title: Critical review of bariatric surgery, medically supervised diets, and behavioural interventions for weight management in adults.
abstract: OBJECTIVE
  Patient selection of weight management treatment option is often guided by a variety of factors. Currently, there is no comprehensive tool to facilitate informed decision-making for patients and clinicians. This article aims to synthesise evidence on the treatment effectiveness, health benefits, risks, and patient experiences of treatment options presently available at the Weight Management Clinic at The Ottawa Hospital (TOH), as a first step towards developing a decision aid.
  
  
  METHODS
  Narrative and systematic reviews published in English between 1999 and 2014 were included that focused on one or more of the following weight management treatments in adults aged 18 years and over: roux-en-y gastric bypass (RYGB), sleeve gastrectomy (SG), medically supervised meal replacement, and behavioural or lifestyle intervention.
  
  
  RESULTS
  Overall, bariatric surgeries have received the greatest research attention and have been associated not only with greater weight loss and health benefit but also with greater risks, complications, and financial cost. Dietary programmes demonstrated weight loss and health benefits to a lesser extent than with surgery but were associated with lower and shorter-term risks and complications. Behavioural and lifestyle interventions have been studied less yet have shown significant, albeit small, weight loss outcomes alone and in combination with dietary or surgical options; they also appear to be the lowest risk interventions. Patient experiences of weight management options are mixed and not well understood.
  
  
  CONCLUSIONS
  Further research is needed; however, this review identified some general trends related to weight loss outcomes, benefits, risks, and barriers for weight management options that have implications for shared treatment decision-making.
authors.affiliation: Psychology Department, The Ottawa Hospital, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Beaulac
authors.affiliation: Psychology Department, The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Daniella
authors.initials: D
authors.lastname: Sandre
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D001521:Behavior Therapy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control; D004032:Diet / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D009765:Obesity / Q000150:complications / Q000523:psychology / Q000628:therapy*; D010349:Patient Compliance; D017060:Patient Satisfaction; D012891:Sleep Apnea Syndromes / Q000517:prevention & control; D061217:Weight Reduction Programs / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*
keywords: review; shared decision-making; treatment; weight management