title: A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration.
abstract: In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.
authors.affiliation: William S. Middleton VA Hospital, Madison, WI, USA.|Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Funk
authors.affiliation: The George Washington University, Washington, DC, USA.
authors.forename: W
authors.initials: W
authors.lastname: Gunnar
authors.affiliation: U.S. Department of Veterans Affairs, Washington, DC, USA.|Division of Gastroenterology, University of Washington, Seattle, WA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Dominitz
authors.affiliation: VA Palo Alto Health Care System, Palo Alto, CA, USA.|Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Eisenberg
authors.affiliation: VA Palo Alto Health Care System, Palo Alto, CA, USA.|Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Frayne
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.|Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Maggard-Gibbons
authors.affiliation: School of Nursing and Department of Psychology, Duquesne University, Pittsburgh, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Kalarchian
authors.affiliation: JAMA, Chicago, IL, USA.|Department of Surgery at the UT Southwestern School of Medicine, Dallas, TX, USA.
authors.forename: E
authors.initials: E
authors.lastname: Livingston
authors.affiliation: VA Boston Healthcare System, Boston, MA, USA.|Boston University School of Medicine, Boston, MA, USA.
authors.forename: V
authors.initials: V
authors.lastname: Sanchez
authors.affiliation: VA Long Beach Healthcare System, Long Beach, CA, USA.|Department of Surgery, UC Irvine Medical Center, Irvine, CA, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Smith
authors.affiliation: Center for Health Services Research in Primary Care (152), Durham VA Medical Center, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27705, USA.|Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
authors.forename: H
authors.initials: H
authors.lastname: Weidenbacher
authors.affiliation: Center for Health Services Research in Primary Care (152), Durham VA Medical Center, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27705, USA. matthew.maciejewski@va.gov.|Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA. matthew.maciejewski@va.gov.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D015897:Comorbidity; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D000073319:Obesity Management / Q000379:methods; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D015431:Weight Loss
keywords: Veterans Health Administration; bariatric surgery; health services research; veterans; weight loss