OBESITY, COMORBIDITIES, AND ECONOMIC EVALUATIONS OF SURGICAL TREATMENTS OF OBESIT

描述（由申请人提供）：超重和肥胖的患病率在全球范围内不断增加，这被认为是导致大量慢性疾病和癌症的原因。肥胖症的手术治疗已被证明在长期体重控制中是有效的，为患有肥胖相关疾病的人提供额外的益处，并降低死亡的相对风险。然而，它并不普遍适用于所有类别的肥胖者。这项拟议中的研究将密切关注减肥手术的成本和有效性。最终目标是检查当前NIH指南的适当性，并告知保险公司，患者，供应商和政府最具成本效益的肥胖手术治疗。研究的具体目的是（1）检查肥胖、肥胖相关合并症和死亡率之间的关系;（2）评价减肥手术的安全性和有效性;（3）调查肥胖相关疾病的成本;（4）进行减肥手术的成本-后果分析。研究方法包括计量经济学建模（研究特定目标1和3），荟萃分析（研究特定目标2），微观模拟（研究特定目标3和4）和成本效益分析（研究特定目标4）。为了成功完成拟议的研究，该项目还将为申请人提供三位专家的指导，他们与教学培训相结合，将使申请人成长为一个有效的， 肥胖预防和控制方面的独立卫生服务研究调查员和卫生经济学家。指导团队和申请人共同努力，确定了三个职业发展目标：（1）成为一名独立的外部资助研究人员;（2）获得肥胖流行病学和胃肠病学的工作知识;（3）通过获得公共卫生和定量建模领域的培训来提高研究质量。这些目标将通过各种培训战略来实现，包括与三名导师（他们是相关领域的专家）定期举行一对一会议，教学课程，高质量的在线培训模块，以及参加科学会议和研讨会。拟议的研究将为几个R21和R 01或同等应用提供初步数据和结果。这些项目将扩大到研究控制肥胖的其他干预措施，例如，运动、饮食、药物和手术，并将在一个强度指标内进行比较;或者，这些项目将研究肥胖和癌症之间的关系，以及控制肥胖的干预措施如何改变这种关系。

DESCRIPTION (provided by applicant): The prevalence of overweight and obesity is increasing globally, which is thought to account for a substantial number of chronic diseases and cancers. Surgical treatment of obesity has been shown to be effective in long- term weight control, provide additional benefits to people with obesity-related diseases, and reduce relative risk of death. However, it is not universally available to all classes of obese people. The proposed research will closely examine the costs and effectiveness of bariatric surgery. The ultimate goal is to examine the appropriateness of current NIH guidelines and to inform insurance companies, patients, providers, and the government of the most cost-effective surgical treatment of obesity. The Research Specific Aims are to (1) examine the association between obesity, obesity-related comorbidities, and mortality; (2) evaluate the safety and effectiveness of bariatric surgery; (3) investigate the costs attributable to obesity-related diseases; and (4) conduct cost-consequence analyses of bariatric surgery. The research methodology includes econometric modeling (Research Specific Aim 1 and 3), meta-analysis (Research Specific Aim 2), microsimulation (Research Specific Aim 3 and 4), and cost-effectiveness analysis (Research Specific Aim 4). In order to successfully complete the proposed research, this project will also provide the applicant with mentoring by three experts who, in conjunction with didactic training, will enable the applicant to grow into an effective and independent health services research investigator and health economist in obesity prevention and control. The mentoring team and the applicant have worked together and identified three Career Development Aims: (1) to become an independent and externally-funded researcher; (2) to obtain working knowledge of obesity epidemiology and gastroenterology; (3) to enhance the quality of research by obtaining training in the areas of public health and quantitative modeling. These aims will be achieved through a variety of training strategies, including regular one-on-one meetings with each of three mentors who are experts in the relevant domains, didactic coursework, high-quality online training modules, and attendance at scientific conferences and workshops. The proposed research will provide preliminary data and results for several R21 and an R01 or equivalent applications. These projects will expand to examine other interventions to control obesity, e.g., exercise, diet, medications, and surgery and will be compared within a metric of intensity; alternatively, these projects will examine the relationship between obesity and cancer and how interventions to control obesity can alter this relationship.