As the obesity epidemic has spread around the world, a deeper understanding of the drivers of weight gain has emerged. Urbanization; change in diet to more refined foods with high added sugars; differing gut microbiomes, influenced by factors as diverse as breast feeding practices, antibiotic exposure, and dietary fiber; genetics; and our sedentary lifestyle all play a role and have contributed to the American Medical Association's redefinition of obesity as a chronic disease, implying a need for both prevention and long-term management. A recent estimate found that two-thirds of Americans are overweight or obese. The health effects of excess weight are myriad and include the development of type 2 diabetes mellitus (T2DM), hypertension, cardiovascular disease, cancer, high blood pressure, and sleep apnea. Obesity and its sequelae generate an estimated $147 billion annually in health care costs in the US alone. The complexity involved in managing excess weight may affect both patient candidacy for certain treatment options as well as adherence to lifestyle changes necessary to sustain weight loss and improve health outcomes. As a result, there is great clinical interest in treatments that may be used for patients at various levels of obesity, as well as in interventions that promote better adherence to lifestyle change. However, success rates from lifestyle modifications alone have been modest at best. A variety of options await the patient seeking or needing to lose weight beyond conventional weight-loss approaches such as general lifestyle counseling, personal dieting, exercise regimens, and commercial weight loss plans. Bariatric surgery remains a mainstay for those with severe or morbid obesity, and it is also being explored in patients with lower levels of obesity (body mass index [BMI] <35 kg/m2); new devices have emerged or are being tested to suppress appetite and/or reduce food intake; and several medications have recently been approved by the FDA specifically for weight loss. The availability of treatments of differing intensity and invasiveness raises a number of questions, however, including 1) their effects on patients at different thresholds of BMI, 2) their proper place in the treatment continuum for any given group of patients, and 3) their performance and durability of treatment effects over the long term. The purpose of this report for CTAF, therefore, is to examine the comparative clinical effectiveness and comparative value of surgical-, device-, and medication-based treatments in relation to conventional weight-loss management as well as across intervention types. Special attention is also paid to studies conducted in individuals at lower levels of BMI (i.e., 25-35 kg/m2), a key area of uncertainty and controversy.
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