Authors' objectives: This technical brief provides an update on the literature examining the safety, effectiveness and cost effectiveness of surgical and non-surgical interventions for patients with morbid obesity (BMI ≥ 40 or ≥ 35 with serious obesity-related comorbidities). A previous NZHTA technical brief (Day 2005) reviewed reports published up to 2004 and the current report aimed to summarise the literature published subsequent to that report. Recent primary studies were included where the secondary evidence was lacking. Of interest were studies focussing on the effectiveness, safety and cost effectiveness of surgical interventions in comparison with non-surgical (diet, exercise, psychological, pharmacological) interventions, and studies or reviews comparing the relative effectiveness and cost effectiveness of different surgical procedures. Where possible, information was included regarding the safety of different interventions, including long-term and short-term complications, and the effect of interventions on obesity-related comorbid conditions.

Authors' recommendations: Overall, bariatric surgery appears to be a more clinically effective and a more cost effective treatment option for patients with morbid obesity compared with non-surgical treatments. Surgical intervention results in significantly greater weight loss and this in turn leads to the improvement and often resolution of obesity-related comorbid conditions. Less clear is the relative clinical effectiveness of different surgical procedures, mainly due to a lack of randomised controlled trials with long-term follow-up of an adequate proportion of patients. The cost effectiveness literature is also limited and does not allow for the recommendation of one surgical procedure over another. Many reviews suggest that the choice and success of bariatric procedures should depend largely on patient characteristics, such as baseline BMI, comorbidities, food habits and psychological differences, as well as patient and surgeon preference. Current research is focusing on the identification of the best treatment options for patients with differing risk profiles and characteristics but there is still a need for well-controlled long-term trials to ascertain which procedures may be the most appropriate and most effective for different patient groups.

Project Status: Completed

Year Published: 2007

URL for published report: http://nzhta.chmeds.ac.nz/publications/morbidob07.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: New Zealand

Organisation Name: New Zealand Health Technology Assessment

Contact Address: Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, P.O. Box 4345, Christchurch, New Zealand. Tel: +64 3 364 1145; Fax: +64 3 364 1152;

Contact Name: nzhta@chmeds.ac.nz

Contact Email: nzhta@chmeds.ac.nz