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

描述(申请人提供)：超重和肥胖的流行在全球范围内正在增加，这被认为是相当多的慢性病和癌症的原因。手术治疗肥胖症已被证明在长期控制体重方面有效，为患有肥胖症相关疾病的人提供了额外的好处，并降低了相对死亡风险。然而，它并不是所有类别的肥胖者都可以使用的。这项拟议的研究将仔细检查减肥手术的成本和效果。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、提供者和政府最具成本效益的肥胖症手术治疗方法。研究的具体目标是(1)检查肥胖、肥胖相关并发症和死亡率之间的联系；(2)评估减肥手术的安全性和有效性；(3)调查肥胖相关疾病的成本；以及(4)进行减肥手术的成本-结果分析。研究方法包括计量经济模型(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)。为了成功地完成拟议的研究，该项目还将向申请人提供三名专家的指导，他们将结合教学培训，使申请人成长为一名有效和 肥胖预防和控制领域的独立健康服务研究调查员和健康经济学家。指导团队和申请者共同努力，确定了三个职业发展目标：(1)成为一名独立的外部资助的研究人员；(2)获得肥胖症流行病学和胃肠病学的实用知识；(3)通过获得公共卫生和定量建模领域的培训，提高研究质量。这些目标将通过各种培训战略来实现，包括定期与相关领域的三名专家导师进行一对一的定期会议、教学课程、高质量的在线培训模块以及参加科学会议和讲习班。拟议的研究将提供几个R21和R01或同等应用的初步数据和结果。这些项目将扩大到检查其他控制肥胖的干预措施，例如运动、饮食、药物和手术，并将在强度度量范围内进行比较；或者，这些项目将检查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.