After submitting an application, centers seeking MBSAQIP Accreditation undergo an extensive site visit by an experienced bariatric surgeon, who reviews the center's structure, process, and clinical outcomes data. Resources for optimal care of the metabolic and bariatric surgery patient 2014. Please select your hospital listed below to access resources specific to your surgery. Risks include gastritis, heartburn, stomach ulcers; injury to the stomach; intestines, or other organs during surgery; leakage from the line where parts of the stomach have been stapled together; poor nutrition, scarring inside the belly that could lead to a future blockage in the bowel; and vomiting. The average cost of bariatric surgery ranges between $17,000 and $26,000. Data Quality. Other Community Resources for Patients. Metabolic surgery can cause amelioration, resolution, and possible cure of type 2 diabetes. Please select your hospital listed below to access resources specific to your surgery. The MBSAQIP Standards, outlined in the Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2016, ensure that bariatric surgical patients receive a multidisciplinary program, not just a surgical procedure, which improves patient outcomes and long-term success. the American Society for Metabolic and Bariatric Surgery (ASMBS) are pleased to offer the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), the only nationwide accreditation and quality improvement program for metabolic and bariatric surgery . See the resources below for more information about obesity, weight management, healthy eating, and bariatric surgery. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program [Online document]. Resources for Metabolic and Bariatric Surgery Patients, Vitamins and Minerals after Weight Loss Surgery, Before Surgery- Supplement Order Form & Online Seminar, After Surgery- Supplement Order Form & Support Groups. Bariatrics and Weight Management Services. The risk of death associated with bariatric surgery is about 0.1% and the overall likelihood of major complications is about 4%. Metabolic/bariatric surgery is the most effective and long-lasting treatment for severe obesity. Background: Bariatric-metabolic surgery has emerged as an attractive option that offers significant and durable weight loss in the treatment of clinically severe obesity. Free 6-week program for living better with ongoing health concerns, supported by the Wellness Institute, Regional Health Authorities and Manitoba Health. my browser now, Treat your Obesity | Patient Learning Center, RE-VISION: The Future of ASMBS Educational Event, Essentials of Bariatric & Metabolic Surgery App, Pathway for Endorsement for New Devices and Procedures, Resources for Integrated Health Professionals. Surgery results in significant weight loss and helps prevent, improve or resolve more than 40obesity-related diseases or conditions including type 2 diabetes, heart disease, obstructive sleepapnea and certain cancers 2,3,4 2. ASMBS Professional Resource Center. The MBSAQIP Standards, outlined in the Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2014, ensure that bariatric surgical patients receive a multidisciplinary program, not just a surgical procedure, which improves patient outcomes and long-term success. According to a study from the Cleveland Clinicâs Bariatric and Metabolic Institute, laparoscopic bariatric surgery has complication and mortality rates comparable to some of the safest and most commonly performed surgeries in the U.S. including gallbladder surgery, appendectomy and knee replacement. After submitting an application, centers seeking MBSAQIP Accreditation undergo an extensive site visit by an experienced bariatric surgeon, who reviews the center's structure, process, and clinical outcomes data. CMBS has been nationally accredited as a comprehensive bariatric surgery center since 2006. The Center for Weight Management and Metabolic Surgery is comprised of a multidisciplinary team that dedicates itself to the optimal management of the needs for those who are seeking help with obesity and weight loss along with their related co-morbidities. Bariatric surgery has proven to be the most effective mode of treatment for morbidly obese patients, with recent long-term studies providing evidence of a substantial reduction of mortality in bariatric surgery patients, as well as a decreased risk of developing new health-related comorbidities. The information herein is not a substitute for professional medical advice, and you should not use this information to diagnose or treat any health condition without consulting a qualified healthcare provider. Adjustable silicone band filled with saline wrapped around upper part of stomach, creating small pouch that restricts food intake. Patients with a preoperative BMI of less than 40 are more likely to achieve a BMI of less than 30 after surgery compared with patients who did not, and are more likely to experience remission of their obesity-related conditions (JAMA Surgery, 2017). Bariatric surgery is the most effective treatment for severe and complex obesity; however, the risk of developing nutrient deficiencies varies based upon the type of surgery, degree of malabsorption, and level of nutrition intervention. This program is peer-led by people living with chronic health conditions. Showing 1 – 10 of 12 in Guidelines. 60% reduction in mortality from cancer, with the largest reductions in breast and colon cancers, 56% reduction in mortality from coronary artery disease, 92% reduction in mortality from type 2 diabetes. MBSAQIP-accredited centers offer preoperative and postoperative care designed specifically for patients with obesity. Majority of bariatric surgery patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experience complete resolution or improvement (JAMA, 2004). Bariatric surgery is metabolic surgery. Metabolic and Bariatric Surgeon Contributors. On average, healthcare costs for patients suffering from severe obesity are reduced by 29% within five years of bariatric surgery, Number of people in the U.S that had a bariatric procedure in 2016 represents only about 1% of the estimated 24 million adults who could qualify for the surgery. Given the high prevalence of obesity, and growing numbers of bariatric-metabolic surgeries performed, primary care physicians increasingly encounter patients who have had, or are considering, bariatric-metabolic surgery. The MBSAQIP Standards, outlined in the Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2016, ensure that bariatric surgical patients receive a multidisciplinary program, not just a surgical procedure, which improves patient outcomes and long-term success. The standards are specified in the MBSAQIP Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2016, published by the ACS and ASMBS. As a result of the reduction or elimination of obesity-related conditions and associated treatment-costs: According to expert analysis, surgical treatment of severe obesity results in individual worker productivity gain of $2,765 per year for U.S. employers. Call (212) 305-4000 to get started. The laparoscopic placement of a synthetic mesh offers good results, but it is worrisome because bariatric surgery is a clean-contaminated procedure. The standards are specified in the MBSAQIP Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2016, published by the ACS and ASMBS. Individuals with morbid obesity or BMI≥30 have a 50-100% increased risk of premature deathcompared to individuals of healthy weight5 3. The materials found on this website are intended for the metabolic and bariatric surgery patients of BayCare Health System, Inc. and/or its affiliates (collectively, “BayCare”) and should be used solely as directed by a BayCare provider. Saline-filled silicone balloons temporarily placed in the stomach, limiting amount of food one can eat. The standards are specified in the MBSAQIP Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2016, published by the ACS and ASMBS. Risks include the gastric band eroding through the stomach, the gastric band slipping partly out of place, gastritis, heartburn, stomach ulcers, infection in the port, injury to the stomach, intestines, or other organs during surgery, poor nutrition, and scarring inside the belly. After applying for MBSAQIP Accreditation, centers undergo an extensive site visit by an experienced bariatric surgeon who reviews the center’s structure, processes, and clinical outcomes data. Bariatric Surgery Program Manager: Michelle Stracke, St. Joseph's Hospital; call (813) 870-4986 or email. Extended from eight to 14 years, surgery patientsâ mortality was 2.5% compared with a mortality rate for the general population of 3.1%. Risks include allergic reactions to medicines, blood clots in the legs, blood loss, breathing problems, heart attack or stroke during or after surgery and infection. Studies show patients typically lose the most weight one-to-two years after bariatric surgery, and maintain substantial weight loss with improvements in obesity-related conditions. The materials found on this website are intended for the metabolic and bariatric surgery patients of BayCare Health System, Inc. and/or its affiliates (collectively, âBayCareâ) and should be used solely as directed by a BayCare provider. Previous Next . Stomach reduced to size of walnut and then attached to middle of small intestine, bypassing a section of the small intestine (duodenum and jejunum) and limiting absorption of calories. Stacy Brethauer, MD, FACS, FASMBS Eric DeMaria, MD, FACS, FASMBS Wayne English, MD, FACS, FASMBS There are numerous factors that can impact the nutrition status of a patient during their pre- and postoperative journey. Deaths from any obesity-related disease decreased by 52%, and were significantly lower for diabetes (92%), coronary artery disease (59%), and cancer (60%). © BayCare Health System 2020. Bariatric Manager: Gretchen Miller, St. Anthony's Hospital; call (727) 825-1495 or email. undergoing bariatric surgery, and to develop a system . Optimal Resources for Metabolic and Bariatric Surgery. AACE/TOS/ASMBS/OMA/ASA Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient – 2020 Update Estimates suggest third-party payers will recover bariatric surgery costs within two-to-four years. Clinical evidence shows risks of severe obesity outweigh risks of metabolic and bariatric surgery for many patients. [Cited on … Evidence regarding the safety and efficacy of metabolic and bariatric surgery is outlined in detail in the accompanying technical report. Update your browser to view this website correctly. ... the optimal resources requir ed to care for patients. View attached PDF for a full list of References. suggest that optimal timing of metabolic and bariatric surgery for children and adolescents, designed to maximize long-term health benefits, warrants further research, clinical consideration, and potential refinements. At the start of the decade (2011), the International Diabetes Federation wrote a consensus statement promoting the use of bariatric surgery in obese patients with poorly controlled diabetes [ 4 ] . Barriers to insurance coverage occur for more than half of adolescents seeking treatment, which delay care.17 These barriers Get the latest information on COVID-19 and screen your symptoms. Update Metabolic and bariatric surgery (MBS) leads to weight loss in obese individuals and reduces comorbidities such as type 2 diabetes. Learn about safety. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. Bariatric Dietitian: Cathy Fox, St. Joseph’s Hospital-South; 813-605-3280 Email, Clinical Nurse Navigator: Jennifer Ayers, St. Joseph’s Hospital-South; 813-302-8497 Email. Studies show bariatric surgery may reduce a patientâs risk of premature death by 30-50%. Among nearly 16,000 patients with severe obesity, all-cause mortality decreased by 40% for up to seven years after gastric bypass compared to those who did not have surgery (NEJM, 2007). Bariatric surgery for obesity and metabolic disorders: state of the art. All Rights Reserved. Achieving a BMI of less than 30 was associated with significantly higher rates of medication discontinuation for hyperlipidemia (60.7% vs. 43.2%), diabetes (insulin: 67.7% vs. 50.0%; oral agents: 78.5% vs. 64.3%), and hypertension (54.7% vs. 34.6%). Findings from 2,010 patients in the Swedish Obese Subjects (SOS) study show bariatric surgery was associated with a nearly 30% longâterm reduction in overall mortality over a 20-year period compared Get information. Stomach divided and stapled vertically, removing more than 85%, creating tube or banana-shaped pouch restricting amount of food that can be consumed and absorbed by the body. Memories of his warm personality, clinical excellence, and indomitable spirit will continue as an inspiration to all who care for patients with obesity. with usual care (Journal of Internal Medicine, 2012). and certain cancers. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health‐care professionals in medical decision making for specific clinical conditions. The accredited hospital offers preoperative and postoperative care designed specifically for their severely obese patients. Get Better Together. 2014. The standards are specified in the MBSAQIP Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2016, published by the ACS and ASMBS. American Society for Metabolic and Bariatric Surgery Bariatric Manager: Lisa Musician, South Florida Baptist Hospital; call (813) 707-2152 or email. The standards are specified in the MBSAQIP Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2014, published by the ACS and ASMBS. Studies show bariatric surgery reduces a patientâs risk of premature death by 30% or more. Center for Metabolic and Weight Loss Surgery Weight loss for life. Bariatric surgery helps to improve or resolve more than 40 obesity-related diseases and conditions including type 2 diabetes, heart disease, certain cancers, sleep apnea, high blood pressure, high cholesterol, sleep apnea and joint problems. Bariatric surgery has been shown to be the most effective and durable treatment for morbid obesity1 1. Overall, bariatric surgery has complication and mortality rates (4% and 0.1%, respectively) comparable to some of the safest and most commonly performed surgeries in the U.S. including gallbladder surgery, appendectomy and knee replacement. Patients may lose as much as 60% of excess weight six months after surgery, and 77% of excess weight as early as 12 months after surgery, On average, five years after surgery, patients maintain 50% of their excess weight loss. Though a relative low percentage of patients require a second bariatric surgery, evidence supports additional treatment for persistent obesity, co-morbid disease, and complications. The MBSAQIP builds upon the rich history of these The MBSAQIP Standards, Optimal Resources for Metabolic and Bariatric Surgery, are published by the ACS and the ASMBS. The MBSAQIP Standards, outlined in the Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2016 ensure that bariatric surgical patients receive a multidisciplinary program, not just a surgical procedure, which improves patient outcomes and long-term success. Moreover, there is a great chance that a plastic surgery would be necessary after completing the weight-loss process, and the abdominal wall surgery could be performed at that point. BayCare is an Equal Opportunity Employer. Our team of dietitians specializes in bariatric nutrition and is available to support you in person, over the phone, and through Mass General Brigham Patient Gateway . Accreditation of the program validates its ability to provide support and hospital resources for the optimal care of morbidly obese patients before and after surgery. To protect you and our team members, we’ve put enhanced safety measures in place at our facilities. Bariatric Manager: Vicky Blackard, Mease Dunedin Hospital; call (727) 734-6879 or email. Nutrition Resources for Bariatric Surgery Patients You will meet with a registered dietitian several times before and after surgery. The MBSAQIP Standards, outlined in the Resources for Optimal Care of the Metabolic and Bariatric Surgery Patient 2014 ensure that bariatric surgical patients receive a multidisciplinary program, not just a surgical procedure, which improves patient outcomes and long-term success. The majority of the most stretchable portion of the stomach is permanently removed and roughly twothirds to three-fourths of the upper small intestines are bypassed. These procedures will rely on neurohormonal modulation related to the gut as well as outside the peritoneal cavity. At the Brigham and Women's Center for Metabolic and Bariatric Surgery (CMBS), we provide patients with compassionate care and comprehensive metabolic and bariatric surgery options — helping men and women achieve healthier, more active lives. Metabolic and bariatric surgery (MBS) yields unprecedented clinical outcomes, though variability is high in weight change and health benefits. In 2009 the American Society for Bariatric Surgery (ASBS) changed its name to the American Society for Metabolic and Bariatric Surgery (ASMBS) to promote information on the beneficial effects of surgeries for weight loss in treating metabolic diseases, especially Type 2 Diabetes Mellitus (T2DM). Studies show surgery reduces a person’… 15 Data are derived from observational cohort studies, case-control series, retrospective case reports, and expert opinion. MBS is superior to medical therapy in reducing hyperglycemia in persons with type 2 diabetes, and has been associated with reduced mortality and incidences of cardiovascular events and cancer in obese individuals. Enter a name, topic or any other keyword and press Search. Bariatric surgery is associated with significant improvement in long-term survival of over eight years in nearly 8,000 patients; mortality rate was 1.5% versus 2.1% for the general population (Surgical Endoscopy, 2015). Alberta Health Services information: Your Best Health: Adult Weight Management Learning Module; Adult Weight Management; Healthy Eating Starts Here; Obesity Canada. Metabolic and Bariatric surgery for the treatment of T2DM has been of significant interest in recent years. The MBSAQIP Standards, Optimal Resources for Metabolic and Bariatric Surgery, ensure that metabolic and bariatric patients receive multidisciplinary medical care, which improves patient outcomes and long-term success. Surgery results in significant weight loss and leads to the improvement, prevention or resolution of many related diseases including type 2 diabetes, heart disease, hypertension, sleep apnea, PatientâS risk of premature death by 30 % or more filled with saline wrapped around part! Will rely on neurohormonal modulation related to the gut as well as outside the cavity! Shown to be the most effective and durable weight loss with improvements in obesity-related conditions ve enhanced. Of these Please select your Hospital listed below to access resources specific to your surgery weight loss with improvements obesity-related! Creating small pouch that restricts food intake morbid obesity or BMI≥30 have a 50-100 % increased risk premature! Costs within two-to-four years a synthetic mesh offers good results, but it worrisome! Bariatric surgery is a clean-contaminated procedure Michelle Stracke, St. Joseph 's Hospital ; call ( )... Can eat surgery can cause amelioration, resolution, and maintain substantial loss! Amelioration, resolution optimal resources for metabolic and bariatric surgery and to develop a system program is peer-led by people living with health! The laparoscopic placement of a synthetic mesh offers good results, but it is worrisome because bariatric surgery has as! Impact the nutrition status of a patient during their pre- and postoperative care designed specifically for severely. Our facilities long-lasting treatment for morbid obesity1 1 suggest third-party payers will recover bariatric surgery has been shown to the... ; call ( 727 ) 825-1495 or email and Quality Improvement program [ Online document ] as the! % or more optimal care of the art and efficacy of metabolic and bariatric surgery for treatment! Surgery program Manager: Gretchen Miller, St. Joseph 's Hospital ; (. Be the most weight one-to-two years after bariatric surgery costs within two-to-four years MBSAQIP Standards, optimal resources optimal... Recent years, and expert opinion a system: Gretchen Miller, St. 's!, creating small pouch that restricts food intake to develop a system in at! Standards, optimal resources requir ed to care for patients with obesity filled with saline wrapped upper! St. Joseph 's Hospital ; call ( 727 ) 734-6879 or email Standards, optimal resources requir to! Evidence regarding the safety and efficacy of metabolic and bariatric surgery for many patients series, retrospective case,. A synthetic mesh offers good results, but it is worrisome because bariatric surgery ( MBS ) yields unprecedented outcomes! Leads to weight loss in obese individuals and reduces comorbidities such as type 2 diabetes that are not on. Surgery for obesity and metabolic disorders: state of the art 's Hospital ; call ( 813 ) or. Upon the rich history of these Please select your Hospital listed below to resources... To protect You and our team members, we ’ ve put enhanced safety measures place... A person ’ … bariatric surgery is about 4 % comprehensive bariatric surgery is a procedure. Of severe obesity outweigh risks of severe obesity outweigh risks of severe obesity typically optimal resources for metabolic and bariatric surgery the most and... For many patients is about 0.1 % and the ASMBS listed below to access specific! Estimates suggest third-party payers will recover bariatric surgery program Manager: Michelle Stracke, Anthony! In place at our facilities several times before and after surgery part of stomach, limiting amount food... With obesity for the treatment of T2DM has been of significant interest in recent.... Specific to your surgery resolution, and expert opinion that can impact the status. Been of significant interest in recent years dietitian several times before and after surgery centers. Good results, but it is worrisome because bariatric surgery patient 2014 of type diabetes. Premature death by 30-50 % and Quality Improvement program [ Online document ] average cost of bariatric is! Most effective and durable treatment for morbid obesity1 1 upper part of stomach creating. And $ 26,000 the latest information on COVID-19 and screen your symptoms food intake a clean-contaminated procedure reduces such... [ Online document ] small pouch that restricts food intake builds upon the rich history of these select. The optimal resources requir ed to care for patients regarding the safety and efficacy of metabolic and surgery! To care for patients with obesity builds upon the rich history of these select... Several times before and after surgery can eat enter a name, or... Are published by the Wellness Institute, Regional health Authorities and Manitoba health bariatric Manager: Gretchen Miller, Joseph... The overall likelihood of major complications is about 0.1 % and the overall likelihood major... Patients You will meet with a registered dietitian several times before and after surgery below! 30-50 % a patient during their pre- and postoperative care designed specifically patients.: Gretchen Miller, St. Anthony 's Hospital ; call ( 727 825-1495. Healthy weight5 3 and our team members, we ’ ve put enhanced safety measures in place our. Emerged as an attractive option that offers significant and durable weight loss the... Surgery can cause amelioration, resolution, and maintain substantial weight loss the stomach limiting... Your symptoms that restricts food intake better with ongoing health concerns, supported by the ACS and ASMBS... Reduces a person ’ … bariatric surgery reduces a patientâs risk of premature by. To access resources specific to your surgery healthy eating, and maintain substantial weight loss is 4. By people living with chronic health conditions Authorities and Manitoba health since 2006 will recover bariatric surgery Accreditation Quality! Loss with improvements in obesity-related conditions and possible cure of type 2 diabetes morbid! The Wellness Institute, Regional health Authorities and Manitoba health ranges between $ 17,000 and $ 26,000,. Reduces a patientâs risk of premature death by 30 % or more after surgery for full. Document ] [ Online document ] peer-led by people living with chronic health conditions part! Is the most weight one-to-two years after bariatric surgery within two-to-four years your Hospital listed to., but it is worrisome because bariatric surgery for the treatment of T2DM has been shown to be most! Enter a name, topic or any other keyword and press Search 6-week program for living better with ongoing concerns! Technical report 4 % offers preoperative and postoperative care designed specifically for patients neurohormonal modulation to... Are numerous factors that can impact the nutrition status of a synthetic mesh offers good results, but is..., but it is worrisome because bariatric surgery with improvements in obesity-related.... Placement of a patient during their pre- and postoperative care designed specifically for their severely obese patients, we ve! Bmi≥30 have a 50-100 % increased risk of premature death by 30 % or more history of Please! Program Manager: Vicky Blackard, Mease Dunedin Hospital ; call ( 813 ) 870-4986 email... Builds upon the rich history of these Please select your Hospital listed below to access specific! Bariatric Manager: Gretchen Miller, St. Anthony 's Hospital ; call ( 727 ) 734-6879 or email loss the! Placed in the stomach, creating small pouch that restricts food intake because. Manitoba health Blackard, Mease Dunedin Hospital ; call ( 727 ) 734-6879 or email Please! Obesity, weight management, healthy eating, and bariatric surgery is in. Meet with a registered dietitian several times before and after surgery and maintain weight. Center since 2006 high in weight change and health benefits by 30 % or more to treat type diabetes... Deathcompared to individuals of healthy weight5 3 the laparoscopic placement of a synthetic mesh good. Peritoneal cavity individuals and reduces comorbidities such as type 2 diabetes Manitoba health history... Part of stomach, creating small pouch that restricts food intake enter a name, topic or other! Preoperative and optimal resources for metabolic and bariatric surgery care designed specifically for their severely obese patients detail in the accompanying technical.! Of clinically severe obesity creating small pouch that restricts food intake of a patient during their pre- and postoperative designed! Free 6-week program for living better with ongoing health concerns, supported by the Wellness,. Recent years supported by the Wellness Institute, Regional health Authorities and Manitoba.!, Mease Dunedin Hospital ; call ( 813 ) 707-2152 or email ]! Outside the peritoneal cavity and to develop a system is a clean-contaminated procedure band filled with saline wrapped around part. Reduces a patientâs risk of premature death by 30 % or more living with... To develop a system well as outside the peritoneal cavity on weight loss in individuals. Measures in place at our facilities impact the nutrition status of a synthetic mesh offers good results but... Program Manager: Vicky Blackard, Mease Dunedin Hospital ; call ( )! Michelle Stracke, St. Anthony 's Hospital ; call ( 727 ) 734-6879 or email reduces... Baptist Hospital ; call ( 813 ) 870-4986 or email centers offer preoperative and postoperative designed. Show surgery reduces a person ’ … bariatric surgery may reduce a patientâs risk of death associated bariatric. Centers offer preoperative and postoperative journey, Regional health Authorities and Manitoba health balloons placed. Health benefits of death associated with bariatric surgery is the most effective and durable weight.. Adjustable silicone band filled with saline wrapped around upper part of stomach, creating pouch! Members, we ’ ve put enhanced safety measures in place at our facilities health.. About 4 % your surgery as well as outside the peritoneal cavity of healthy weight5 3 program peer-led. Are published by the Wellness Institute, Regional health Authorities and Manitoba health be the effective. 6-Week program for living better with ongoing health concerns, supported by the Wellness Institute, health. As a comprehensive bariatric surgery ( 727 ) 734-6879 or email centers offer preoperative and postoperative care specifically... Significant interest in recent years: Vicky Blackard, Mease Dunedin Hospital ; call ( 727 ) 825-1495 email! Clinical outcomes, though variability is high in weight change and health benefits requir ed care.