Surgery remains the most effective and cheapest weight loss treatment for people who are severely obese according to new research.
The University of Aberdeen study found that high quality weight management programmes (WMPs) are effective tools in reducing weight for up to ten years in some cases.
Researchers reviewed 236 previous studies looking at evidence for acceptability, effectiveness and value for money of surgery, diet and exercise weight management and the drug orlistat.
The review carried out in conjunction with the University of Oxford and the UK Health Forum found that surgery for obesity had the best long-term weight loss results and could be a good use of NHS resources, compared with no surgery or weight management programmes on their own.
Of non-surgical approaches, very low-calorie diets produced the best weight-loss result at 12 months, but it was unclear if weight-loss was any greater than standard WMPs for longer than this. Adding a very low-calorie diet to an existing weight management programme was shown to not be a good use of NHS resources.
However, most weight management programmes, including those with very low-calorie diets, appeared to be a good use of NHS resources compared with doing nothing at all.
Low-carbohydrate Atkins-type diets, higher protein intakes or the use of meal replacements had small added effects on improving weight loss compared to other WMPs at 12 months but no evidence was found they were better than other diets after 12 months.
The best result for long-term non-surgical weight loss (over nearly ten years) came from an intensive WMP with all of the following – a low-fat reducing diet, a calorie goal of 1200-1800 kcal/day, initial meal replacements, a tailored exercise programme, cognitive behavioural therapy, intensive group and individual support, and follow-up by telephone or e-mail. However, this type of WMP would be more costly for the NHS than simpler WMPs.
Other components of effective interventions included increasing physical activity to prevent long-term weight regain and longer-term help with diets or using the drug orlistat. Adding telephone or internet support, and group support, also helped to keep weight off.
Lead author Prof Alison Avenell from the University of Aberdeen said: “The purpose of this study was to examine the available evidence looking at the effectiveness and cost-effectiveness of different weight management procedures from the perspective of the NHS.
“Whilst the study shows surgical interventions remain more effective, provision of surgery for obesity management by the NHS is very low. Other weight management programmes can be effective in terms of helping people who are severely obese lose weight and are cost-effective.”