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Topic Suggestion Description

View Topic Suggestion Disposition (PDF) 67 kB

Date submitted: June 08, 2011

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
Management of obesity in primary care
Evidence Question #1
What is the evidence that pharmacotherapy is effective in weight loss and maintenance of weight loss?
Evidence Question #2
Are certain agents more effective than others?
Evidence Question #3
Do certain populations (e.g., gender- or age-related, racial/ethnic populations) benefit more from different agents?
Evidence Question #4
What is the optimum amount of time to treat, and what is the optimum level of weight loss to target? Do optimum amount of time to treat and optimum levels of weight loss differ according to a patient’s age? Gender? Racial/ethnic population?
Evidence Question #5
What are the most effective non-pharmacological, non-surgical treatment approaches (e.g., individual vs. group; specific dietary regimens in conjunction with other therapies; alternative medicine; motivational techniques/interventions)?

Evidence Question #6
What is the safety and efficacy of surgical therapies compared to each other and compared to non-surgical therapy for the treatment of morbid obesity?

Evidence Question #7
What are the long-term outcomes (4-6 yrs) in patients who have undergone surgical procedures, and what is appropriate follow-up for these patients?

Evidence Question #8
What is the safety and efficacy of high-volume centers for surgical treatment of obesity?

Evidence Question #9
What are the long-term health effects following significant weight loss (e.g., nutritional, endocrinological, gallstones, eating disorders, depression/suicide)?

Evidence Question #10
What is appropriate follow-up for patients who have undergone surgical procedures and who have not lost or have regained a significant amount of weight?
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
Obesity is defined as a body mass index (BMI) of 30 kg/m2 or greater. The target population is obese adults.
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
Describe any health-related risks, side effects, or harms that you are concerned about.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
yes
Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Obesity
AHRQ Priority Populations
  • Low income groups
  • Minority groups
  • Children
Federal Health Care Program
  • Medicaid
  • Medicare

Importance

Describe why this topic is important.
More than one third of American adults, and 17% of American children are obese. In 2006-2008, blacks had 51% and Hispanics had 21% higher obesity prevalence compared with whites. Low-income families are also especially burdened with the disease. Obesity increases the risk of major health problems including diabetes, heart disease, hypertension, dyslipidemia, cancer, stroke, and other diseases.
Obesity and the ensuing health problems contribute to the high cost of health care. In 2008 the medical costs associated with obesity totaled approximately $147 billion in the U.S. alone. Since obesity is a growing health concern, many studies have assessed the efficacy of various treatments for obese patients.
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
Based on the evidence review, ACP plans to update our 2005 clinical practice guideline: Pharmacologic and Surgical Management of Obesity in Primary Care: A Clinical Practice Guideline from the American College of Physicians, which was also based on an EPC review. ACP will also develop patient materials derived from the guidelines. Our guideline will be submitted for consideration for publication in Annals of Internal Medicine with a target audience of clinicians treating obese patients. Our guidelines are all freely available and are also posted on ACP’s website. Newly developed guidelines are advertised in a publication for our membership, ACP Internist. Guidelines are also entered into databases including National Guidelines Clearinghouse and Guidelines International Network. ACP surveys its membership about the use of the clinical practice guidelines.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
yes
If yes, please explain:
Many pharmacologic treatments for obesity have been taken off of the market, and new surgical procedures continue to be developed, therefore an updated systematic review of the current literature would be valuable. Both Medicare and Medicaid are faced with decisions on whether to support obesity treatments, including expensive surgical procedures.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?
ACP will use an evidence report to generate an update to our 2005 guideline, which was also based on an EPC review. This guideline will provide clinicians with the most up to date evidence-based recommendations for treating obese patients. Patient education materials will also be developed based on the guideline to help inform patients about their treatment options.
Describe the timeframe in which an answer to your question is needed.
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
  • Administrator (Hospital or Other)
Are you making a suggestion as an individual or on behalf of an organization?
Organization - American College of Physicians
Please tell us how you heard about the Effective Health Care Program