title: Weight loss and outcomes in wait-listed, medically managed, and surgically treated patients enrolled in a population-based Bariatric program: prospective cohort study.
abstract: BACKGROUND
  Multidisciplinary bariatric care is increasingly being delivered in Canada within publicly funded regional programs. Demand is high, wait lists are long, and clinical effectiveness is unknown.
  
  
  OBJECTIVE
  To examine the "real-world" outcomes associated with a publicly funded, population-based regional bariatric (medical and surgical) program.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  Five hundred consecutive patients (150 wait-listed, 200 medically treated, 150 surgically treated) from the Edmonton Weight Wise program were enrolled.
  
  
  METHODS
  The primary outcome was weight change (kg). Between-group changes were analyzed using multivariable regression adjusted for age, sex, and baseline weight and "last-observation-carried-forward" was used for missing data. Subjects transitioning between groups (wait-list to medical or medical to surgery) were censored when crossing over.
  
  
  RESULTS
  At baseline, mean age was 43.7 ± 9.6 years, mean body mass index was 47.9 ± 8.1 kg/m, and 88% were female. A total of 412 subjects (82%) completed 2-year follow-up and 143 (29%) subjects crossed over to the next treatment phase. Absolute and relative (% of baseline) mean weight reductions were 1.5 ± 8.5 kg (0.9 ± 6.1%) for wait-listed, 4.1 ± 11.6 kg (2.8 ± 8.1%) for medically treated, and 22.0 ± 19.7 kg (16.3 ± 13.5%) for surgically treated (P<0.001) subjects. For surgery, weight reductions were 7.0 ± 9.7 kg (5.8 ± 7.9%) with banding, 21.4 ± 16.0 kg (16.4 ± 11.6%) with sleeve gastrectomy, and 36.6 ± 19.5 kg (26.1 ± 12.2%) with gastric bypass (P<0.001). Rates of hypertension, diabetes, and dyslipidemia decreased to a significantly greater degree with surgery than medical management (P<0.001) and stayed the same or increased in wait-listed subjects.
  
  
  CONCLUSIONS
  Population-based bariatric care, particularly bariatric surgery, was clinically effective. Weight and cardiometabolic risk was relatively stable wait-listed patients receiving "usual care."
authors.affiliation: *Department of Medicine, University of Alberta †Alberta Diabetes Institute ‡Department of Surgery and CAMIS (Center for the Advancement of Minimally Invasive Surgery), Royal Alexandra Hospital §Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Padwal
authors.forename: Christian F
authors.initials: CF
authors.lastname: Rueda-Clausen
authors.forename: Arya M
authors.initials: AM
authors.lastname: Sharma
authors.forename: Calypse B
authors.initials: CB
authors.lastname: Agborsangaya
authors.forename: Scott
authors.initials: S
authors.lastname: Klarenbach
authors.forename: Dan W
authors.initials: DW
authors.lastname: Birch
authors.forename: Shahzeer
authors.initials: S
authors.lastname: Karmali
authors.forename: Linda
authors.initials: L
authors.lastname: McCargar
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
mesh_terms: D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D015992:Body Mass Index; D002170:Canada / Q000453:epidemiology; D015928:Cognitive Behavioral Therapy; D003920:Diabetes Mellitus / Q000453:epidemiology; D004032:Diet; D050171:Dyslipidemias / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000628:therapy*; D011446:Prospective Studies; D014850:Waiting Lists; D015431:Weight Loss; D055815:Young Adult