Search

Background: Obesity runs in families, and family-based behavioral treatment (FBT) is associated with weight loss in overweight/obese children and their overweight/obese parents. This study was designed to estimate the costs and cost-effectiveness of FBT compared to separate group treatments of the overweight/obese parent and child (PC)., Methods: Fifty overweight/obese 8- to 12-year-old children with overweight/obese parents were randomly assigned to 12 months of either FBT or PC treatment program. Assessment of societal costs (payer plus opportunity costs) were completed based on two assumptions: (1) programs for parent and child were available on separate days (PC-1) or (2) interventions for parent and child were available in the same location at sequential times on the same day (PC-2). Cost-effectiveness was calculated based on societal cost per unit of change using percent overBMI for children and weight for parents., Results: The average societal cost per family was $1,448 for FBT and $2,260 for PC-1 (p < 0.001) and $2,124 for PC-2 (p < 0.001). Child cost-effectiveness for FBT was $209.17/percent overBMI, compared to $1,036.50/percent overBMI for PC-1 and $973.98/percent overBMI for PC-2. Parent cost-effectiveness was $132.97/pound (lb) for FBT and $373.53/lb (PC-1) or $351.00/lb (PC-2)., Conclusions: For families with overweight/obese children and parents, FBT presents a lower cost per unit of weight loss for parents and children than treating the parent and child separately. Given the high rates of pediatric and adult obesity, FBT may provide a unique cost-effective platform for obesity intervention that alters weight in overweight/obese parents and their overweight/obese children.

Bariatric surgery is becoming an accepted option for obese people with type 2 diabetes. Our aim was to assess the impact of laparoscopic adjustable gastric banding (LAGB) through a systematic review of the literature. Data was sourced from Scopus, MEDLINE and EMBASE published from 2000 through May 2011, and five unpublished studies that were performed by industry for regulatory approval were also included. Studies were selected on the basis that they provide some detail of diabetes status before and after LAGB. There were 35 studies meeting the inclusion criteria. There was considerable heterogeneity in study design, sample size, length of follow-up, attrition rates and classification of diabetes status. Weight loss was progressive over the first 2 years with a weighted average of 47% excess weight loss at 2 years. Remission or improvement in diabetes varied from 53% to 70% over different time periods. Results were broadly consistent, demonstrating clinically relevant improvements in diabetes outcomes with sustained weight loss in obese people with type 2 diabetes following LAGB surgery. However, there were significant shortcomings in the reviewed literature with few high-quality studies, inconsistent reporting of diabetes outcomes and high attrition rates. Long-term studies that address these limitations are needed., (© 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.)

The 'obesity paradox' refers to observations that run counter to the thesis that normal weight (BMI 18.5-24.9 g/m(2)) provides the lowest mortality and higher weight is associated with greater mortality. We argue that the weight of lowest mortality is influenced by aging and chronic disease, with mortality advantage extending into the overweight and even class I obese ranges under some circumstances. A focus on quality nutrition, physical activity, fitness, and maintaining function in these weight ranges may be preferable to a focus on intentional weight loss, which has uncertain effects. The 'obesity paradox' is no 'paradox' if one defines and interprets 'ideal' weight appropriately. [ABSTRACT FROM AUTHOR]