Obesity Surgery

, Volume 22, Issue 9, pp 1496–1506 | Cite as

Weight Loss Surgery for Mild to Moderate Obesity: A Systematic Review and Economic Evaluation

  • Joanna PicotEmail author
  • Jeremy Jones
  • Jill L. ColquittEmail author
  • Emma Loveman
  • Andrew J. Clegg



A systematic review and economic evaluation was commissioned to determine the effectiveness and cost-effectiveness of bariatric surgery for mild [class I, body mass index (BMI) 30 to 34.99] or moderate (class II, BMI 35 to 39.99) obesity.


We searched 17 electronic resources (to February 2010) and other sources. Studies meeting predefined criteria were identified, data-extracted and assessed for risk of bias using standard methodology. A model was developed to estimate cost-effectiveness.


Two RCTs were included. Evidence from both indicated a statistically significant benefit from laparoscopic adjustable banding (LAGB) compared to a non-surgical comparator for weight loss and in obesity-related comorbidity. Both interventions were associated with adverse events. LAGB costs more than non-surgical management. For people with class I or II obesity and type 2 diabetes (T2D), the incremental cost-effectiveness ratio (ICER) at 2 years is £20,159, reducing to £4,969 at 5 years and £1,634 at 20 years. Resolution of T2D makes the greatest contribution to this reduction. In people with class I obesity, the ICER is £63,156 at 2 years, £17,158 at 5 years, and £13,701 at 20 years. Cost-effectiveness results are particularly sensitive to utility gain from reduction in BMI, factors associated with poorer surgical performance and diabetes health state costs.


Bariatric surgery appears to be a clinically effective and cost-effective intervention for people with class I or II obesity who also have T2D but is less likely to be cost-effective for people with class I obesity.


Bariatric surgery Obesity Diabetes mellitus Systematic review Cost-effectiveness 


Conflict of Interest

All contributing authors declare that they have no conflicts of interest.


  1. 1.
    Ruhm CJ. Current and future prevalence of obesity and severe obesity in the United States. Working Paper 13181. 2007. National Bureau of Economic Research.Google Scholar
  2. 2.
    McPherson K, Marsh T, Brown M. Foresight. Tackling obesities: future choices—modelling future trends in obesity and the impact on health. 2nd Edition; 2007.Google Scholar
  3. 3.
    Sassi F, Devaux M, Cecchini M, et al. The obesity epidemic: analysis of past and projected future trends in selected OECD countries. OECD Health Working Papers, No. 45. 2009. OECD Publishing.Google Scholar
  4. 4.
    Buchwald H. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis. 2005;1:371–81.PubMedCrossRefGoogle Scholar
  5. 5.
    Report by the comptroller and auditor general. Tackling obesity in England. 1–65. London: The Stationery Office; 2001.Google Scholar
  6. 6.
    Department of Health. Health risk and costs of obesity. 2007. Accessed 3 March 2009.
  7. 7.
    The Information Centre, Yorkshire & Humber Public Health Observatory. Prescribing for Diabetes in England. An analysis of volume, expenditure and trends; 2007.Google Scholar
  8. 8.
    Dixon JB, Pories WJ, O’Brien PE, et al. Surgery as an effective early intervention for diabesity: why the reluctance? Diabetes Care. 2005;28:472–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Smith Jr SC, Smith SCJ. Multiple risk factors for cardiovascular disease and diabetes mellitus [Review] [34 refs]. Am J Med. 2007;120:S3–S11.PubMedCrossRefGoogle Scholar
  10. 10.
    Anselmino M, Mellbin L, Wallander M, et al. Early detection and integrated management of dysglycemia in cardiovascular disease: a key factor for decreasing the likelihood of future events. Rev Cardiovasc Med. 2008;9:29–38.PubMedCrossRefGoogle Scholar
  11. 11.
    Brunton SA, Davis SN, Renda SM, et al. Early intervention to achieve optimal outcomes in type 2 diabetes: a case presentation. [Review] [40 refs]. Clin Cornerstone. 2006;8 Suppl 2:S6–S18.PubMedCrossRefGoogle Scholar
  12. 12.
    Wylie-Rosett J, Herman WH, Goldberg RB, et al. Lifestyle intervention to prevent diabetes: intensive and cost effective. Curr Opin Lipidol. 2006;17:37–44.PubMedCrossRefGoogle Scholar
  13. 13.
    Fonseca VA, Fonseca VA. Early identification and treatment of insulin resistance: impact on subsequent prediabetes and type 2 diabetes. [Review] [66 refs]. Clin Cornerstone. 2007;8 Suppl 7:S7–S18.PubMedCrossRefGoogle Scholar
  14. 14.
    Depaula AL, Macedo AL, Mota BR et al. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21–29. Surg Endosc. 2008.Google Scholar
  15. 15.
    Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI>35 and <35 kg/m2. J Gastrointest Surg. 2008;12:945–52.PubMedCrossRefGoogle Scholar
  16. 16.
    Batsis JA, Sarr MG, Collazo-Clavell ML, et al. Cardiovascular risk after bariatric surgery for obesity. Am J Cardiol. 2008;102:930–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Cohen R, Pinheiro JS, Correa JL, et al. Laparoscopic Roux-en-Y gastric bypass for BMI < 35 kg/m(2): a tailored approach. Surg Obes Relat Dis. 2006;2:401–4. discussion.PubMedCrossRefGoogle Scholar
  18. 18.
    Wadden TA, Tsai AG. Bariatric surgery: crossing a body mass index threshold. Ann Intern Med. 2006;144:689–91.PubMedGoogle Scholar
  19. 19.
    Ahima RS. Should eligibility for bariatric surgery be expanded? Gastroenterology. 2008;134:15.PubMedCrossRefGoogle Scholar
  20. 20.
    Padwal R. Laparoscopic surgery was better than an intensive non-surgical intervention for weight loss in mild to moderate obesity. Evid Based Med. 2006;11:146.PubMedCrossRefGoogle Scholar
  21. 21.
    Clegg AJ, Colquitt J, Sidhu MK, et al. The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation. Health Technol Assess. 2002;6:1–153.PubMedGoogle Scholar
  22. 22.
    Colquitt J, Clegg A, Loveman E, et al. Surgery for morbid obesity. Cochrane Database Syst Rev. 2005; Issue 4. Art. No.:CD003641. doi: 10.1002/14651858.CD003641.pub2.
  23. 23.
    Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13:1–357. iii.Google Scholar
  24. 24.
    Cochrane Collaboration. Assessing risk of bias in included studies. In: Higgins J, Altman D, editors. Cochrane handbook for systematic reviews of interventions, Preliminary Draft, 3 December 2007 edition; 2007.Google Scholar
  25. 25.
    Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–23.PubMedCrossRefGoogle Scholar
  26. 26.
    O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial.[see comment][summary for patients in Ann Intern Med. 2006 May 2;144(9):I12; PMID: 16670127]. Ann Intern Med. 2006;144:625–33.PubMedGoogle Scholar
  27. 27.
    Dixon JB, Strauss BJ, Laurie C, et al. Changes in body composition with weight loss: obese subjects randomized to surgical and medical programs. Obesity (Silver Spring, Md). 2007;15:1187–98.CrossRefGoogle Scholar
  28. 28.
    Colditz GA, Willett WC, Rotzinsky A, et al. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. 1995;122:481–6.PubMedGoogle Scholar
  29. 29.
    Andersen KM, Odell PM, Wilson WF, et al. Cardiovascular disease risk profiles. Am Hear J. 1991;121:2–293.Google Scholar
  30. 30.
    Caro JJ, O’Brien JA, Hollenbeak CS, et al. Economic burden and risk of cardiovascular disease and diabetes in patients with different cardiometabolic risk profiles. Value Health. 2007;10:S12–20.CrossRefGoogle Scholar
  31. 31.
    Hakim Z, Wolf A, Garrison LP. Estimating the effect of changes in body mass index on health state preferences. PharmacoEconomics. 2008;20(6):393–404.CrossRefGoogle Scholar
  32. 32.
    Department of Health. NHS Reference Costs 2006–2007. Department of Health; 2008. 27-2-0008.Google Scholar
  33. 33.
    Curtis L. Unit costs of Health and Social Care, PSSRU, University of Kent; 2007.Google Scholar
  34. 34.
    Ward S, Lloyd Jones M, Pandor A, et al. A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess. 2007;11.Google Scholar
  35. 35.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.PubMedCrossRefGoogle Scholar
  36. 36.
    Keating CL, Dixon JB, Moodie ML, et al. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care. 2009;32:580–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Keating CL, Dixon JB, Moodie ML, et al. Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis. Diabetes Care. 2009;32:567–74.PubMedCrossRefGoogle Scholar

Copyright information

© Southampton Health Technology Assessments Centre, Crown Copyright 2012

Authors and Affiliations

  1. 1.Southampton Health Technology Assessments Centre (SHTAC)University of SouthamptonSouthamptonUK

Personalised recommendations