There are six types of treatment available for obesity and excess weight:
- Lifestyle interventions – such as community weight management programmes
- Cognitive and behavioural therapies
- Physical activity
- Dietary approaches
- Pharmacological interventions
- Surgical interventions – bariatric surgery
There is inconsistent evidence with regards to the effectiveness of the first four types of obesity treatment[1].
Pharmacological treatment (orlistat) has been recommended by NICE as a cost-effective intervention for adults with BMI greater than 30kg/m² (or BMI greater than 28 kg/m² with comorbidities)[2]. Orlistat can be used in children only with physical comorbidities. Recommending use should involve a multidisciplinary approach.
Bariatric surgery is a treatment option recommended by NICE for people with obesity if all the following criteria are fulfilled: they have a BMI of 40 kg/m² or more, or between 35 kg/m2 and 40 kg/m² and other significant diseases (for example type 2 diabetes or high blood pressure) that could be improved if they lost weight. Individuals are also required to have shown they have attempted to lose weight through multi-component interventions.[3].
Table 1 below reports cost-effectiveness figures for three main types of surgical intervention for obesity.
Table 1: Cost per QALY[4] by type of bariatric surgery[5]
| Surgery type | Cost per QALY (£) |
| Gastric bypass | 6,289 |
| Adjustable silicone gastric band | 8,527 |
| Vertical gastric banding | 10,237 |
Evidence suggests that surgery in general is a cost-effective intervention in a typical severely obese group with cost per QALY between £6,289 and £10,237.
[1] NICE: Health economics: evidence statements and reviews. Available from: https://www.nice.org.uk/guidance/cg43/evidence/full-guideline-section-6-health-economics-evidence-statements-and-reviews-pdf-195027235
[2] NICE: Clinical Guidance 43. Available from: https://www.nice.org.uk/guidance/cg43
[3] NICE: Obesity: identification, assessment and management. Available from: https://www.nice.org.uk/guidance/cg189/chapter/Introduction
[4] The quality-adjusted life year or quality-adjusted life-year (QALY) is a measure of disease burden. It is used in economic evaluation to assess the value for money of medical and psychosocial interventions. More details available from: https://www.nice.org.uk/Glossary?letter=Q
[5] NICE: Health economics: evidence statements and reviews. Available from: https://www.nice.org.uk/guidance/cg43/evidence/full-guideline-section-6-health-economics-evidence-statements-and-reviews-pdf-195027235