Alkharaiji Mohammed, Anyanwagu Uchenna, Donnelly Richard, Idris Iskandar
Department of Surgery, Graduate Entry Medical School Royal Derby Hospital, University of Nottingham Derby UK.
Faculty of Public Health, College of Health The Saudi Electronic University Riyadh Saudi Arabia.
Endocrinol Diabetes Metab. 2018 Oct 25;2(1):e00042. doi: 10.1002/edm2.42. eCollection 2019 Jan.
NHS England has recommended a multidisciplinary weight management services (MWMS-Tier 3 services) for patients requiring specialized management of obesity, including bariatric surgery, but clinical and measurable health-related outcomes from these services remains fragmented. We therefore undertook a systematic review to explore the evidence base of effect on body weight loss and comorbidities outcomes of Tier 3 or UK pre-bariatric MWMPs.
AMED, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO, PubMed, HDAS search and Google Scholar were searched from January 2000 to September 2017 in a free-text fashion and crossed-references of included studies to identify potential illegibility. Inclusion criteria were as follows: (a) published Tier 3 original study abstracts/articles; (b) intervention studies with before and after data; (c) studies that included any sort of MWMPs conducted on British residents with obesity; and (d) studies included T2DM measurements in a MWMPs.
In total, 19 studies met the inclusion criteria. The total number of participants analysed was N = 11,735. Baseline accumulative average BMI was calculated at 42.54 kg/m, weight 117.88 kg and waist circumference 126.9 cm. And at 6 months, 40.73 kg/m, 112.17 kg and 120.3 cm, respectively. Secondary outcome variables were as improved with reduction in HbA1c, fasting blood sugars, insulin usage and blood pressure. Physical activity increased at 3 months then declined after 6 months with no significant changes in cholesterol levels.
Tier 3 and MWMPs have a short to mid-ranged positive effect on obese patients (BMI ≥30 kg/m) living in the UK regarding accumulated reduction in weight, glycaemic control, blood pressure and with subtle improvements in physical activity.
英国国民保健服务体系（NHS England）已建议为需要肥胖症专门管理（包括减肥手术）的患者提供多学科体重管理服务（MWMS - 三级服务），但这些服务的临床及可衡量的健康相关结果仍不完整。因此，我们进行了一项系统综述，以探究三级或英国减肥前多学科体重管理计划（MWMPs）对体重减轻和合并症结果影响的证据基础。
于2000年1月至2017年9月以自由文本方式检索了AMED、CINAHL、EMBASE、HMIC、MEDLINE、PsycINFO、PubMed、HDAS以及谷歌学术，并对纳入研究的参考文献进行交叉引用，以识别潜在的不可读文献。纳入标准如下：（a）已发表的三级原始研究摘要/文章；（b）有前后数据的干预研究；（c）对英国肥胖居民进行的任何类型多学科体重管理计划的研究；（d）多学科体重管理计划中包含2型糖尿病测量的研究。
共有19项研究符合纳入标准。分析的参与者总数为N = 11735。基线累积平均体重指数（BMI）计算为42.54kg/m，体重117.88kg，腰围126.9cm。6个月时，分别为40.73kg/m、112.17kg和120.3cm。次要结局变量随着糖化血红蛋白（HbA1c）、空腹血糖、胰岛素使用量和血压的降低而改善。身体活动在3个月时增加，6个月后下降，胆固醇水平无显著变化。
三级多学科体重管理计划对居住在英国的肥胖患者（BMI≥30kg/m）在体重累积减轻、血糖控制、血压方面有短期至中期的积极影响，且身体活动有细微改善。
