THE ROLE OF OBESITY SURGERY IN OBESITY TREATMENT IN TURKEY

Year 2016, Volume: 1 Issue: 1, 20 - 62, 14.02.2016

BILGEHAN Karadayı , GUVENC Kockaya FATMA BETUL Yenılmez OLGUN Sener , ASLIHAN Beyan

Abstract

Obesity is defined by the World Health Organization (WHO) as “abnormal or excess fat accumulation that may impair health.” To define obesity, the patient’s body weight in kilograms is divided by the square of height in meters to calculate the body mass index (BMI). In Turkey, it has been reported that 34.8% of the population are overweight, 44.2% are of normal weight, and 3.9% are lean in 2012. With respect to gender, 20.9% and 30.4% of the women are obese and overweight, respectively. The aim of this study was to determine the role of obesity surgery in Turkey. Materials and Methods: This study was conducted during the period February 2013–April 2014. The Task Force under Department of Health Technologies Assessment, General Directorate of Health Research, Ministry of Health, and specialists performed this study in accordance with the Basic Model Submission Assessment Component Format for Medical and Surgical Interventions of EUnetHTA. Results: Obesity is a major disorder that threatens world populations, and governments are developing many strategies to fight this disease. It has been shown that medical treatment is ineffective and that obesity surgery may be useful, especially in patients with a high BMI plus comorbidities. Conclusion: Obesity surgery is both clinically effective and cost-effective; however, its ethical, social, and organizational aspects should also be evaluated and taken into consideration when deciding on the correct patient, the correct surgeon, the correct center, and the correct surgical method.

Keywords

obesity surgery, cost-effectiveness, economic value, obesity, obesity treatment

References

• Ackroyd, R., Mouiel, J., Chevallier, J. M., & Daoud, F. (2006). Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obesity Surgery, 16(11), 1488–1503.
• Active Citizenship Network (2002). European Charter of Patients’ Rights. The European Charter of Patients' Rights Rome Declaration Retrieved from http://www.activecitizenship.net/patients-rights.html
• Anselmino, M., Bammer, T., Fernández, Cebrián, J. M., Daoud, F., Romagnoli, G., & Torres, A. (2009). Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries (II). Obesity Surgery, 19(11), 1542–1549.
• Arda, B., & Güvercin, C. H. (2013). Stem cell research: Ethical considerations. In K. Turksen (Ed.), Stem cells: Current challenges and new directions (pp. 341–359). Retrieved from http://link.springer.com/book/10.1007/978-1-4614-8066-2
• Baser, O., Huang, A., Li, L., & Wang, L. (2013, May). Obese patients in the veteran population in the United States: A health care cost and utilization analysis. Poster session presented at the meeting of the International Society for Pharmaeconomics and Outcomes Research (ISPOR), New Orleans, LA.
• Beauchamp T. L., & Childress, J. F. (2001). Principles of biomedical ethics (5th ed.). New York, NY: Oxford University Press.
• Berg, J. W., Appelbaum, P. S., Lidz, C.W., & Parker, L. (2001). Informed consent: Legal theory and clinical practice (2nd ed.). New York, NY: Oxford University Press.
• Brown, B. B. (1968). Delphi process: A methodology used for the elicitation of opinions of experts. RAND (Document No: P-3925. Santa Monica, CA: RAND Corporation. Retrieved from https://www.researchgate.net/publication/277728819_Delphi_Process_A_Methodology_Used_for_the_Elicitation_of_Opinions_of_Experts
• Buchwald, H. (2012). Buchwald’s atlas of metabolic & bariatric surgical techniques and procedures. Philadelphia, PA: Elsevier Saunders.
• Buchwald, H., & Buchwald, J. N. (2002). Evolution of operative procedures for the management of morbid obesity 1950–2000. Obesity Surgery, 12(5), 705–717.
• Buchwald, H., & Buchwald, J. N. (2007). Evolution of surgery for morbid obesity. In C. Pitombo, K. B. Jones, K. D. Higa, & J. C. Pareja (Eds.), Obesity surgery: principles and practice (pp. 4–14). New York, NY: McGraw-Hill Education/Medical.
• Buchwald, H., & Oien, D. M. (2013). Metabolic/bariatric surgery worldwide 2011. Obesity Surgery, 23(4), 427–436.
• Campos, G. M., Rabl, C., Roll, G. R., Peeva, S., Prado, K., Smith, J., & Vittinghoff, E. (2011). Better weight loss, resolution of diabetes, and quality of life for laparoscopic gastric bypass vs banding. Archives of Surgery, 146(2), 149–155. doi:10.1001/archsurg.2010.316
• Canadian Medical Association. (2007). 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. [Supplemental material]. Canadian Medical Association Journal, 176(8), S1–S13.
• Chang, S. H., Stoll, C. R. T., & Colditz, G. A. (2011). Cost-effectiveness of bariatric surgery: Should it be universally available? Maturitas, 69(3), 230–238.
• Charuzi, I., Lavie, P., Peiser, J., & Peled, R. (1992). Bariatric surgery in morbidly obese sleep-apnea patients: Short- and long-term follow-up. [Supplemental material]. American Journal of Clinical Nutrition, 55(2), S945–S946.
• Christou, N. V., Sampalis, J. S., Liberman, M., Look, D., Auger, S., McLean, A. P., & MacLean, L. D. (1999). Annual deaths attributable to obesity in the United States. Journal of the American Medical Association, 282(16), 1530–1538.
• Christou, N. V., Sampalis, J. S., Liberman, M., Look, D., Auger, S., McLean, A. P., & MacLean, L. D. (2004). Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Annals of Surgery, 240(3), 416–423.
• Clegg, A., Colquitt, J., Sidhu, M., Royle, P., & Walker, A. (2003). Clinical and cost effectiveness of surgery for morbid obesity: A systematic review and economic evaluation. International Journal of Obesity and Related Metabolic Disorders, 27(10), 1167–1177.
• Cremieux, P. Y., Buchwald, H., Shikora, S. A., Ghosh, A., Yang, H. E., & Buessing, M. A. (2008). Study on the economic impact of bariatric surgery. American Journal of Managed Care, 14(9), 589–596.
• Dixon, J. B., & O’Brien, P. E. (2002). Changes in comorbidities and improvements in quality of life after LAP-BAND placement. American Journal of Surgery, 184(6b), 51S–54S.
• EUnetHTA. (2012). HTA core model for medical and surgical interventions. Retrieved from http://www.eunethta.eu/outputs/hta-core-model-medical-and-surgical-interventions-10r
• Ewing, B. T., Thompson, M. A., Wachtel, M. S., & Frezza, E. E. A. (2011). A cost–benefit analysis of bariatric surgery on the South Plains Region of Texas. Obesity Surgery, 21(5), 644–649.
• Friedman, D., Cunco, S., Valenzano, M., Marinari, G. M., Adami, G. F., Gianetta, E., … Scopinaro, N. (1995). Pregnancies in an 18-year follow-up after biliopancreatic diversion. Obesity Surgery, 5(3), 308–313.
• Frigg, A., Peterli, R., Peters, T., Ackermann, C., & Tondelli, P. (2004). Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding. Obesity Surgery, 14(2), 216–223.
• Guh, D. P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C. L., & Anis, A. H. (2009). The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health, 9(88).
• Guvercin, C. H., Arda, B., & Rispler-Chaim, V. (2010, April). The vision of the presidency of religious affairs of Republic of Turkey on various bioethical problems. Paper presented at the meeting of the Islam and Bioethics International Conference Programme, Ankara, Turkey.
• Haslam, D. W., & James, W. P. (2005). Obesity. Lancet, 366(9492), 1197–1209.
• Health Population Association. (2014). Physiological problems of obesity and obesity surgery. Retrieved from http://www.sagliklitoplum.org.tr/obezite-ve-cerrahisinin-hastada-yarattigi-psikolojik-sorunlar/
• Holm, S. (2007). Obesity interventions and ethics. [Supplemental material.] Obesity Reviews (S1), 207–210.
• Istanbul Bariatrics. (2012). Post operational term of obesity surgery. Retrieved from http://www.sismanlik-obezite.com/obezite-cerahisi/ameliyat-sonrasi-donem/
• Keating, C. L., Dixon, J. B., Moodie, M. L., Peeters, A., Playfair, J., O’Brien, P. E. (2009). Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: A randomized controlled trial. Diabetes Care, 32(4), 580–584.
• Kockaya, G., Yenilmez, F. B., Ergin, G., Atikeler, K., & Tatar, M. (2016). Cost effectiveness and economic value of obesity surgery for Turkey (CEVOS-T). Obesity Medicine, 1, 33–37.
• Kockaya, G., Yenilmez, F. B., Ergin, G., Atikeler, K., Tatar, M., Ozmen, M. M., … Taskin, M. (2014). Operational cost of obesity surgery in Turkey. European Journal of Endoscopic Laparoscopic Surgery,1(2), 78–83.
• Ed. Harun Tepe (2000). Art of ethics and medicine., Türkiye Felsefe Kurumu Yayınları, 1. Baskı s, 36–38.
• Ed. Kothari, SN. (2012). Surgical Clinics of North America. Bariatric and metabolic surgery. Philadelphia, PA: Elsevier Saunders.
• Kushner, R. (2007). Treatment of the obese patient (contemporary endocrinology). Totowa, NJ: Humana Press.
• Lopez, A. D., & Murray, C. J. L. (1998). The global burden of disease, 1990–2020. Nature Medicine, 4(11):1241–1243.
• Mäklin, S., Malmivaara, A., Linna, M., Victorzon, M., Koivukangas, V., & Sintonen, H. (2011). Cost-utility of bariatric surgery for morbid obesity in Finland. British Journal of Surgery, 98(10), 1422–1429. doi: 10.1002/bjs.7640
• McEwen, L. N., Coelho, R. B., Baumann, L. M., Bilik, D., Nota-Kirby, B., & Herman, W. H. (2010). The cost, quality of life impact, and cost–utility of bariatric surgery in a managed care population. Obesity Surgery, 20(7), 919–928.
• Mechanick, J. I., Kushner, R. F., Sugerman, H. J., Gonzalez-Campoy, J. M., Collazo-Clavell, M. L., Guven, S., … Dixon, J. B. (2013). American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Retrieved from http://www.guideline.gov/content.aspx?id=13022
• Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., … Brethauer, S. (2013). ACS BSCN Accreditation Program ManualVersion V4.03_01_11b. Retrieved from http://www.mbsaqip.org/docs/Program%20Manual%20v4%2006-11-13.pdf
• Ministry of Health—Turkey. (2004). National Burden of Diseases Report. Ankara, Turkey. Retrived From: http://ekutuphane.tusak.gov.tr/kitaplar/turkiye_hastalik_yuku_calismasi.pdf
• Ministry of Health—Turkey. (2010). General Directorate of Health Researches: Turkey Nutrition and Health Research. Ankara, Turkey.
• Mohos, E., Schmaldienst, E., & Prager, M. (2011). Quality of life parameters, weight change and improvement of co-morbidities after laparoscopic Roux Y gastric bypass and laparoscopic gastric sleeve resection—comparative study. Obesity Surgery, 21(3), 288–294.
• National Health and Medical Research Council. (2003). Clinical practice guidelines for the management of overweight and obesity in adults. Canberra: NHMRC, 2003
• National Institute for Health and Care Excellence (NICE). (2006). Obesity prevention: NICE guidelines [CG43]. Retrieved from https://www.nice.org.uk/guidance/cg43
• Nguyen, N. T., Goldman, C., Rosenquist, C. J., Arango, A., Cole, C. J., Lee, S. J., & Wolfe, B. M. (2001). Laparoscopic versus open gastric bypass: A randomized study of outcomes, quality of life, and costs. Annals of Surgery, 234(3), 279–291.
• Onat, A., & Sansoy, V. (Eds.) (2009). Onat A TEKHARF study, obesity, abdominal obesity, diagnoses and outcomes in Turkish adults. Cortex Iletisim Hizmetleri AS, 106–117. Retrived from: tekharf.org/images/2009/bolum9.pdf (2012)
• Organization for Economic Cooperation and Development (OECD). (2010). Obesity and the economics of prevention: Fit not fat. Retrieved from www.oecd.org/health/fitnotfat
• Organization for Economic Cooperation and Development (OECD). (2014). OECD obesity report. Retrieved from http://www.oecd.org/health/Obesity-Update-2014.pdf
• Ozmen, D., Ozmen, E., Ergin, D., Cakmakci Centinkaya, A., Sen, N., Erbay Dunday, P., & Taskin, E. O. (2007). The association of self-esteem, depression and body satisfaction with obesity among Turkish adolescents. BMC Public Health, 7(80).
• Padwal, R. S., Majumdar, S. R., Klarenbach, S., Birch, D. W., Karmali, S., McCargar, L., … Sharma, A. M. (2010). The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES) study: Background, design and rationale. BMC Health Services Research, 10(284).
• Paxton, J. H., & Matthews, J. B. (2005). The cost effectiveness of laparoscopic versus open gastric bypass surgery. Obesity Surgery, 15(1), 24–34.
• Perryman, M. R., & Gleghorn, V. (2010). Obesity-related costs and the economic impact of laparoscopic adjustable gastric banding procedures: Benefits in the Texas Employees Retirement System. Journal of Medical Economics, 13(2) 339–350.
• Picot, J., Jones, J., Colquitt, J. L., Gospodarevskaya, E., Loveman, E., Baxter, L., & Clegg, A. J. (2009). The clinical effectiveness and cost effectiveness of bariatric (weight loss) surgery for obesity: A systematic review and economic evaluation. Health Technology Assessment, 13(41).
• Picot, J., Jones, J., Colquitt, J. L., Loveman, E., Clegg, A. J. (2012). Weight loss surgery for mild to moderate obesity: A systematic review and economic evaluation. Obesity Surgery, 22(9),1496–1506.
• Prospective Studies Collaboration. (2009). Body-mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083–96. DOI:10.1016/S0140
• Ross, K. R., Hart, M. A., Storfer-Isser, A., Kibler, A. M., Johnson, N. L., Rosen, C. L., … Redline, S. (2009). Obesity and obesity related co-morbidities in a referral population of children with asthma. Pediatric Pulmonology, 44(9), 877–884. doi:10.1002/ppul.21065
• Rouf, M. C. (2004). Vulnerability, vulnerable populations, and policy. Kennedy Institute of Ethics Journal, 14(4), 411–425.
• Salem, L., Jensen, C. C., & Flum, D. R. (2005). Are bariatric surgical outcomes worth their cost? A systematic review. Journal of the American College of Surgeons, 200(2), 270–278.
• Salem, L., Devlin, A., Sullivan, S. D., & Flum, D. R. (2008). A cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding and non-surgical weight loss interventions. Surgery for Obesity and Related Diseases, 4(1), 26–32.
• Satman, I., & TURDEP-II Working Group. (2011). Turkey diabetes and hypertension epidemiology research I-II (TURDEP I/II). Retrieved from http://docplayer.biz.tr/6823167-Turkiye-diyabet-prevalans-calismalari-turdep-i-ve-turdep-ii.html
• Sauerland S., Angrisani, L., Belachew, M., Chevallier, J. M., Favretti, F.. Finer, N., … (2005). Obesity surgery: Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surgical Endoscopy, 19(2), 200–221.
• Scottish Intercollegiate Guidelines Network (SIGN). (2010). Management of obesity. A national clinical guideline. Retrieved from http://www.sign.ac.uk/pdf/sign115.pdf
• Seidell, J. C., de Beer, J. J., & Kuijpers, T. (2008). Guideline ‘diagnosis and treatment of obesity in adults and children.’ Ned Tijdschr Geneeskd, 152(38), 2071–2076.
• Sjöström, C. D., Lissner, L., Wedel, H., & Sjöström, L. (1999). Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: The SOS Intervention Study. Obesity Research, 7(5),477–484.
• Sjöström, L. (2013). Review of the key results from the Swedish Obese Subjects (SOS) trial – a prospective controlled intervention study of bariatric surgery. Journal of Internal Medicine, 273(3), 219–234. doi: 10.1111/joim.12012
• Smith, M. D., Patterson, E., Wahed, A. S., Belle, S. H., Berk, P. D., Courcoulas, A. P., … Wolfe, B. M. (2011). Thirty-day mortality after bariatric surgery: Independently adjudicated causes of death in the longitudinal assessment of bariatric surgery. Obesity Surgery, 21(11), 1687–1692.
• Snow, L. L., Weinstein, L. S., Hannon, J. K., Lane, D. R., Ringold, F. G., Hansen, P. A., & Pointer, M. D. (2004). The effect of Roux-en-Y gastric bypass on prescription drug costs. Obesity Surgery, 14(8), 1031–1035.
• Society of American Gastrointestinal and Endoscopic Surgeions (SAGES). (2008). Guidelines for laparoscopic application of bariatric surgery. Retrieved from http://www.sages.org/publications/guidelines/guidelines-for-clinical-application-of-laparoscopic-bariatric-surgery/
• Sugerman, H. J., Felton, W. L., Sismanis, A., Kellum, J. M., Demaria E. J., & Sugerman, E. L. (1999). Gastric surgery for pseudotumor cerebri associated with severe obesity. Annuls of Surgery, 229(5), 634–640.
• Taskin, M., Zengin, K., Apaydin, B., & Unal, E. (2000). Laparoscopy in Turkish bariatric surgery: Initial experience. Obesity Surgery, 10(3), 263–265.
• Tatar, M. (2013). Economic impact and cost of obesity and obesity surgery for Turkey. POLAR Health Economics and Policy Consultancy.
• Tiwari, M. M., Reynoso, J. F., High, R., Tsang, A. W., & Oleynikov, D. (2011). Safety, efficacy, and cost-effectiveness of common laparoscopic procedures. Surgical Endoscopy, 25(4), 1127–1135.
• Türkiye Istatistik Kurumu (TUIK). (2014). Demographic data, Ankara. Retrieved from http://www.tuik.gov.tr
• Turkey Public Health Agency. (2013). Handbook for fight against obesity for primary care physicians. Retrieved from: http://beslenme.gov.tr/content/files/basin_materyal/obezite_mucadele_el_kitabi.pdf
• Whitlock, G., Lewington, S., Sherliker, P., Clarke, R., Emberson, J., Halsey, J., … Peto, R. (2009). Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet, 373(9669),1083–1096.
• World Health Organization. (2000). The World Health Report 2000. Retrieved from http://www.who.int/whr/2000/en/whr00_en.pdf
• World Health Organization. (2015). Obesity and overweight. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en/