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Biomedical subjects

Adam Gilden Tsai

Publications and source records attributed to Adam Gilden Tsai.

12 recordsLinked to original sources
PubMed2006

Insurance coverage for obesity treatment.

Recent work demonstrates the benefits of weight loss from intensive lifestyle modification. One barrier to counseling may be lack of reimbursement. We sought to quantify the obesity coverage policies of insurers in Pennsylvania. A three-page questionnaire was sent to eligible Pennsylvania health plans. Respondents included company medical directors and administrators from other departments, including public relations, provider relations, disease management, and utilization review. The questionnaire inquired about major treatment modalities for obesity, including details of coverage. Sixteen of 19 eligible plans (84%) responded. All plans provided some coverage for bariatric surgery. Nine out of 16 companies (56%) stated that they covered individual dietary counseling, but only five paid for intensive counseling. Less than 50% of plans reimbursed other forms of lifestyle modification or weight loss medication. Surgery was covered significantly more often than all other treatment modalities (P<0.02 for all comparisons). No differences in reimbursement were found by plan type or by number of enrollees. Insurance reimbursement for obesity in Pennsylvania does not consistently reflect recent evidence for the benefits of lifestyle modification. Given the increasing evidence for the clinical and cost-effectiveness of nonsurgical weight loss therapy, coverage policies may begin to change.

Bariatric Surgery↗
PubMed2006

The evolution of very-low-calorie diets: an update and meta-analysis.

OBJECTIVE: Very-low-calorie diets (VLCDs), providing <800 kcal/d, have been used since the 1970s to induce rapid weight loss. Previous reviews of the literature have disagreed concerning the relative efficacy of VLCDs vs. conventional low-calorie diets (LCDs) for achieving long-term weight loss. RESEARCH METHODS AND PROCEDURES: We sought to update findings on the clinical use, safety, and efficacy of VLCDs and to perform a meta-analysis of randomized trials that compared the long-term efficacy of LCDs and VLCDs. Original research articles were retrieved by a Medline search and from prior reviews of VLCDs. Trials were included only if they were randomized comparisons of LCDs and VLCDs and included a follow-up assessment at least 1 year after maximum weight loss. Data were abstracted by both authors regarding: duration of VLCD, total length of treatment, attrition, short- and long-term weight loss, changes in weight-related comorbidities, and adverse effects. RESULTS: Six randomized trials were found that met inclusion criteria. VLCDs, compared with LCDs, induced significantly greater short-term weight losses (16.1 +/- 1.6% vs. 9.7 +/- 2.4% of initial weight, respectively; p = 0.0001) but similar long-term losses (6.3 +/- 3.2% vs. 5.0 +/- 4.0%, respectively; p > 0.2). Attrition was similar with VLCD and LCD regimens. DISCUSSION: VLCDs did not produce greater long-term weight losses than LCDs. In the United States, the use of liquid meal replacements as part of a 1000 to 1500 kcal/d diet may provide an effective and less expensive alternative to VLCDs. In Europe, VLCDs are used with less intensive medical supervision than in the United States, which reduces the cost of this approach.

Caloric Restriction↗
PubMed2005

Systematic review: an evaluation of major commercial weight loss programs in the United States.

BACKGROUND: Each year millions of Americans enroll in commercial and self-help weight loss programs. Health care providers and their obese patients know little about these programs because of the absence of systematic reviews. PURPOSE: To describe the components, costs, and efficacy of the major commercial and organized self-help weight loss programs in the United States that provide structured in-person or online counseling. DATA SOURCES: Review of company Web sites, telephone discussion with company representatives, and search of the MEDLINE database. STUDY SELECTION: Randomized trials at least 12 weeks in duration that enrolled only adults and assessed interventions as they are usually provided to the public, or case series that met these criteria, stated the number of enrollees, and included a follow-up evaluation that lasted 1 year or longer. DATA EXTRACTION: Data were extracted on study design, attrition, weight loss, duration of follow-up, and maintenance of weight loss. DATA SYNTHESIS: We found studies of eDiets.com, Health Management Resources, Take Off Pounds Sensibly, OPTIFAST, and Weight Watchers. Of 3 randomized, controlled trials of Weight Watchers, the largest reported a loss of 3.2% of initial weight at 2 years. One randomized trial and several case series of medically supervised very-low-calorie diet programs found that patients who completed treatment lost approximately 15% to 25% of initial weight. These programs were associated with high costs, high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years. Commercial interventions available over the Internet and organized self-help programs produced minimal weight loss. LIMITATIONS: Because many studies did not control for high attrition rates, the reported results are probably a best-case scenario. CONCLUSIONS: With the exception of 1 trial of Weight Watchers, the evidence to support the use of the major commercial and self-help weight loss programs is suboptimal. Controlled trials are needed to assess the efficacy and cost-effectiveness of these interventions.

Commerce↗
PubMed2005

Cost-effectiveness of a low-carbohydrate diet and a standard diet in severe obesity.

OBJECTIVE: Low-carbohydrate diets have become a popular alternative to standard diets for weight loss. Our aim was to compare the cost-effectiveness of these two diets. RESEARCH METHODS AND PROCEDURES: The patient population included 129 severely obese subjects (BMI = 42.9) from a randomized trial; participants had a high prevalence of diabetes or metabolic syndrome. We compared within-trial costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (CER) for the two study groups. We imputed missing values for QALYs. The CER was bootstrapped to derive 95% confidence intervals and to define acceptability cut-offs. We took a societal perspective for our analysis. RESULTS: Total costs during the one year of the trial were 6742 dollars +/- 6675 and 6249 dollars +/- 5100 for the low-carbohydrate and standard groups, respectively (p = 0.78). Participants experienced 0.64 +/- 0.02 and 0.61 +/- 0.02 QALYs during the one year of the study, respectively (p = 0.17 for difference). The point estimate of the incremental CER was -1225 dollars/QALY (i.e., the low-carbohydrate diet dominated the standard diet). However, in the bootstrap analysis, the wide spread of CERs caused the 95% confidence interval to be undefined. The probabilities that the low-carbohydrate diet was acceptable, using cut-offs of 50,000 dollars/QALY, 100,000 dollars/QALY, and 150,000 dollars/QALY, were 72.4% 78.6%, and 79.8%, respectively. DISCUSSION: The low-carbohydrate diet was not more cost-effective for weight loss than the standard diet in the patient population studied. Larger studies are needed to better assess the cost-effectiveness of dietary therapies for weight loss.

Adult↗
PubMed2005

Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study.

OBJECTIVES: The American College of Rheumatology (ACR) Guidelines for the medical management of osteoarthritis (OA) emphasize the use of nonpharmacologic interventions including exercise. Implementation of an exercise program can be difficult for patients, and little is known about the benefits of alternative therapies such as yoga. The aim of this pilot study was to assess the feasibility of using yoga in the tradition of B.K.S. Iyengar to treat the symptoms of osteoarthritis of the knee. DESIGN: Participants were instructed in modified Iyengar yoga postures during 90-minute classes once weekly for 8 weeks. SUBJECTS: Participants met ACR criteria for osteoarthritis of the knee and completed a medical history and physical examination, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Arthritis Impact Measurement Scale 2 (AIMS2), Patient Global Assessment (GA) by Visual Analog Scale (VAS), Physician GA by VAS, and 50-foot Walk Time before and following an 8-week course of yoga instruction. Eleven (11) subjects enrolled, nine completed at least one session and seven (six of whom were obese) had data from pre- and post-course time points available for analysis. RESULTS: Statistically significant reductions in WOMAC Pain, WOMAC Physical Function, and AIMS2 Affect were observed when participants' status were compared to their pre-course status. WOMAC Stiffness, AIMS2 Symptoms, Social and Role, Physician GA, and Patient GA measured trends in improvement of symptoms. No adverse events from treatment were reported. CONCLUSIONS: This pilot study suggests that yoga may provide a feasible treatment option for previously yoga-naive, obese patients >50 years of age and offers potential reductions in pain and disability caused by knee OA. Future studies should compare yoga to other nonpharmacologic interventions for knee OA, such as patient education or quadriceps-strengthening exercises.

Aged↗
PubMed2003

Availability of nutrition services for Medicaid recipients in the northeastern United States: lack of uniformity and the positive effect of managed care.

OBJECTIVES: To evaluate third-party coverage of medical nutrition therapy for the Medicaid population, among whom obesity is a common health problem, and to compare coverage in managed care Medicaid programs with that in fee-for-service state Medicaid programs. METHODS: Fifty-four Medicaid organizations in 14 states were surveyed by telephone and asked about their provision of nutrition counseling to members. RESULTS: Overall, similar percentages of state Medicaid programs and Medicaid managed care organizations (MCOs) reimbursed for nutrition counseling; significantly more Medicaid MCOs reimbursed for this service for treatment of obesity alone. Analysis of Medicaid MCO responses by plan size failed to show a difference in the nutrition services offered. CONCLUSIONS AND RECOMMENDATIONS: Nutritionist consultation, an inexpensive and effective intervention for treatment of obesity, is not uniformly available to Medicaid patients. The inclusion of managed care in Medicaid has increased access to this service in the northeastern United States. We propose that all Medicaid recipients should have access to visits with a registered dietician or certified nutritionist either as part of a defined benefit structure or through a disease management program for obesity.

Capitation Fee↗