Developing a Decision Aid for Clinical Obesity Services in the Real World: the DACOS Nationwide Pilot Study

Evan Atlantis¹, Nic Kormas^{2

3}, Milan Piya^{3

4}, Mehdi Sahebol-Amri⁵, Kathryn Williams^{6

7}, Hsin-Chia Carol Huang^{8

9

10}, Ramy Bishay^{4

11}, Viral Chikani¹², Teresa Girolamo¹³, Ante Prodan¹⁴, Paul Fahey¹⁵

Affiliations

¹ School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, Australia. e.atlantis@westernsydney.edu.au.
² Department of Endocrinology, Concord Hospital, Concord, New South Wales, Australia.
³ South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, Australia.
⁴ School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
⁵ Ryde Hospital, Northern Sydney Local Health District, Ryde, New South Wales, Australia.
⁶ Department of Endocrinology, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia.
⁷ Charles Perkins Centre-Nepean, The University of Sydney, Kingswood, New South Wales, Australia.
⁸ Respiratory & Sleep Medicine, Canberra Hospital, Garran, Canberra, Australian Capital Territory, Australia.
⁹ Canberra Obesity Management Service, Canberra Health Services, Belconnen, Canberra, Australian Capital Territory, Australia.
¹⁰ College of Health and Medicine, Australian National University, Acton, Australian Capital Territory, Australia.
¹¹ Metabolic & Weight Loss Clinic, University Clinics, Western Sydney University, Blacktown Hospital, Blacktown, New South Wales, Australia.
¹² Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
¹³ Re:You Health, Adelaide Weight Management and Wellness, Adelaide, South Australia, Australia.
¹⁴ School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, Australia.
¹⁵ School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, Australia.

PMID: 38467898
PMCID: PMC11127827
DOI: 10.1007/s11695-024-07123-6

Developing a Decision Aid for Clinical Obesity Services in the Real World: the DACOS Nationwide Pilot Study

Evan Atlantis et al. Obes Surg. 2024 Jun.

. 2024 Jun;34(6):2073-2083.

doi: 10.1007/s11695-024-07123-6. Epub 2024 Mar 11.

Authors

Affiliations

¹ School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, Australia. e.atlantis@westernsydney.edu.au.
² Department of Endocrinology, Concord Hospital, Concord, New South Wales, Australia.
³ South Western Sydney Metabolic Rehabilitation and Bariatric Program, Camden and Campbelltown Hospitals, Campbelltown, New South Wales, Australia.
⁴ School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
⁵ Ryde Hospital, Northern Sydney Local Health District, Ryde, New South Wales, Australia.
⁶ Department of Endocrinology, Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia.
⁷ Charles Perkins Centre-Nepean, The University of Sydney, Kingswood, New South Wales, Australia.
⁸ Respiratory & Sleep Medicine, Canberra Hospital, Garran, Canberra, Australian Capital Territory, Australia.
⁹ Canberra Obesity Management Service, Canberra Health Services, Belconnen, Canberra, Australian Capital Territory, Australia.
¹⁰ College of Health and Medicine, Australian National University, Acton, Australian Capital Territory, Australia.
¹¹ Metabolic & Weight Loss Clinic, University Clinics, Western Sydney University, Blacktown Hospital, Blacktown, New South Wales, Australia.
¹² Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
¹³ Re:You Health, Adelaide Weight Management and Wellness, Adelaide, South Australia, Australia.
¹⁴ School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, Australia.
¹⁵ School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, Australia.

PMID: 38467898
PMCID: PMC11127827
DOI: 10.1007/s11695-024-07123-6

Abstract

Purpose: The purpose of this study is to develop a decision aid tool using "real-world" data within the Australian health system to predict weight loss after bariatric surgery and non-surgical care.

Materials and methods: We analyzed patient record data (aged 16+years) from initial review between 2015 and 2020 with 6-month (n=219) and 9-/12-month (n=153) follow-ups at eight clinical obesity services. Primary outcome was percentage total weight loss (%TWL) at 6 months and 9/12 months. Predictors were selected by statistical evidence (p<0.20), effect size (±2%), and clinical judgment. Multiple linear regression and bariatric surgery were used to create simple predictive models. Accuracy was measured using percentage of predictions within 5% of the observed value, and sensitivity and specificity for predicting target weight loss of 5% (non-surgical care) and 15% (bariatric surgery).

Results: Observed %TWL with bariatric surgery vs. non-surgical care was 19% vs. 5% at 6 months and 22% vs. 5% at 9/12 months. Predictors at 6 months with intercept (non-surgical care) of 6% include bariatric surgery (+11%), BMI>60 (-3%), depression (-2%), anxiety (-2%), and eating disorder (-2%). Accuracy, sensitivity, and specificity were 58%, 69%, and 56%. Predictors at 9/12 months with intercept of 5% include bariatric surgery (+15%), type 2 diabetes (+5%), eating disorder (+4%), fatty liver (+2%), atrial fibrillation (-4%), osteoarthritis (-3%), sleep/mental disorders (-2-3%), and ≥10 alcohol drinks/week (-2%). Accuracy, sensitivity, and specificity were 55%, 86%, and 53%.

Conclusion: Clinicians may use DACOS to discuss potential weight loss predictors with patients after surgery or non-surgical care.

Keywords: Decision support model; Management; Obesity; Weight loss.

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Conflict of interest statement

This pilot work was supported by grants from Novo Nordisk Pharmaceuticals, in partnership with the National Association of Clinical Obesity Services (NACOS) and Western Sydney University (P00026163). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the abstract. EA is the Founding President of NACOS and is employed at Western Sydney University. He has also received honoraria from Novo Nordisk and NACOS for participating at conferences. KW has received honoraria from Novo Nordisk, Eli Lilly, Pfizer, and Boehringer Ingelheim. TG has received honoraria for educational events sponsored by Novo Nordisk, Inova Pharmaceuticals, and Johnson & Johnson and for serving on advisory boards for Novo Nordisk and Inova Pharmaceuticals. MS received financial support from the above grant (P00026163) as a project officer.

References

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1. Atlantis E, et al. Usefulness of the Edmonton Obesity Staging System for stratifying the presence and severity of weight-related health problems in clinical and community settings: a rapid review of observational studies. Obes Rev. 2020;21(11):e13120. doi: 10.1111/obr.13120. - DOI - PubMed
1. Atlantis E, et al. Comparing the predictive ability of the Edmonton Obesity Staging System with the body mass index for use of health services and pharmacotherapies in Australian adults: a nationally representative cross-sectional study. Clin Obes. 2020;10(4):e12368. doi: 10.1111/cob.12368. - DOI - PubMed
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Developing a Decision Aid for Clinical Obesity Services in the Real World: the DACOS Nationwide Pilot Study

Affiliations

Developing a Decision Aid for Clinical Obesity Services in the Real World: the DACOS Nationwide Pilot Study

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

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Full Text Sources

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