The term "bariatric care" was used at the workshop and in this report and includes lifestyle interventions, surgery, pharmacotherapy, behavioral and cognitive therapy, rehabilitation care, and medical services. The following is a report on the Canadian Institutes of Health Research (CIHR) Institute of Nutrition, Metabolism and Diabetes (INMD) and Canadian Obesity Network (CON) Workshop: Developing a Research Agenda to Support Bariatric Care in Canada, held December 8-10 .in Montreal, Quebec. These questions were asked to stimulate discussion regarding research gaps, knowledge translation needs, and strengths of the Canadian bariatric care research community.
National strategy and standardization of care: decision trees for access to medical treatments and bariatric surgery; assessment and performance measures; waiting list prioritization; guidelines for bariatric treatment interdisciplinary team size and composition; accreditation and evaluation; and remuneration of health care providers for the delivery of obesity treatment. The spirit and experience of collaboration in Canada, including CON and regional bariatric care networks. Philip Sherman, Scientific Director, CIHR-Institute of Nutrition, Metabolism and Diabetes, and Dr.
Arya Sharma, Scientific Director and CEO of the Canadian Obesity Network and an international expert on obesity-related research, including bariatric care. Sherman noted the targeted nature of the workshop, which aims to help INMD set a research agenda in bariatric care. Richard's evening presentation on advances in basic science aspects of bariatric care and obesity-related research.
Hans Berthoud (Baton Rouge) summarized the effects of Roux-en-Y gastric bypass on food reward functions.
Jean‐Guy Felteau Bariatric care patient
In this context, it was emphasized that the objectives of the workshop cover more than bariatric surgery, including the full continuum of bariatric care. The growth over the past decade in CIHR funding of obesity and healthy weight research is summarized. The need for a joint approach to support a research agenda focused on bariatric care was highlighted.
Lifestyle interventions combining diet and exercise and interventions based on medical management (including pharmacotherapies) show a moderate effect in the short term. In summary, while approximately 33% of individuals with severe obesity have some benefit from lifestyle interventions, it remains a challenge to identify the profile of those who will be successful, even in the short term. The knowledge gained from such research will serve to guide primary care approaches to the management of patients with severe obesity that are safe, effective, and cost-effective.
A team approach is essential that combines primary and specialist health care with a chronic disease management approach. An integrated model of care can make bariatric care more cost-effective and, therefore, more accessible. Results were presented showing a large reduction in health care costs and positive weight loss outcomes based on this stepped care approach.
Langlois went on to describe barriers to working with severely obese patients in the primary care setting, highlighting the need for improved training of health care physicians. The plan calls for standardized program pathways, decision-making tools and a strong research component as well as a comprehensive evaluation framework to monitor success in the short, medium and longer term. The proposal highlights strategic links between health care providers that cross the care and age continuum.
There are currently over 100 university researchers in the province engaged in overweight/obesity research. Education and training in primary care are important subgoals to improve bariatric care across the province. Research on matching patient type to surgical approach; longer-term monitoring of lap results; and determining the optimal medical-behavioral treatment model are at the center of attention for decision-makers.
Christian‐Marc Lanouette
SETTING PRIORITIES
Participants also emphasized the need to answer the matching question for both adults and adolescents. This included a strong view on articulating a cradle-to-grave approach to planning and delivery across the continuum of care; that is, research should support closer integration of bariatric care services for children and adults. Other points raised related to the need to build greater capacity in primary care in general, and research to support a stronger role of primary care providers.
This research should include evaluation of how to improve skills and attitudes and the impact of different compensation models on the delivery of bariatric care. Another main theme identified is the need for a better understanding of factors associated with access and barriers to treatment. In particular, this collaborative approach should support larger, more longitudinal follow-up studies given the current knowledge of intervention effectiveness (mainly based on short-term follow-up studies) and the many complications that can arise in the delivery of bariatric care.
Discussion points related to better cost accounting and economic evaluations included the importance of collecting better cost data to support a business case for investments in bariatric care. Other cost-related issues include the need for more cost-effectiveness studies (such as comparing the outcomes of alternative interventions that vary in cost), as well as costs. A third important theme related to research capacity is the need for more qualitative and participatory research to better understand and leverage the lived experience of people with obesity and those who have experienced different aspects of the bariatric care continuum.
The first and most prominent theme of knowledge translation concerns the need for a national strategy and the development of standards. The need for updated guidelines regarding the size and composition of the bariatric care team, as well as the development of industry standards for medical devices, was highlighted. The strategy should also address issues related to accreditation and evaluation, funding models, remuneration of health care providers for obesity care, and the important links between obesity prevention/public health and the full continuum of bariatric care.
A second, and closely related, theme is the need for a comprehensive environmental scan for bariatric care in Canada, building on two weight management services scans undertaken by CON members, which can be found on the CON website. These assessments describe bariatric care services, including financing and reimbursement; the scope of work integrated with surgical interventions; and opportunities for collaboration between researchers, clinicians and decision makers. Several discussion points linked the need to involve decision makers to the issue of weight bias and discrimination.
This may be necessary, for example, to obtain support for training in the delivery of bariatric care (including compensation for healthcare providers to attend continuing education events) and to make available the use of specific clinical tools and techniques. The need for decision makers to have better access to and synthesis of outcome and cost data to support the business case for bariatric treatment, including surgical interventions, was highlighted.
APPENDIX I
Marie Lambert Medical Genetics Division, Department of Pediatrics CHU Sainte-Justine and Université de Montréal. Philip Sherman Workshop Co-Chair and Scientific Director of CIHR Institute of Nutrition, Metabolism and Diabetes.
APPENDIX II
Agenda
