Table 1.

Eligibility Criteria

Population: Our primary focus is adult patients with BMI ≥50 kg/m2. To maximize applicability, we included only studies that focused exclusively on the super obese or that included a subgroup analysis of super obese. We did not include studies that had patients with mean or median BMI ≥ 50 kg/m2 but that encompassed a broader range of patients overall.

Intervention: Bariatric surgery interventions.

Comparator: Non-surgical weight loss interventions (including lifestyle, dietary changes, medications) and different bariatric surgical procedures, usual care

Outcomes: Primary outcomes of interest include long-term (defined as ≥ 5 years, based on recent NIH Funding Opportunity Announcement #PAR-14-262 for long-term outcomes of bariatric surgery using large data sets) weight loss (% excess weight lost, BMI change), mortality, remission/resolution of physical and mental health conditions, complications, and cost. Secondary outcomes include barriers to obtaining bariatric surgery (patient attitudes, provider attitudes, access, etc.) and short-term (<5 years) weight loss (% excess weight lost, BMI change), mortality, remission/resolution of physical and mental health conditions, complications, and cost.

Timing: No restrictions

Setting: Within and outside VA. We will prioritize VA studies, but will look outside of the VA to fill gaps in VA evidence, including international studies.

Study design: Using a best evidence approach, we will prioritize evidence from systematic reviews and multi-site comparative studies that adequately controlled for potential patient-, provider-, and system-level confounding factors. Inferior study designs (e.g., single-site, inadequate control for confounding, non-comparative) will be accepted only to fill gaps in higher-level evidence.