Specialist Weight Management Service Research Articles

Tier 3 specialist weight management service and pre-bariatric multicomponent weight management programmes for adults with obesity living in the UK: A systematic review.

SummaryBackgroundNHS England has recommended a multidisciplinary weight management services (MWMS—Tier 3 services) for patients requiring specialized management of obesity, including bariatric surgery, but clinical and measurable health‐related outcomes from these services remains fragmented. We therefore undertook a systematic review to explore the evidence base of effect on body weight loss and comorbidities outcomes of Tier 3 or UK pre‐bariatric MWMPs.MethodsAMED, CINAHL, EMBASE, HMIC, MEDLINE, PsycINFO, PubMed, HDAS search and Google Scholar were searched from January 2000 to September 2017 in a free‐text fashion and crossed‐references of included studies to identify potential illegibility. Inclusion criteria were as follows: (a) published Tier 3 original study abstracts/articles; (b) intervention studies with before and after data; (c) studies that included any sort of MWMPs conducted on British residents with obesity; and (d) studies included T2DM measurements in a MWMPs.ResultsIn total, 19 studies met the inclusion criteria. The total number of participants analysed was N = 11,735. Baseline accumulative average BMI was calculated at 42.54 kg/m2, weight 117.88 kg and waist circumference 126.9 cm. And at 6 months, 40.73 kg/m2, 112.17 kg and 120.3 cm, respectively. Secondary outcome variables were as improved with reduction in HbA1c, fasting blood sugars, insulin usage and blood pressure. Physical activity increased at 3 months then declined after 6 months with no significant changes in cholesterol levels.ConclusionTier 3 and MWMPs have a short to mid‐ranged positive effect on obese patients (BMI ≥30 kg/m2) living in the UK regarding accumulated reduction in weight, glycaemic control, blood pressure and with subtle improvements in physical activity.

Beyond lifestyle interventions: exploring the potential of anti-obesity medications in the UK.

SummaryIn the UK, over one‐quarter of the adult population have obesity (body mass index ≥30 kg m−2). This has major implications for patients’ health and the National Health Service. Despite published studies showing that significant weight loss can be achieved and maintained in primary care, and guidance from the National Institute for Health and Care Excellence, weight management services are inconsistently implemented. This may be due primarily to workload and financial constraints. There is also a lack of belief that specialist weight management services and anti‐obesity medications (AOMs) are a viable alternative to bariatric surgery for long‐term maintenance of weight loss. This article discusses the challenges facing obesity management and explores the reasons for the lack of investment in AOMs in the UK to date. The aim of this article is to identify whether the newer AOMs, such as naltrexone/bupropion and liraglutide 3.0 mg, are likely to perform better in a real‐world setting than current or withdrawn AOMs. In addition, it considers whether the equitable provision of specialist weight management services and future clinical trial design could be improved to help identify those individuals most likely to benefit from AOMs and, thus, improve outcomes for people with obesity in the UK.

The impact of a specialist weight management service on symptoms of depression: a retrospective service evaluation project

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Exploring the evidence base for Tier 3 specialist weight management interventions for children aged 2-18 years in the UK: a rapid systematic review.

The impact of specialist weight management services (Tier 3) for children with severe and complex obesity in the UK is unclear. This review aims to examine the impact of child Tier 3 services in the UK, exploring service characteristics and implications for practice. Rapid systematic review of any study examining specialist weight management interventions in any UK setting including children (2-18 years) with a body mass index >99.6th centile or >98th centile with comorbidity. Twelve studies (five RCTs and seven uncontrolled) were included in a variety of settings. Study quality was moderate or low and mean baseline body mass index z-score ranged from 2.7 to 3.6 units. Study samples were small and children were predominantly older (10-14 years), female and white. Multidisciplinary team composition and eligibility criteria varied; dropout ranged from 5 to 43%. Improvements in zBMI over 1-24 months ranged from -0.13 to -0.41 units. Specialist weight management interventions for children with severe obesity demonstrated a reduction in zBMI, across a variety of UK settings. Studies were heterogeneous in content and thus conclusions on service design cannot be drawn. There is a paucity of evidence for Tier 3 services for children, and further research is required.

The association between musculoskeletal pain and weight change in patients attending a specialist weight management service

The association between musculoskeletal pain and weight change in patients attending a specialist weight management service

Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study

ObjectiveTo determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS).DesignCross-sectional study.SettingRegional specialist WMS located in the West...

Commissioning guidance for weight assessment and management in adults and children with severe complex obesity.

The challenge of managing the epidemic of patients with severe and complex obesity disease in secondary care is largely unmet. In England, the National Institute of Health and Care Excellence and the National Health Service England have published guidance on the provision of specialist (non-surgical) weight management services. We have undertaken a systematic review of 'what evidence exists for what should happen in/commissioning of: primary or secondary care weight assessment and management clinics in patients needing specialist care for severe and complex obesity?' using an accredited methodology to produce a model for organization of multidisciplinary team clinics that could be developed in every healthcare system, as an update to a previous review. Additions to the previous guidance were multidisciplinary team pathways for children/adolescent patients and their transition to adult care, anaesthetic assessment and recommendations for ongoing shared care with general practitioners, as a chronic disease management pathway.

Exploring the evidence base for Tier 3 weight management interventions for adults: a systematic review.

Specialist weight management services provide a treatment option for severe obesity. The objective of the study is to review the characteristics, impact and practice implications of specialist weight management services for adults in the UK. Systematic review: EMBASE, MEDLINE and PsycINFO were searched from January 2005 to March 2016 with supplementary searches. Adults with a body mass index of ≥40 kg m-2 , or ≥35 kg m-2 with comorbidity or ≥30 kg m-2 with type 2 diabetes and any study of multicomponent interventions, in any UK or Ireland setting, delivered by a specialist multidisciplinary team are the inclusion criteria. Fourteen studies in a variety of settings were included: 1 randomized controlled trial, 3 controlled and 10 observational studies. Mean baseline body mass index and age ranged from 40 to 54 kg m-2 and from 40 to 58 years. The studies were heterogeneous making comparisons of service characteristics difficult. Multidisciplinary team composition and eligibility criteria varied; dropout rates were high (43-62%). Statistically significant reduction in mean body mass index over time ranged from -1.4 to -3.1 kg m-2 and mean weight changes ranged from -2.2 to -12.4 kg. Completers achieving at least 5% reduction of initial body weight ranged from 32 to 51%. There was evidence for improved outcomes in diabetics. Specialist weight management services can demonstrate clinically significant weight loss and have an important role in supporting adults to manage severe and often complex forms of obesity. This review highlights important variations in provision and strongly indicates the need for further research into effective approaches to support severely obese adults.

The association between baseline persistent pain and weight change in patients attending a specialist weight management service.

ObjectiveTo quantify the influence of baseline pain levels on weight change at one-year follow-up in patients attending a National Health Service specialist weight management programme.MethodsWe compared one-year follow-up weight (body mass) change between patient sub-groups of none-to-mild, moderate, and severe pain at baseline. A mean sub-group difference in weight change of ≥5kg was considered clinically relevant.ResultsOf the 141 complete cases, n = 43 (30.5%) reported none-to-mild pain, n = 44 (31.2%) reported moderate pain, and n = 54 (38.3%) reported severe pain. Covariate-adjusted mean weight loss (95%CI) was similar for those with none-to-mild (8.1kg (4.2 to 12.0kg)) and moderate pain (8.3kg (4.9 to 11.7kg). The mean weight loss of 3.0kg (-0.4 to 6.4kg) for the severe pain group was 5.1kg (-0.6 to 10.7, p = 0.08) lower than the none-to-mild pain group and 5.3kg (0.4 to 10.2kg, p = 0.03) lower than the moderate pain group.ConclusionsPatients with severe pain upon entry to a specialist weight management service in England achieve a smaller mean weight loss at one-year follow-up than those with none-to-moderate pain. The magnitude of the difference in mean weight loss was clinically relevant, highlighting the importance of addressing severe persistent pain in obese patients undertaking weight management programmes.

Comparison of glycated haemoglobin and fasting blood glucose in the diagnosis of diabetes mellitus and pre-diabetes in a cohort of obese patients

Diabetes mellitus (DM) has historically been diagnosed by measurement of blood glucose concentrations. More recently, the use of glycated haemoglobin (HbA1c) has been advocated in the diagnosis of diabetes, complementing its existing role in the monitoring of glycaemic control. A recent study has shown that obesity is an important problem in the UK Armed Forces. Obese patients are at increased risk of diabetes and intermediate hyperglycaemia (pre-diabetes). It is unclear whether the application of diagnostic criteria based on HbA1c would produce different categorisation of obese patients compared with standard glucose-based criteria. In the current study, we compared HbA1c with fasting plasma glucose in the diagnosis of type 2 diabetes and intermediate hyperglycaemia in a cohort of obese patients. Patients were recruited from the NHS Tayside Specialist Weight Management Service. They were classified into three categories (normoglycaemia, pre-diabetes, and diabetes) according to their fasting plasma glucose (FPG) and HbA1c. The diagnostic criteria of three organisations were applied: the World Health Organisation (WHO); the American Diabetes Association (ADA); and the International Expert Committee (IEC). Glucose, insulin, cholesterol, triglycerides, uric acid, liver function tests and sex hormone-binding globulin (SHBG) were measured. By WHO (fasting glucose) criteria, 102 subjects were classified as normal, 13 as having impaired fasting glycaemia (IFG) and 5 as having diabetes mellitus (DM). By IEC (HbA1c) criteria, 89 subjects were classified as normal, 21 as pre-diabetes and 7 as DM. By ADA (HbA1c) criteria, 69 subjects were classified as normal, 41 as pre-diabetes and 7 as DM. Alkaline phosphatase was significantly higher in hyperglycaemic states compared with normal subjects, with ANOVA F statistics of 9.45 for WHO (p < 0.001), 9.24 for IEC (p < 0.001), and 6.87 for ADA (p < 0.01). Although the numbers were small, more obese patients were categorised as hyperglycaemic (pre-diabetes and diabetes) when HbA1c-based criteria were applied, compared with WHO (glucose-based) criteria. Further studies are required to confirm this preliminary observation.

Evaluation of a Tier 3 Specialist Weight Management Service for morbidly obese patients

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PTU-309 Assessing the impact of a specialist dietitian led weight management service in hepatology

<h3>Introduction</h3> In 2013 Health service for England (HSE) reported that 62.1% of adults had a body mass index (BMI) of more than 25 kg/m². Obesity is a risk factor for non-alcoholic fatty liver disease (NAFLD) which is the most common cause of liver disease in the United Kingdom and western countries. Reduction in total body weight (TBW) through diet and lifestyle modification is the mainstay of management for NAFLD. We aimed to assess the impact of an outpatient dietitian led specialist weight (wt) management (mgt) service offered exclusively to patients (pts) known to hepatology services on changes in wt observed. Secondary outcomes assessed included reasons for referral to the service, the demographics of pts, adherence to follow up (FU) through the service and whether any wt loss was maintained 6 months post discharge (d/c) from the service. <h3>Method</h3> Information was analysed from a database created and maintained by dietitians. Data was collected on all pts accessing the service for 33 months between 2012–2014. <h3>Results</h3> In 33 months, 72% (204/284) of pts referred to the service attended for assessment (axe) (144/204 (71%) males (M); 60/204 (29%) females (F); age range 16–19, median age 43). 116/204 (57%) of pts were Caucasian and 88/204 (43%) of Asian ethnicity. After axe, future FU was optional. FU ranged from 1–12 appointments (apt): 79/204 (39%) attended 1 FU, 39/204 (19%) attended 2 FU, 21/204 (10%) 3 FU, 28/204 (14%) 4 FU apt and 37/204 (18%) attended 5 or more apt. At the end of the study 19/204 (10%) were still receiving care, 60/204 (29%) of pts attended all arranged FU, 104/204 (51%) of pts were d/c due non-attendance; 15/204 (7%) self d/c, 6/204 (3%) were lost to FU. 113/204 (55%) had more than 1 FU apt and wt changes were recorded in this cohort. FU time ranged from 4–107 weeks. In total 88/113 (78%) lost weight (59M, 29F), of these 35/88 (40%) of pts lost more than 5% of their TBW. Wt loss ranged from 0.3–30.4 kg; average wt loss: 4.1 kg per pt. No pts in this cohort received wt mx surgery. Long term data was available for 33 pts 6/12 after d/c from the service; 16/33 (48%) had regained wt, 4/33 (12%) had remained stable (defined as less than 0.5 kg increase or decrease in wt) and 13/33 (40%) had continued to lose wt. <h3>Conclusion</h3> Even though a significant number of patients failed to engage with service, wt loss results observed in pts adhering to FU and attending more than 1 apt with the dietitian led service were very encouraging. Poor engagement may be due to a lack of motivation, poor education on the role of the dietitian or pts failure to take ownership of their medical problems. Once d/c from the service, 48% of patients regained weight suggesting that motivation to continue to modify lifestyle and diet is poor once the period of active FU has ended. <h3>Disclosure of interest</h3> None Declared.

Description and preliminary results from a structured specialist behavioural weight management group intervention: Specialist Lifestyle Management (SLiM) programme

BackgroundSpecialist Lifestyle Management (SLiM) is a structured patient education and self-management group weight management programme. Each session is run monthly over a 6-month period providing a less intensive long-term approach....

Quality of life and mental health in extreme obesity. A study of individuals attending a Specialist Weight Management Service

Quality of life and mental health in extreme obesity. A study of individuals attending a Specialist Weight Management Service

Weight management during and after pregnancy: A multi-disciplinary approach.

The Specialist Weight Management Service (SWMS) Maternity Pathway was launched in January 2012 as a result of growing public health issues surrounding obesity and the production of NICE Guidelines for weight management before, during and after pregnancy (PH27). Our unique NHS service is aimed at pregnant women with a BMI>35 and supports them with introducing healthy lifestyle changes during pregnancy and safely minimising weight gain in this period. We also actively encourage service users to re-engage with the integrated SWMS pathway for up to 18months post-partum. The majority of referrals are received directly from midwives, and women can also self-refer. Pregnant women who come to our service are seen in multi-disciplinary clinics by a Dietitian, Physiotherapist and Health-Improvement Midwife. The service-users can also access Occupational Therapists, Medical Consultants and Health Trainers if required. Our staff use a patient-centred behavior change approach, often adopting motivational interviewing techniques to help engage patients with implementing positive lifestyle changes. The pathway also helps expectant mothers and their wider families access other services including smoking cessation, breastfeeding networks and healthy-start services to name a few. Plans are in place to launch an outreach service to the more deprived areas of the Borough, where drop-in sessions will be held at accessible locations to improve engagement of pregnant women in these areas. We believe that this multi-disciplinary approach to weight management is unique, and early statistics indicate that the support we offer pregnant women during the ante and post natal period are a success in terms of key outcome measures.

The association between adiposity, mental well-being, and quality of life in extreme obesity.

ObjectivesTo explore the cross-sectional association between adiposity, mental well-being, and quality of life in extreme obese individuals entering a UK specialist weight management service prior to treatment commencement.MethodsThe sample comprised 263 extreme obese individuals who were referred to the service as a result of having a body mass index (BMI) ≥40 kg/m2 or ≥35 kg/m2 with a co-morbid health condition. In a retrospective analysis, routinely collected baseline clinical examination data and self-report questionnaires (Impact of Weight on Quality of Life: IWQOL-Lite, EQ5D-3L, and Hospital Anxiety and Depression Scale: HADS) were analysed to examine the cross-sectional association between adiposity and quality of life.ResultsThe sample was predominantly female (74.8%) with mean BMI 47.0±7.9 kg/m2. Increasing adiposity was significantly negatively associated with quality of life, with an increase of 1 BMI unit associated with decreases of 1.93 in physical function (95% CI −2.86 − −1.00, p<0.001), 1.62 in self-esteem (95% CI −2.67 − −0.57, p<0.05), 2.69 in public distress (95% CI −3.75 − −1.62, p<0.001), 1.33 in work (95% CI −2.63 − −0.02, p<0.05), and 1.79 in total IWQOL-Lite scores (95% CI −2.65 − −0.93, p<0.001). Adiposity was associated with significantly increased risk of problems in mobility (OR = 3.44, 95% CI 1.47−8.05), and performing usual activities (OR = 2.45, 95% CI 1.10−5.46) in highest relative to lowest BMI tertile. The prevalence of experience of symptoms of anxiety (70.3%) and depression (66.2%) as measured by HADS was consistently high.ConclusionsWe identified a high prevalence of psychological co-morbidity, including widespread experience of symptoms of anxiety and depressive disorders and reduced quality of life among these extreme obese individuals seeking weight management treatment. Clinical implications include the need for the incorporation of strategies to improve mental well-being into multi-disciplinary weight management interventions.

The characteristics of a patient population with extreme and complex obesity attending a specialist weight management service

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The Prevalence and Severity of Obstructive Sleep Apnea in Severe Obesity: The Impact of Ethnicity

The South Asian population is at increased risk of cardiovascular disease. We compared the prevalence and severity of obstructive sleep apnea (OSA) in South Asians and white Europeans with severe obesity. Data from consecutive patients attending a specialist weight management service were analyzed. Self-reported age, gender, and ethnicity were recorded. Objective measurements of blood pressure, body mass index (BMI), and apneahypopnea index (AHI) were also acquired. A total of 308 patients (72.7% women; 13% South Asian) were included, with mean age and BMI of 46 ± 12 y and 49 ± 8 kg/m2, respectively. South Asians had significantly increased prevalence of OSA compared to white Europeans (85% vs. 66% [p = 0.017]) and were more likely to have severe OSA (42.5% vs. 21.6% [p = 0.015]). South Asians had significantly higher median AHI (24 events/h: interquartile range [IQR] 9.3-57.6 vs. 9 events/h: IQR 3.4-26.6; p < 0.01), significantly lower minimum oxygen saturation (76%: IQR 64% to 84% vs. 83%: IQR 77% to 87%; p < 0.01), and spent a significantly greater amount of time < 90% oxygen saturation (8.4%: IQR 1.0% to 24.3% vs. 2.4%: IQR 0.2% to 16.0%; p = 0.03). South Asian ethnicity, independent of demographics, BMI, and comorbidities, was associated with β = 1.84 (95% CI: 1.27-2.65) increase in AHI+1 compared to white Europeans. Furthermore, we confirmed other independent OSA risk factors including increasing age, BMI, and male gender (all p < 0.001). Severely obese South Asians had significantly greater prevalence and severity of OSA than white Europeans. OSA may contribute to increased cardiovascular risk in South Asians compared to white Europeans with severe obesity. Mechanisms mediating the observed associations between these ethnicities require further investigation.

PP63 The Role of Ethnicity Concerning the Prevalence and Severity of Obstructive Sleep Apnoea in Severely Obese Patients

BackgroundThe South Asian population is at increased risk of cardiovascular disease. South Asians residing in western countries also have increased risk of obesity and associated comborbidities compared to white European...

Managing blame in NHS weight management treatment: Psychologizing weight and ‘obesity’

AbstractWeight management services in the UK's National Health Service (NHS) are on the increase, partly due to rising rates of patients classified as ‘obese’. Those attending such services are held accountable, on some level, for their weight, although this issue is rarely addressed in clinical research in this area. By contrast, critical social research on ‘obesity’ considers blame a prominent issue though has yet to examine this in situ, in interactions between patients and health professionals. This paper uses discursive psychology to examine how blame is managed in the turn‐by‐turn interaction in group meetings within NHS weight management treatment. The data corpus comprises of digital audio recordings of 27 discussion‐based group meetings between patients and practitioners in a specialist weight‐management service in central Scotland. The analysis focuses on those moments in which patients appear to resist the notion that they are responsible for their weight gain. Such moments are typically managed by patients in one of two ways: By denying having performed the blameworthy activity, or locating the blame as outside of individual control. Both strategies, however, rely on an individualistic concept of weight that reifies the medical model, while at the same time, troubling that model and its efficacy. The paper concludes with a consideration of the implications of these discursive practices and their relevance within the field. Copyright © 2009 John Wiley &amp; Sons, Ltd.