Journal of General Internal Medicine

, Volume 32, Supplement 1, pp 65–69 | Cite as

A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration

  • L. M. Funk
  • W. Gunnar
  • J. A. Dominitz
  • D. Eisenberg
  • S. Frayne
  • M. Maggard-Gibbons
  • M. A. Kalarchian
  • E. Livingston
  • V. Sanchez
  • B. R. Smith
  • H. Weidenbacher
  • Matthew L. Maciejewski
Perspective

Abstract

In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA’s capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.

KEY WORDS

bariatric surgery Veterans Health Administration health services research weight loss veterans 

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Copyright information

© Society of General Internal Medicine 2016

Authors and Affiliations

  • L. M. Funk
    • 1
    • 2
  • W. Gunnar
    • 3
  • J. A. Dominitz
    • 4
    • 5
  • D. Eisenberg
    • 6
    • 7
  • S. Frayne
    • 6
    • 8
  • M. Maggard-Gibbons
    • 9
    • 10
  • M. A. Kalarchian
    • 11
  • E. Livingston
    • 12
    • 13
  • V. Sanchez
    • 14
    • 15
  • B. R. Smith
    • 16
    • 17
  • H. Weidenbacher
    • 18
    • 19
  • Matthew L. Maciejewski
    • 18
    • 19
  1. 1.William S. Middleton VA HospitalMadisonUSA
  2. 2.Department of SurgeryUniversity of Wisconsin-MadisonMadisonUSA
  3. 3.The George Washington UniversityWashingtonUSA
  4. 4.U.S. Department of Veterans AffairsWashingtonUSA
  5. 5.Division of GastroenterologyUniversity of WashingtonSeattleUSA
  6. 6.VA Palo Alto Health Care SystemPalo AltoUSA
  7. 7.Department of SurgeryStanford University School of MedicineStanfordUSA
  8. 8.Department of MedicineStanford University School of MedicineStanfordUSA
  9. 9.VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  10. 10.Department of SurgeryDavid Geffen School of Medicine at the University of CaliforniaLos AngelesUSA
  11. 11.School of Nursing and Department of PsychologyDuquesne UniversityPittsburghUSA
  12. 12.JAMAChicagoUSA
  13. 13.Department of Surgery at the UT Southwestern School of MedicineDallasUSA
  14. 14.VA Boston Healthcare SystemBostonUSA
  15. 15.Boston University School of MedicineBostonUSA
  16. 16.VA Long Beach Healthcare SystemLong BeachUSA
  17. 17.Department of SurgeryUC Irvine Medical CenterIrvineUSA
  18. 18.Center for Health Services Research in Primary Care (152)Durham VA Medical CenterDurhamUSA
  19. 19.Division of General Internal Medicine, Department of MedicineDuke UniversityDurhamUSA

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