The model (Figure 1 ) was used to capture the complex nature of obesity and its associated comorbidities over time. Patients could occupy a diabetes health state (either with T2DM, without T2DM or in T2DM remission), and transition between T2DM and remission on an ongoing basis. Patients could simultaneously occupy and transition between mutually exclusive health states (stroke, myocardial infarction [MI], cancer) as they progressed through the model. Prior to entering the Markov model structure, complication, reoperation and 30-day mortality rates due to surgery were allocated to the BMS cohort alongside associated costs and utilities. BMS and conventional treatment led to changes in BMI, blood pressure (BP), lipid ratio (LR) and rate of T2DM remission accordingly. BMI affected the probability of transitioning to T2DM. Age, sex, BP, LR and T2DM status affected the risk of stroke and MI, based on Framingham risk equations.[20] Patients could also experience knee pain and sleep apnea.

Model structure. Abbreviations: MI: myocardial infarction; T2DM: type 2 diabetes mellitus.

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