifestyle modifications in overweight or obese adults treated in a primary care setting.

2017 JBI database of systematic reviews and implementation reports

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