Quality of Life Outcomes and Economic Impacts of Bariatric Surgery
Condition: Obesity
MeSH terms: Obesity
Study type: Observational

Summary: 
      The purpose is to determine the economic, clinical and quality of life outcomes of bariatric
      surgery and describe the consequences of protracted wait-times (~ 2 years) for this
      procedure.
    

Detailed description: 
      Severe obesity affects approximately 3% of Canadians (nearly 1 million people) and is
      becoming increasingly common and costly. Surgery for severe obesity, known as bariatric
      surgery, substantially reduces weight and the risk of death, decreases obesity-related health
      problems and increases quality of life. However, surgery carries a 0.5-2% up-front risk of
      death, has potentially serious short and long-term complications, and an uncertain
      cost-to-benefit ratio. Surgery is becoming increasingly popular, programs are being initiated
      or expanded across the country, and waiting lists are several years long. Provincial
      governments, unable to keep pace with surgical demand, are sending patients to the US for
      surgery and patients are petitioning governments for increased access to care.

      By collecting data from a clinical obesity program that services an entire Canadian health
      region of over 1 million people and linking these data to provincial and regional data
      sources, this study aims to:

        1. Determine whether surgery improves 2-yr medical and patient-centered outcomes (such as
           quality of life, satisfaction, and others) compared to both medical and community
           wait-list control patients;

        2. Comprehensively compare the 3-yr costs of surgical and non-surgical care;

        3. Determine the impact of 2-yr wait times for surgery on patient health and wellness,
           including quality of life and patient satisfaction.

      This study will provide essential data to accurately determine the benefits, risks, and costs
      of bariatric surgery in the Canadian context for patients, care providers, and decision
      makers. Equally important, it will determine whether the health and quality of life of
      Canadians waiting for surgery is adversely affected because of extended wait-times. Results
      will directly influence and streamline patient care, will be applicable to similar programs
      across the country, and serve as an important foundation for future research and data
      collection.
    

Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Three participant goups (n=500:)

        Bariatric Surgery(Sx):150 participants. Patients approved for bariatric surgery in an Adult
        Weight Management Clinic (AWMC) will be eligible (BMI ≥35 kg/m2 and a major medical
        comorbidity or BMI ≥ 40 kg/m2). Contraindications to surgery are pregnancy, unstable
        psychiatric disease, patients deemed too medically high-risk, age > 60 years, active
        substance abuse, or an active eating disorder.

        Medical Treatment(Mx):200 participants. Patients will be approached for the study upon
        their first visit in the AWMC.

        Both medical and surgical patients receive intensive lifestyle counseling (diets, exercise,
        behavioral modification) delivered according to current recommendations. Other than
        receiving extra education about surgery and post-operative diets, there is no difference in
        care between the medical and surgical arms.

        Community Wait-List Control(Wx):150 participants will be enrolled from the list of newly
        referred patients to the AWMC.
      
Keywords: Bariatric Surgery; Body Weight; Health care costs; Obesity; Obesity Complications; Prolonged wait times; Quality of Life