Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For non-pregnant women, what is the comparative effectiveness of pharmacotherapy versus surgical therapy in the treatment of obesity?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Various weight-loss medications, such as appetite suppressants, fat absorption inhibitors, lipid-lowering agents, anti-depressants Various bariatric (weight-loss) surgical approaches, such as laparoscopic adjustable gastric banding (“lap band”), Roux-en-y gastric bypass (RYGB)

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.)

Obese non-pregnant adult women – medical conditions and effectiveness of therapies often differ by gender. For that reason, the topic ID stakeholder panel is interested in a review specifically targeting the comparative effectiveness of pharmacotherapy and surgical treatments in women.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Additional subgroups include obesity classes Consider differences of benefits and harms by age, race, ethnicity

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Weight loss Health outcomes – avoidance of diabetes, degenerative arthritis, hypertension, myocardial infarction, and other cardiovascular diseases; improved mental health status

Describe any health-related risks, side effects, or harms that you are concerned about.

Surgical complications, nutrient deficiencies, metabolic disorders, adverse effects of pharmacotherapy, labeling, depression

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)

• Arthritis and nontraumatic joint disorders
• Cardiovascular disease, including stroke and hypertension
• Depression and other mental health disorders
• Diabetes mellitus
• Obesity

AHRQ Priority Populations

• Women

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Obesity is a substantial and growing problem for the US population and healthcare system. Reducing the prevalence of obesity is one of the 2020 Healthy People objectives. The last comparative review of bariatric surgery versus pharmacotherapy was conducted in 2004. There have been advances and substantial literature since that time. Additionally, there is increasing awareness of the impact of gender on risk and response to therapies. This project would highlight those differences to optimize the care of women.

While there is an ongoing EHC comparative effectiveness review on bariatric surgery and non-surgical therapy, it focuses on a different population (those with metabolic conditions and a specified body mass index) than proposed in this topic nomination.

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.)

This question was prioritized by stakeholders engaged in the Topic Identification project conducted by the Oregon Evidence-based Practice Center on “Prevention in Women’s Health.”

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:

All medical and surgical therapies have benefits and harms, so the goal is to understand those differences and to optimize therapy for subgroups. In particular, there is uncertainty related to the effectiveness and harms of various weight loss therapies applied to women specifically.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

This report would help women in their decisionmaking, as well as aid the clinicians who care for them.

Describe the timeframe in which an answer to your question is needed.

There isn’t a specific guideline or conference with a particular due date for this topic, yet it is a high priority topic.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Women Minorities Low income Populations who are disproportionately affected by obesity

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)

This report would help women in their decisionmaking, as well as aid the clinicians who care for them.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program