How to evaluate bariatric surgery as a treatment for chronic morbid obesity in an HMO population

The purpose of publishing this study is not really to share outcomes, though those might be useful. The reason I want to share this study is to assist other wishing to devise similar ones.

There are several medical treatments for morbid obesity, including medication, surgery, and prescribed diet and exercise plans. The purpose of this study was to evaluate the effectiveness of bariatric surgery as a treatment for morbid obesity, analyze the impact to utilization, and to evaluate other treatment options in comparison to surgery.

It's a common idea that once a patient undergoes weight loss surgery, all is well. They lose the weight and become healthier because of it. However, in 2016 I was introduced to the idea that not only do bariatric surgery patients regain the weight within 10 years, but gain back more weight than they started with. To say this is troubling is an understatement. 

We wanted to evaluate bariatric surgery effectiveness for long-term weight loss for patients in our own medical group and also understand the ROI of bariatric surgery.

Other questions I answer in this study include 

1. Are medications effective for weight loss in morbidly obese patients?
2. Is bariatric surgery an effective treatment for related comorbidities such as diabetes, hyperlipidemia, and hypertension?
3. Is one bariatric procedure more effective than another (VSG vs. Roux-en-Y) for long-term weight loss?

So you will find those answers in this study as well.

The most promising conclusion I was able to draw from this study was that out of all patients receiving bariatric surgery as a treatment for morbid obesity, not a single patient had a new diabetes diagnosis in the entire follow-up period. In the control group (morbidly obese patients not having surgery) the percentage of patients with a diabetes diagnosis increased from 30% to almost 50% - so having 0 in the surgery group is a great outcome.

Again, these conclusions may not apply to all populations, as our medical group has/had different practices, follow-up protocols, prescribing habits, etc. than another medical group, and this study is completely limited to patients receiving all of their care within the HMO and with our physicians.

I hope this study helps you in designing a similar study for your medical group or morbidly obese population, including methodologies for defining patient groups, how to conduct retrospective studies using claims data and medical records, and how to present conclusions in a way that is easy to understand for doctors, nurses, and administrators in your organization.

Enjoy!

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Slideshow summary - Exec-level presentation

Complete Write-Up - Morbid Obesity Treatment Evaluation