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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 248 Research Studies DisplayedKumar AJ, Parthasarathy C, Prescott HC
Pneumosepsis survival in the setting of obesity leads to persistent steatohepatitis and metabolic dysfunction.
The purpose of this study was to explore the long-term effect of sepsis on pre-existing NAFLD and hyperglycemia. The researchers randomized male mice to either a high-fat diet or a control diet (CD). After 24 weeks on the diet, mice were inoculated with Klebsiella pneumoniae (Kpa). To assess whether persistent inflammation could be reproduced in other abnormal liver environments, mice were also challenged with Kpa after exposure to a methionine-choline-deficient high-fat diet. Finally, a retrospective cohort of 65,139 patients was analyzed to evaluate whether obesity was related with liver injury after sepsis. The study found that after Kpa inoculation, high-fat diet mice had normalized fasting blood glucose without a change in insulin sensitivity but with a notable decrease in pyruvate utilization. Liver examination revealed focal macrophage collections and a unique inflammatory gene signature on RNA analysis. In the clinical cohort, preobesity, and class 1 and class 2 obesity were related with higher odds of elevated aminotransferase levels 1-2 years after sepsis.
Citation: Kumar AJ, Parthasarathy C, Prescott HC .
Pneumosepsis survival in the setting of obesity leads to persistent steatohepatitis and metabolic dysfunction.
Hepatol Commun 2023 Sep; 7(9). doi: 10.1097/hc9.0000000000000210..
Keywords: Sepsis, Obesity
Darling KE, West C, Jelalian E
The buffering effect of family support on the association between weight-based teasing and adolescent weight management outcomes.
This study examined the buffering effect that family support on the association between weight-based victimization (WBV) and adolescent weight management options. Parents of adolescents (n = 78) completed psychosocial measures at baseline of a clinical weight management program. Objective height and weight were measured at baseline and follow-up at Visit 3. There was a significant moderating effect of family support on the association between WBV and weight change (p = .04), accounting for 5.0% of the variance in weight change.
AHRQ-funded; HS02707.
Citation: Darling KE, West C, Jelalian E .
The buffering effect of family support on the association between weight-based teasing and adolescent weight management outcomes.
J Fam Psychol 2023 Sep; 37(6):942-46. doi: 10.1037/fam0001084..
Keywords: Children/Adolescents, Obesity, Obesity: Weight Management
Warnick J, Darling KE, Topor LS
Formative development of a weight management intervention for adolescents with type 1 diabetes mellitus and obesity.
Researchers interviewed overweight or obese adolescents with type 1 diabetes mellitus (T1D), their caregivers, and pediatric endocrinologists to understand if they would be interested in a weight management intervention adapted for youth with T1D. The results provided detailed recommendations for the adaptation of a behavioral weight management intervention. Five central themes emerged: program content, programmatic messaging, program structure, social support, and risk of eating disorders.
AHRQ-funded; HS027071.
Citation: Warnick J, Darling KE, Topor LS .
Formative development of a weight management intervention for adolescents with type 1 diabetes mellitus and obesity.
Pediatr Diabetes 2023; 2023. doi: 10.1155/2023/9584419..
Keywords: Children/Adolescents, Obesity, Chronic Conditions, Obesity: Weight Management
Holtrop JS, Connelly L, Gomes R
Models for delivering weight management in primary care: qualitative results from the MOST obesity study.
The purpose of this study was to examine how clinical primary care practices successfully and feasibly implement weight management services. The researchers utilized multiple methods including site visits, observations, interviews, and document reviews to practices across the United States. Qualitative research was conducted to identify unique features that were feasible to implement in primary care. The study identified 4 delivery models across 21 practices: group delivery, delivery integrated into standard primary care, hiring an "other" professional for delivery, and delivery utilizing a specific program. Features of the model included who delivered the services, whether the services were delivered to an individual or a group, the methods the service utilized, and how the care was paid. The majority of practices combined weight management services and primary care delivery, but some developed specific programs.
AHRQ-funded; HS024943.
Citation: Holtrop JS, Connelly L, Gomes R .
Models for delivering weight management in primary care: qualitative results from the MOST obesity study.
J Am Board Fam Med 2023 Aug 9; 36(4):603-15. doi: 10.3122/jabfm.2022.220315R2..
Keywords: Obesity, Primary Care
Lucy AT, Rakestraw SL, Stringer C
Readability of patient education materials for bariatric surgery.
This paper examined readability and reading level of online bariatric surgery and standardized perioperative electronic medical record (EMR) patient education materials (PEM). National organizations recommend that PEM not exceed a sixth grade reading level. One institution was used to assess readability of PEM. Text readability was assessed by seven validated instruments and mean readability scores calculated with standard deviations and compared using unpaired t-tests. A total of 32 webpages and seven EMR education documents were assessed. Web pages were overall assessed as "difficult to read" compared to "standard/average" readability EMR materials. All web pages were at or above high school reading levels, with the highest reading levels being pages with nutrition information and the lowest reading level patient testimonials. EMR materials were found to be at sixth to ninth grade reading level.
AHRQ-funded; HS023009.
Citation: Lucy AT, Rakestraw SL, Stringer C .
Readability of patient education materials for bariatric surgery.
Surg Endosc 2023 Aug; 37(8):6519-25. doi: 10.1007/s00464-023-10153-3..
Keywords: Surgery, Education: Patient and Caregiver, Obesity: Weight Management, Obesity, Health Literacy
Heerman WJ, Sneed NM, Sommer EC
Ultra-processed food consumption and BMI-Z among children at risk for obesity from low-income households.
The purpose of this study was to assess the relationship between baseline ultra-processed food consumption in early childhood and child BMI Z-score over 36 months. Among 595 children, median baseline age was 4.3 years, 65.4% had normal weight, 33.8% were overweight, and 0.8% were obese. When compared with low ultra-processed consumption (300 kcals/day), High ultra-processed intake (1300 kcals/day) was related with a 1.2 higher BMI-Z at 36 months for 3-year-olds and a 0.6 higher BMI-Z for 4-year-olds. The difference was not statistically significant for 5-year-olds or overall.
AHRQ-funded; HS026122.
Citation: Heerman WJ, Sneed NM, Sommer EC .
Ultra-processed food consumption and BMI-Z among children at risk for obesity from low-income households.
Pediatr Obes 2023 Aug; 18(8):e13037. doi: 10.1111/ijpo.13037..
Keywords: Children/Adolescents, Obesity, Low-Income, Nutrition, Vulnerable Populations
Darling KE, Hayes JF, Evans EW
Engaging stakeholders to adapt an evidence-based family healthy weight program.
The purpose of this study was to describe the procedure of utilizing qualitative data from community and intervention stakeholders, children with overweight or obesity from low-income backgrounds, and caregivers to inform adaptations to the JOIN for ME pediatric weight management intervention. The researchers conducted qualitative interviews with 21 key community and intervention stakeholders, and conducted focus groups in both Spanish and English with 35 children with overweight or obesity from low-income backgrounds and 71 caregivers of children with overweight or obesity from low-income backgrounds. The results of the qualitative data analysis guided intervention modifications including content revisions to simplify and tailor materials, contextual revisions to improve intervention engagement and framing, resource awareness, and modality of delivery, training adaptations, and implementation/scale-up activities to improve community partner connections.
AHRQ-funded; HS02707.
Citation: Darling KE, Hayes JF, Evans EW .
Engaging stakeholders to adapt an evidence-based family healthy weight program.
Transl Behav Med 2023 Jul; 13(7):423-31. doi: 10.1093/tbm/ibac113..
Keywords: Obesity, Family Health and History, Evidence-Based Practice, Children/Adolescents
Zamudio J, Kanji FF, Lusk C
Identifying workflow disruptions in robotic-assisted bariatric surgery: elucidating challenges experienced by surgical teams.
The goal of this observational study was to investigate the impact of robotic bariatric surgery (RBS) on the surgical work system via the study of flow disruptions (FDs), or deviations from the natural workflow progression. Twenty-nine RBS procedures were observed at three sites; FDs were recorded in real time and subsequently classified into one of nine work system categories. FDs occurred approximately every 2.4 minutes and happened most frequently during the final patient transfer and robot docking phases of RBS. The coordination challenges that contributed most to these disruptions were associated with waiting for staff/instruments and readjusting equipment.
AHRQ-funded; HS026491.
Citation: Zamudio J, Kanji FF, Lusk C .
Identifying workflow disruptions in robotic-assisted bariatric surgery: elucidating challenges experienced by surgical teams.
Obes Surg 2023 Jul; 33(7):2083-89. doi: 10.1007/s11695-023-06620-4..
Keywords: Obesity: Weight Management, Surgery, Workflow, Obesity
Barnett S, Matthews K, DeWindt L
Deaf Weight Wise: a novel randomized clinical trial with Deaf sign language users.
The purpose of this research was to address the lack of scientifically supported weight management programs specifically designed for the Deaf population. The researchers developed the Deaf Weight Wise (DWW) trial and intervention which was informed by community-based participatory research. The primary focus of DWW is promoting a healthy lifestyle and weight management through dietary adjustments and physical activity. A total of 104 Deaf adults aged 40 to 70 years, with a BMI ranging from 25 to 45, were recruited from community settings in Rochester, New York. Participants were randomized into either immediate intervention (n = 48) or a 1-year delayed intervention group (n = 56). The latter group served as a no-intervention control until the trial's midpoint. Data were collected at five time points (every six months) from baseline to 24 months. All DWW intervention leaders and participants were Deaf individuals using American Sign Language (ASL). The study found that at the 6-month mark, the average weight change difference between the immediate-intervention group and the delayed-intervention group (no intervention yet) was -3.4 kg. A majority (61.6%) of those in the immediate intervention group lost ≥5% of their baseline weight, compared to 18.1% in the no-intervention-yet group. Indicators of participant engagement included an average attendance of 11/16 sessions (69%), and 92% completed the 24-month data collection. The researchers concluded that the DWW program, which is community-engaged, culturally tailored, and provides language accessibility, successfully supported weight loss among Deaf ASL users.
AHRQ-funded; HS015700
Citation: Barnett S, Matthews K, DeWindt L .
Deaf Weight Wise: a novel randomized clinical trial with Deaf sign language users.
Obesity 2023 Apr;31(4):965-76. doi: 10.1002/oby.23702.
Keywords: Obesity: Weight Management, Disabilities, Obesity
Halliday TM, McFadden M, Cedillo M
Lifestyle strategies after intentional weight loss: results from the MAINTAIN-pc randomized trial.
The aim of this study was to explore the strategies related with successful long-term weight loss maintenance. Researchers analyzed data from the 24-month Maintaining Activity and Nutrition Through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) trial. MAINTAIN-pc recruited 194 adults with recent intentional weight loss and randomized participants a group using tracking tools plus coaching (i.e., coaching group) or tracking tools without coaching (i.e., tracking-only group). The participants reported the lifestyle strategies they utilized in the previous 6 months, including self-monitoring, group support, behavioral skills, and professional support. The study found that at baseline, 100% used behavioral skills, 73% used group support, 69% used self-monitoring, and 68% used professional support in the past 6 months; at 24 months, the rates were 98%, 60%, 75%, and 61%, respectively. The number of participants using individual strategies did not vary significantly over time, but the overall number of strategies participants reported decreased. A greater number of strategies were utilized at baseline and 6 months compared to 12- and 24-month follow-ups. The coaching group utilized a greater number of strategies at months 6 and 12 than the tracking-only group. Consistent utilization of professional support strategies over the 24-month study period was related with less weight regain.
AHRQ-funded; HS021162.
Citation: Halliday TM, McFadden M, Cedillo M .
Lifestyle strategies after intentional weight loss: results from the MAINTAIN-pc randomized trial.
Transl J Am Coll Sports Med 2023 Spring; 8(2). doi: 10.1249/tjx.0000000000000220..
Keywords: Lifestyle Changes, Obesity, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT)
Darling KE, Warnick J, Guthrie KM
Weight management engagement for teens from low-income backgrounds: qualitative perspectives from adolescents and caregivers.
Adolescents from low-income backgrounds are at a higher risk for obesity and obesity-related negative health outcomes. In addition, these adolescents have lower access to, and success in, weight management (WM) programs. The purpose of this qualitative study was to explore engagement in a hospital-based WM program from the adolescent and caregiver perspective at varying levels of program initiation and engagement. The researchers conducted qualitative interviews with 55 participants, including 29 adolescents and 26 caregivers. This included: a) those who were referred to WM treatment, but never initiated (non-initiators); b) those who dropped out from treatment; and c) those who that had continuous participation in treatment (engaged). The study found that participants across all groups reported that they did not have a complete understanding of the scope or goals of the WM program after initial referral. In addition, many participants identified misperceptions of the program (e.g., perceptions of a screening visit as compared to an intensive program). Both caregivers and adolescents identified caregivers as drivers of engagement, with adolescents often tentative about participation in the program. However, engaged adolescents found the program valuable and sought ongoing participation following caregiver initiation.
AHRQ-funded; HS02707.
Citation: Darling KE, Warnick J, Guthrie KM .
Weight management engagement for teens from low-income backgrounds: qualitative perspectives from adolescents and caregivers.
J Pediatr Psychol 2023 Feb 15; 48(7):593-601. doi: 10.1093/jpepsy/jsad008..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Low-Income, Patient and Family Engagement
Barlow SE, Yudkin J, Nelson V
Dynamo Kids!/¡Niños Dinámicos! A web site for pediatric primary care providers to offer parents of children 6-12 years old with overweight and obesity: web site development and protocol for pilot study.
The purpose of this study will be to determine whether a self-guided web site offered by pediatric primary care providers could assist parents with applying healthy behaviors. If successful, a large, controlled study may be conducted to further assess. The Dynamo Kids/¡Niños Dinámicos program was created with feedback from parents and health care professionals, developing a bilingual site for parents to about healthy behavior changes for their children and how to implement them. Electronic health record modifications alert providers to qualified children at well-child encounters. Parents complete online surveys before entering the site. In month 3 of the study, the practitioners will examine children in weight-focused appointments. Outcomes include change in Family Nutrition and Physical Activity parent survey score (primary) and change in child relative BMI (secondary). Additional data include time spent on site, provider surveys, and provider and parent interviews.
AHRQ-funded; HS022418.
Citation: Barlow SE, Yudkin J, Nelson V .
Dynamo Kids!/¡Niños Dinámicos! A web site for pediatric primary care providers to offer parents of children 6-12 years old with overweight and obesity: web site development and protocol for pilot study.
J Pediatr Health Care 2023 Jan-Feb; 37(1):17-24. doi: 10.1016/j.pedhc.2022.09.003..
Keywords: Children/Adolescents, Primary Care, Obesity, Obesity: Weight Management, Education: Patient and Caregiver, Family Health and History
Cedillo M, Kukhareva PV, Larsen SM
Impact of electronic health record-coaching features in weight change: a secondary analysis from the MAINTAIN-pc randomized trial.
This study evaluated whether coaching features were successfully transmitted via electronic health record (EHR) communication and to evaluate their relationship with weight change in a previously tested EHR-based coaching intervention. The authors conducted a secondary analysis from the Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) study randomized clinical trial in nine primary care practices and one specialty practice (endocrinology) affiliated with the University of Pittsburgh Medical Center. Eligible participants were aged 18 to 75 years, had intentional 5% weight loss in the previous 2 years, had access to an internet-connected computer, and had receipt of care from a University of Pittsburgh Medical Center primary care provider. Participants content with intervention delivery via the EHR and those who felt a strong connection to their coach had significantly less weight regain. Participants who had needs unmet by the intervention (e.g., "in-person" support in a group setting or individual settings) regained more weight. The results suggest heterogeneity in the patient population regarding preference for in-person versus EHR-based coaching formats.
AHRQ-funded; HS021162.
Citation: Cedillo M, Kukhareva PV, Larsen SM .
Impact of electronic health record-coaching features in weight change: a secondary analysis from the MAINTAIN-pc randomized trial.
Obesity 2023 Jan;31(1):31-36. doi: 10.1002/oby.23595..
Keywords: Electronic Health Records (EHRs), Obesity, Obesity: Weight Management, Lifestyle Changes
Shen MR, Jiang S, Millis MA
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
The purpose of this study was to examine whether differences exist in baseline characteristics or access to care between white and non-white patients of bariatric surgery. The researchers utilized a statewide bariatric-specific data registry and assessed all patients of bariatric surgery who completed a baseline questionnaire prior to the operation and compared data among racial groups. A total of 73,141 patients were included with 25.5% self-identifying as non-white. Non-white males were the least represented group with 4% of all bariatric surgery cases performed. Despite having higher rates of college education, when compared to white patients non-white patients were more likely to be younger, disabled, and have Medicaid. Despite having higher rates of patients with a body mass index above 50 kg/m the median time from the first evaluation to surgery was longer among non-white patients (157 days vs. 127 days.) The study concluded that despite presenting with higher rates of severe obesity, when compared with white patients non-white patients of bariatric surgery are an extremely diverse group with greater socioeconomic disadvantages and longer wait times.
AHRQ-funded; HS000053.
Citation: Shen MR, Jiang S, Millis MA .
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
Surg Endosc 2023 Jan; 37(1):564-70. doi: 10.1007/s00464-022-09292-w..
Keywords: Racial and Ethnic Minorities, Surgery, Obesity: Weight Management, Obesity, Disparities
Borgatti AC, Crockett KB, Jacob AE
Correlates of psychological distress among adults with obesity during the COVID-19 pandemic.
The objective of this study was to evaluate changes in stress and loneliness among participants with obesity who were engaged in weight loss self-management in the US during COVID-19, and to identify risk factors that may increase psychosocial distress during this period. Participants completed an online survey about social, economic and health behavior changes during COVID-19 and their relationship to changes in perceived stress and loneliness. Results indicated that stress and loneliness increased two months into the COVID-19 pandemic-related shutdown. Factors associated with increased stress and/or loneliness included higher body mass index, social distancing, alcohol intake, and working from home. The authors concluded that ongoing attention to psychosocial well-being among individuals with obesity remains imperative both during the ongoing pandemic and afterwards.
AHRQ-funded; HS013852.
Citation: Borgatti AC, Crockett KB, Jacob AE .
Correlates of psychological distress among adults with obesity during the COVID-19 pandemic.
Psychol Health 2022 Dec; 37(12):1547-64. doi: 10.1080/08870446.2022.2038790..
Keywords: COVID-19, Obesity, Stress, Social Stigma, Behavioral Health
Persaud A, Castro I, Simione M
Multi-sector stakeholder's perceptions of determinants of successful implementation of a pediatric weight management intervention.
The objective of this study was to examine the perspectives of local, state, and national clinic and community stakeholders as an aid to developing successful pediatric weight management interventions (PWMI) in primary care and community settings, and to identify barriers and facilitators to implementation. Stakeholders in health centers and predominantly lower income, Hispanic community YMCAs were interviewed. Twenty-six of the stakeholders perceived formal curriculum with illustrative examples, patient- and family-centered programs, group visits, and high-quality multidisciplinary personnel to be components needed for a PWMI. These responses led to the creation of a group visit curriculum, implementation trainings, and cross-site collaborative technical assistance. The authors conclude that their findings highlight the importance of engaging multi-sector stakeholders during pre-implementation to ensure that valued components are included.
AHRQ-funded; HS022986; HS024332.
Citation: Persaud A, Castro I, Simione M .
Multi-sector stakeholder's perceptions of determinants of successful implementation of a pediatric weight management intervention.
Front Public Health 2022 Aug 25;10:954063. doi: 10.3389/fpubh.2022.954063..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity
Chao GF, Chhabra KR, Yang J
Bariatric surgery in Medicare patients: examining safety and healthcare utilization in the disabled and elderly.
The purpose of this study was to compare safety and healthcare use after sleeve gastrectomy versus Roux-en-Y gastric bypass in a national Medicare cohort. The researchers analyzed Medicare claims from 2012-2017 for 30,105 bariatric surgery patients receiving benefits due to age or disability and compared all outcomes between sleeve and bypass for each benefit group at 30 days, 1 year, and 3 years. The study found that among the disabled patients (n = 21,595), sleeve gastrectomy was associated with lower 3-year ED utilization, complications, reinterventions, rehospitalizations, and mortality. Cumulative expenditures were $46,277 after sleeve gastrectomy and $48,211 after gastric bypass. Among the elderly (n = 8510), sleeve was associated with lower 3-year ED utilization, complications, reinterventions, and rehospitalizations. Expenditures were $38,632 after sleeve gastrectomy and $39,270 after gastric bypass. Procedure treatment effect significantly differed by benefit group for paraesophageal hernia repair, revision, and mortality. The study concluded that healthcare utilization benefits of sleeve over bypass are maintained across Medicare elderly populations and Medicare disabled subpopulations.
AHRQ-funded; HS025778.
Citation: Chao GF, Chhabra KR, Yang J .
Bariatric surgery in Medicare patients: examining safety and healthcare utilization in the disabled and elderly.
Ann Surg 2022 Jul 1;276(1):133-39. doi: 10.1097/sla.0000000000004526..
Keywords: Obesity: Weight Management, Obesity, Surgery, Medicare, Elderly, Disabilities
Huo T, Li Q, Cardel MI
Enhancing quality measurement with clinical information: a use case of body mass index change among children taking second generation antipsychotics.
The authors sought to examine the extent to which body mass index (BMI) was available in electronic health records for Florida Medicaid recipients aged 5 to 18 years taking Second-Generation Antipsychotics (SGAP). They concluded that meeting the 2030 CMS goal of digital monitoring of quality of care will require continuing expansion of clinical encounter data capture to provide the data needed for digital quality monitoring. Using linked electronic health records and claims data allows identifying children at higher risk for SGAP-induced weight gain.
AHRQ-authored; AHRQ-funded; HS025298.
Citation: Huo T, Li Q, Cardel MI .
Enhancing quality measurement with clinical information: a use case of body mass index change among children taking second generation antipsychotics.
Acad Pediatr 2022 Apr;22(3S):S140-S49. doi: 10.1016/j.acap.2021.11.012..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Obesity, Obesity: Weight Management, Quality Measures, Quality of Care
Crockett KB, Borgatti A, Tan F
Weight discrimination experienced prior to enrolling in a behavioral obesity intervention is associated with treatment response among Black and White adults in the Southeastern U.S.
This study examined the role that weight discrimination and race is associated with pre-treatment depressive symptoms. A cohort of Black and White adults were enrolled in a 16-week obesity intervention treatment (N = 271; mean BMI = 35.7 kg/m2); 59% Black; 92% women). They reported prior experiences of weight discrimination and completed the Center for Epidemiological Studies Depression (CES-D) Scale at baseline. Their weekly attendance at group sessions was recorded, and weight was measured at baseline and post-treatment. Participants with a history of weight discrimination scored 2.4 points higher on the CES-D and lost 2% less weight relative to those without weight discrimination. Race modified the association between weight discrimination and treatment session attendance, such that Black participants attended fewer sessions if they had prior experience of weight discrimination. However, this association was not true among White individuals.
AHRQ-funded; HS013852.
Citation: Crockett KB, Borgatti A, Tan F .
Weight discrimination experienced prior to enrolling in a behavioral obesity intervention is associated with treatment response among Black and White adults in the Southeastern U.S.
Int J Behav Med 2022 Apr;29(2):152-59. doi: 10.1007/s12529-021-10009-x..
Keywords: Obesity, Obesity: Weight Management, Behavioral Health, Racial and Ethnic Minorities, Depression
Chhabra KR, Telem DA, Chao GF
Comparative safety of sleeve gastrectomy and gastric bypass: an instrumental variables approach.
This study compared the safety of sleeve gastrectomy versus gastric bypass surgery. Sleeve gastrectomy has become the most common bariatric surgery, rising from 52.6% in 2012 to 75% in 2016 among the cohort of 38,153 patients identified using commercially insured patients in the IBM MarketScan claims database. At 2 years from surgery, patients undergoing sleeve gastrectomy had fewer re-interventions (sleeve 9.9%, bypass 15.6%) and complications (sleeve 6.6%, bypass 9.6%), and lower overall healthcare spending ($47,891 vs $55,213), than patients undergoing gastric bypass. However, at the 2-year mark, revisions were slightly more common in sleeve gastrectomy than in gastric bypass (sleeve 0.6%, bypass 0.4%).
AHRQ-funded; HS025778.
Citation: Chhabra KR, Telem DA, Chao GF .
Comparative safety of sleeve gastrectomy and gastric bypass: an instrumental variables approach.
Ann Surg 2022 Mar;275(3):539-45. doi: 10.1097/sla.0000000000004297..
Keywords: Obesity: Weight Management, Obesity, Surgery, Patient Safety
Howard R, Chao GF, Yang J
Medication use for obesity-related comorbidities after sleeve gastrectomy or gastric bypass.
The purpose of this comparative effectiveness research study was to evaluate prior laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass patients and compare the incidence of medication discontinuation and restart of diabetes, hypertension, and hyperlipidemia medications. The researchers reviewed the records of adult Medicare beneficiaries who underwent sleeve gastrectomy or gastric bypass between January 1, 2012, to December 31, 2018, and had a claim for diabetes, hypertension, or hyperlipidemia medication in the 6 months before surgery with a corresponding diagnosis. The study found that when compared with sleeve gastrectomy, gastric bypass was associated with a slightly higher 5-year cumulative incidence of medication discontinuation among 30,588 patients with diabetes medication use and diagnosis at the time of surgery, 5,081 patients with antihypertensive medication use and diagnosis at the time of surgery and 35,055 patients with lipid-lowering medication use and diagnosis at the time of surgery. Among the patients who discontinued medication, gastric bypass was also associated with a slightly lower incidence of medication restart up to 5 years after discontinuation. The researchers concluded that gastric bypass was associated with a slightly higher incidence of medication discontinuation and a slightly lower incidence of medication restart among patients who discontinued medication than sleeve gastrectomy.
AHRQ-funded; HS025778; HS025365.
Citation: Howard R, Chao GF, Yang J .
Medication use for obesity-related comorbidities after sleeve gastrectomy or gastric bypass.
JAMA Surg 2022 Mar;157(3):248-56. doi: 10.1001/jamasurg.2021.6898..
Keywords: Obesity, Obesity: Weight Management, Surgery, Medication
Kumar V, Encinosa W
Revisiting the obesity paradox in health care expenditures among adults with diabetes.
This AHRQ-authored study explored and examined an obesity paradox identified by recent studies which suggests that in people without diabetes mortality risk increases with weight and in people with diabetes mortality risk decreases with weight. The researchers assessed changes in the association between body mass index (BMI) and health care expenditures in populations with diabetes and without diabetes while controlling for confounding risk factors. The researchers found that there is no obesity paradox; it is the result of statistical biases, and the study concluded that obesity in people with diabetes does not save costs.
AHRQ-authored.
Citation: Kumar V, Encinosa W .
Revisiting the obesity paradox in health care expenditures among adults with diabetes.
Clin Diabetes 2022 Spring;40(2):185-95. doi: 10.2337/cd20-0122..
Keywords: Medical Expenditure Panel Survey (MEPS), Obesity, Diabetes, Healthcare Costs
Wu AJ, Aris IM, Hivert MF
Association of changes in obesity prevalence with the COVID-19 pandemic in youth in Massachusetts.
Using the Massachusetts Department of Public Health’s disease surveillance system (MDPHnet), the authors examined obesity prevalence in 3 periods from 2018 to 2020 in a fixed cohort of children and adolescents. They found that, although childhood obesity prevalence was rising prior to COVID-19, the prevalence increased by a greater difference in Massachusetts youth during the COVID-19 pandemic. They observed greater increases in obesity prevalence in Black and Hispanic youth, particularly in boys aged 6 to 11 years.
AHRQ-funded; HS000063.
Citation: Wu AJ, Aris IM, Hivert MF .
Association of changes in obesity prevalence with the COVID-19 pandemic in youth in Massachusetts.
JAMA Pediatr 2022 Feb;176(2):198-201. doi: 10.1001/jamapediatrics.2021.5095..
Keywords: Children/Adolescents, COVID-19, Obesity
Chhabra KR, Ghaferi AA, Yang J
Relationship between health care spending and clinical outcomes in bariatric surgery: implications for Medicare bundled payments.
This study’s objective was to evaluate sources of 90-day episode spending variation in Medicare patients undergoing bariatric surgery and whether spending variation was related to quality of care. A retrospective analysis of fee-for-service Medicare claims data from 761 acute care hospitals providing inpatient bariatric surgery was conducted between January 1, 2011 and September 30, 2016. Of 64,537 bariatric patients, 46% went sleeve gastrectomy, 22% revisited the emergency department (ED) within 90 days, and 12.5% were readmitted. Average 90-day payments were $14,124, ranging from $12,220 to $16,887. The largest components of spending variation were readmissions (44% of variation), post-acute care (19%), and index professional fees (15%). The lowest spending hospitals had the lowest complication, ED visit, post-acute utilization, and readmission rates.
AHRQ-funded; HS024403; HS023597.
Citation: Chhabra KR, Ghaferi AA, Yang J .
Relationship between health care spending and clinical outcomes in bariatric surgery: implications for Medicare bundled payments.
Ann Surg 2022 Feb;275(2):356-62. doi: 10.1097/sla.0000000000003979..
Keywords: Healthcare Costs, Surgery, Obesity, Outcomes
Kumar V, Encinosa W
Explaining the obesity paradox in healthcare utilization among people with type 2 diabetes.
The authors sought to examine changes in the relationship between BMI and number of visits in diabetic vs nondiabetic populations, controlling for confounding risk factors. Using MEPS data, they found that the obesity paradox does not exist at the utilization level and is due to the presence of statistical biases such as confounding and reverse causation.
AHRQ-authored.
Citation: Kumar V, Encinosa W .
Explaining the obesity paradox in healthcare utilization among people with type 2 diabetes.
Diabetol Int 2022 Jan;13(1):232-43. doi: 10.1007/s13340-021-00530-5..
Keywords: Medical Expenditure Panel Survey (MEPS), Obesity, Diabetes, Chronic Conditions, Healthcare Utilization
