Specialist Weight Management Service Research Articles

Liraglutide 3.0 mg in the treatment of adults with obesity and prediabetes using real-world UK data: A clinical evaluation of a multi-ethnic population.

UK guidelines recommend liraglutide 3.0 mg in adults treated within specialist weight management services with BMI ≥35 kg/m2, prediabetes and high cardiovascular disease risk. We aimed to clinically evaluate liraglutide 3.0 mg in specialist weight management services. We evaluated liraglutide 3.0 mg in weight management services at Guys and St Thomas' NHS Foundation Trust. Objective body weight (BW) was measured at baseline and 4 months, allowing classification as 'responders' (≥5% BW reduction) and 'non-responders' (<5% BW reduction). One hundred and twenty-one patients were evaluated. At 4 months, 76.0% attended follow-up (82.6% responders, 17.4% non-responders); BW (-8.6 kg, 95%CI:-9.8, -7.4 kg), BMI (-3.2 kg/m2, 95%CI: -3.6, -2.8) and %-BW (-6.6%, IQR: -8.8%, -5.2%) significantly reduced. In responders, HbA1c reduced by -5.0 mmol/mol (IQR: -7.0. -4.0 mmol/mol). In responders BW continued to reduce up to 12 months (4 m: -10.2 kg, p < .0001; 6 m: -15.6 kg, p < .0001; 9 m: -16.5 kg, p < .0001; 12 m: -16.7 kg, p < .01). Those of Black African and Caribbean ethnicity experienced less BW loss than those of white ethnicity (4.12 kg, p = .017) and had a greater attrition rate. In adults with obesity and prediabetes who are treated within specialist weight management services, liraglutide 3.0 mg reduces BW and HbA1c. Those of Black African and Caribbean ethnicity experienced less BW reduction and greater attrition at 4 months. Further evaluation of the ethnic differences in response to obesity pharmacotherapy is required.

Effectiveness of integrating a pragmatic pathway for prescribing liraglutide 3.0 mg in weight management services (STRIVE study): a multicentre, open-label, parallel-group, randomized controlled trial

An effective prescribing pathway for liraglutide 3mg, an approved obesity pharmacotherapy, may improve treatment access. This trial compared a targeted prescribing pathway for liraglutide 3mg with multiple stopping rules in specialist weight management services (SWMS) to standard SWMS care. This phase four, two-year, multicentre, open-label, parallel-group, real-world randomized clinical trial (ClinicalTrials.gov: NCT03036800) enrolled adults with BMI ≥35kg/m2 plus prediabetes, type 2 diabetes, hypertension or sleep apnoea from five SWMS in Ireland and UK. Participants were randomly allocated (2:1, stratified by centre and BMI) to SWMS care plus a targeted prescribing pathway for once daily subcutaneous liraglutide 3mg (intervention) with stopping rules at 16 (≥5% weight loss, WL), 32 (≥10% WL) and 52 weeks (≥15% WL) or to SWMS care alone (control) through an online randomization service. The primary outcome was WL≥15% at 52 weeks, assessed by complete cases analysis. All randomized participants were included in safety analysis. From November 28, 2017 to February 28, 2020, 434 participants were screened, and 392 randomized (260 intervention; 132 control), while 294 (201 intervention; 93 control) included in the 52 weeks complete case analysis. More intervention than control participants achieved WL≥15% at 52 weeks [51/201 (25.4%) vs 6/93 (6.5%); odds ratio 5.18; 95% CI 2.09, 12.88; p<0.0001]. More adverse events occurred in the intervention (238/260, 91.5%; two deaths) than control (89/132, 67.4%; no deaths) group. A targeted prescribing pathway for liraglutide 3mg helps more people achieve ≥15% WL at 52 weeks than standard care alone. Novo Nordisk A/S.

Predictors of weight loss in a Secondary Care Tier 3 Specialist Weight Management Service Following Modifications due to the COVID-19 Pandemic

Predictors of weight loss in a Secondary Care Tier 3 Specialist Weight Management Service Following Modifications due to the COVID-19 Pandemic

Predictors of weight loss in a secondary care tier 3 specialist weight management service

Predictors of weight loss in a secondary care tier 3 specialist weight management service

The Potential of a Digital Weight Management Program to Support Specialist Weight Management Services in the UK National Health Service: Retrospective Analysis.

Digital weight management interventions (DWMIs) have the potential to support existing specialist weight management services (SWMS) in the National Health Service (NHS) to increase access to treatment for people living with obesity and type 2 diabetes. At present, there is limited real-world evidence and long-term outcomes on the potential effectiveness of DWMIs to support such services. This study aimed to examine real-world data to evaluate the impact of Second Nature's 12-month DWMI for patients living with obesity with or without type 2 diabetes, referred from NHS primary care services, on sustained weight loss over a 2-year period. Retrospective data were extracted in August 2023 for participants who participated in the program between January 1, 2017, and January 8, 2021. Eligible participants were adults with a BMI ≥35 kg/m2, with or without type 2 diabetes. The primary outcomes were weight change in kilograms and percentage weight change at 2 years. Secondary outcomes were weight loss at 1 year, program engagement, and the proportion of participants who achieved >5% and >10% weight loss. Differences in weight loss between baseline and the 1- and 2-year follow-up points were compared using paired 2-tailed t tests. Linear regression models were used to examine whether participants' ethnicity, indices of multiple deprivation, presence of type 2 diabetes, or program engagement were associated with weight loss at 1 year or 2 years. A total of 1130 participants with a mean baseline BMI of 46.3 (SD 31.6) kg/m2 were included in the analysis. Of these participants, 65% (740/1130) were female (mean age 49.9, SD 12.0 years), 18.1% (205/339) were from Black, Asian, mixed, or other ethnicities, and 78.2% (884/1130) had type 2 diabetes. A total of 281 (24.9%) participants recorded weight readings at 2 years from baseline, with a mean weight loss of 13.8 kg (SD 14.2 kg; P<.001) or 11.8% (SD 10.9%; P<.001). A total of 204 (18.1%) participants achieved ≥5% weight loss, and 130 (11.5%) participants reached ≥10% weight loss. Weight loss did not significantly differ by ethnicity, indices of multiple deprivation, presence of type 2 diabetes, or engagement in the program. The findings suggested that Second Nature's DWMI has the potential to support people living with obesity and type 2 diabetes remotely to achieve clinically significant and sustained weight loss at 2 years from baseline. Further research is needed to compare the intervention to standard care and assess integration with multidisciplinary clinical teams and pharmacotherapy in order to support this study's findings.

A Qualitative Exploration of Patient and Staff Experiences of the Receipt and Delivery of Specialist Weight Management Services in the UK.

Addressing the increasing prevalence of obesity is a global public health priority. Severe obesity (body mass index >40) reduces life expectancy, due to its association with people developing complications (e.g. diabetes, cancer, cardiovascular disease), and greatly impairs quality of life. The National Health Service (NHS) in the UK provides specialist weight management services (SWMS) for people with severe obesity, but key uncertainties remain around patient access to and engagement with weight management services, as well as pathways beyond the service. In this multiple methods study, using online forum data and semi-structured interviews, stakeholders' experiences of delivering and receiving SWMS were explored. Using the web search engine Google with keywords and web address (URL) identifiers, relevant public online platforms were sourced with snowball sampling and search strings used to identify threads related to people's experiences of accessing SWMS (n = 57). Interviews were conducted with 24 participants (nine patients, 15 staff), and data from all sources were analysed thematically using the framework approach. Six themes related to access to and engagement with SWMS emerged during data analysis: (1) making the first move, (2) uncertainty and confusion, (3) resource issues, (4) respect and understanding, (5) mode of delivery, and (6) desire for ongoing support. There is a mixed and varied picture of SWMS provision across the UK. The service offered is based on local clinical decision making and available resources, resulting in a range of patient experiences and perspectives. Whilst service capacity issues and patient anxiety were seen as barriers to accessing care, peer support and positive clinical and group interactions (connectedness between individuals) were considered to increase engagement.

Specialist Weight Management Service: COVID19 did not break our spirit

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

Implementation of a Digital Health Tool for Patients Awaiting Input From a Specialist Weight Management Team: Observational Study.

Digital tools are increasingly used on a population level as a weight loss strategy for people living with overweight and obesity. Evidence supports the feasibility of digital tools for the management of obesity in a community setting, but there is only emerging evidence for the feasibility of such tools in specialist weight management services. No study has assessed the uptake of digital tools among patients awaiting their first appointment with a specialist weight management service. The objective of this study was to understand interest, acceptance, and engagement with a digital behavioral change platform to support specialist weight management. This was an observational study registered as a service innovation. All patients on the waiting list for a first appointment in the tier 3 weight management service at University Hospitals Coventry and Warwickshire National Health Service (NHS) Trust were eligible to access the NHS-approved digital tool. Data on interest and engagement with the digital tool were collected. Routine clinical data were used to describe patient demographics. Focus groups were held to explore patients' views on the use of digital tools as part of a specialist weight management service. A total of 199 patients on the waiting list were informed about the available digital tool. Just over a half (n=102, 51.3%) of patients were interested in using the app, with over one-third (n=68, 34%) of all patients engaging with the app. Overall, a third of patients on the waiting list (n=63, 32%) did not respond to the invite and 34 (17%) of patients expressed no interest in the app. Emotional eating and higher BMI was associated with interest in the Gro Health app. Male gender was associated with reduced engagement with the app. There were no differences in interest in the Gro Health app according to age, ethnicity, metabolic measures of glycemia, and lipid profile. It is feasible to offer digital tools such as Gro Health to patients awaiting their first appointment with specialist weight management services. Future research should explore barriers and facilitators of engagement with digital tools. Additionally, there is a need to further evaluate the effectiveness of such tools in specialist weight management services.

Health-related outcomes in patients enrolled on surgical and non-surgical routes in a weight management service.

Background and AimsThis study evaluates a specialist weight management service and compares outcomes in participants referred to the service undergoing either surgery or non‐surgical routes to support weight loss.MethodsFour hundred and forty eight participants were assessed on various weight‐related outcomes (body mass index [BMI], psychological distress, quality of life, nutrition, weight‐related symptoms, physical activity) on referral to the service and on discharge. The effect of group (surgery or non‐surgery) and time in the service were facilitated by doubly multivariate analyses of variance models.ResultsBetween referral and discharge, participants improved significantly on a combination of outcomes (P < .001) and on each outcome assessed individually. The magnitude of overall improvement was moderate (partial‐η2 = 0.141). Individual improvement components varied; including a moderate reduction of 3.2% in the BMI outcome measure and a substantive gain of 64.6% in quality of life. Participants on non‐surgical routes performed significantly better than participants on surgical routes on a linear combination of outcomes (P < .001) and on all outcomes except nutrition; with an effect of route small‐to‐moderate in magnitude (partial‐η2 = 0.090).ConclusionsWeight management services are successful in achieving weight management‐related outcomes in the short‐ and long‐term, with large overall improvements between referral and discharge averaged over all participants observed. Non‐surgical routes appear to confer benefits between referral and discharge compared to surgical routes.

Digital group developments in Acute Psychology Services

Dr Rachel Atherton,Consultant Clinical Psychologist Scottish National Residential Pain Management Programme (SNRPMP) &amp;Dr Ross Shearer,Consultant Clinical Psychologist Specialist Weight Management Service (SWMS) both with NHS Greater Glagsow &amp; Clyde share the practical aspects of moving a pain management group online.

Type 2 diabetes is an independent predictor of weight loss in Tier 3 Weight Assessment and Management Services

Introduction: A specialist weight management service provides an effective treatment option for severe obesity; however, there are limited data exploring the baseline predictors of response and effect on HbA1c following engagement with the service.Methods: We used prospective data from the regional weight management services within the Hull University Teaching Hospitals NHS Trust Tier 3 Obesity Programme. Data were available for 249 patients referred to the service. T-tests were used for univariate baseline characteristics of those with and without 5% weight loss after engagement with the service. Logistic regression analysis was used to identify independent predictors of weight loss at 12 months.Results: A total of 309 patients were referred to the Tier 3 adult weight management service, of which 249 (80.6%) participated in the programme and had at least one follow-up. The median age of the study population was 46 years (range 36–55) and consisted of 66% females with a median baseline body mass index of 44 kg/m2 (range 42–45). The prevalence of type 2 diabetes was 31%, hypertension was 35%, gastro-oesophageal reflux disease was 34% and osteoarthritis was 29%. The median baseline weight on enrolment in the programme was 126 kg (range 115–138). During the follow-up period of 1 year, the median weight fell to 120.5 kg at 3 months, 119.6 kg at 6 months, 117.7 kg at 9 months and 117.5 kg at 12 months. The median HbA1c fell from a baseline of 60.25 mmol/mol to 54.4 mmol/mol during the follow-up period. Sixty-four patients had a baseline HbA1c of &gt;53 mmol/mol (7% HbA1c), which fell to &lt;53 mmol/mol in 21% of patients during the follow-up period. In the logistic regression model, higher age (OR 1.05, p=0.0001), type 2 diabetes (OR 2.54, p=0.002) and dyslipidaemia (OR 2.21, p=0.03) were independently associated with more than 5% weight loss at 12 months follow-up.Conclusion: Engagement with Tier 3 adult weight management is associated with significant weight loss and improvement in glycaemic control in a large proportion of patients at one year. Higher age, diabetes and dyslipidaemia at baseline are independent predictors of weight loss on the Tier 3 weight management service.

Effectiveness and cost of integrating a pragmatic pathway for prescribing liraglutide 3.0 mg in obesity services (STRIVE study): study protocol of an open-label, real-world, randomised, controlled trial

IntroductionIn the UK and Ireland, severe and complex obesity is managed in specialist weight management services (SWMS), which provide multicomponent lifestyle interventions to support weight loss, and use of medication...

Patients with morbid obesity should not be routinely screened for Cushing's syndrome: Results of retrospective study of patients attending a specialist weight management service.

Cushing's syndrome (CS) is a rare condition which results in multi-system involvement and can lead to significant morbidity and mortality. Screening for CS in patients with obesity has been suggested to identify undiagnosed or occult cases. This study was performed to determine whether CS screening is indicated in a tier 3 weight management centre in the UK. A retrospective review of all patients referred to the weight management service between 2013 and 2016 inclusive was undertaken. A final cohort of 569 patients was obtained. Clinic letters and laboratory databases were used to obtain demographic information, patient characteristics and biochemical results. A total of 387 patients were screened using the 1 mg overnight dexamethasone suppression test (ODST) and 182 patients were screened with two 24-hour urinary free cortisol (UFC) collections. A total of 27 patients had an initial abnormal result, of which 16 underwent further testing and had normal results. Six were reviewed and did not demonstrate any clinical features of CS. Five did not attend their clinic appointments but there were neither concerning features within their referrals, nor subsequent diagnoses of CS made. No patients from this cohort were diagnosed with CS. This study does not support routine CS screening of patients affected by severe obesity referred to a specialist tier 3 weight management service. Clinical assessment should be undertaken first and further investigations performed only if deemed necessary.

Sensitivity to change of the UK Diabetes and Diet Questionnaire in a specialist weight management service

AbstractThe UK Diabetes and Diet Questionnaire (UKDDQ) is a brief dietary questionnaire developed for people with, or at high risk of, type 2 diabetes(1). It consists of 20 items scored from 0–5 (0 healthiest, 5 least healthy). It has been demonstrated to be reliable and compares well with food diaries. A study evaluating sensitivity to change of the UKDDQ was undertaken at the specialist weight management service (WMS) at Musgrove Park Hospital, Taunton. WMS patients receive an initial appointment with an endocrinologist and dietitian, followed by referral to group sessions or dietary advice. Follow up appointments with a WMS specialist occur over the next 26 weeks. Adults attending the service were recruited for the study between September 2016-March 2017. Participants completed the UKDDQ in the waiting room at the initial appointment and the first follow-up. Diabetes status, binge eating assessment and weight at both timepoints were obtained from WMS records. UKDDQ scores from 0–5 were calculated for each participant by summing the score for each item and dividing by 20. Change in UKDDQ scores and absolute and percentage change in weight between appointments were calculated. Paired sample t-tests were used to test differences in means for UKDDQ scores and weight from baseline to follow up. Multivariable regression analysis was used to examine associations between changes in the UKDDQ scores and percentage change in weight. The model was adjusted for age, gender, follow up time, diabetes status and binge eating. Forty-eight White British participants completed the study (67% women, 37% type 2 diabetes, 29% binge eating). Baseline mean weight was 132.4 (29.4)kg, mean BMI 46.5(7.7)kg/m2 and mean UKDDQ score was 1.39 (0.49). Participants lost weight (-2.4 (6.9)kg, p = 0.006) and the UKDDQ score improved between baseline and follow up (-0.27(0.53), p = 0.001). The mean percentage weight change was -1.6 (5.0)%. There was some evidence that a one point deterioration in healthy eating was associated with a 2.4 (-0.2 to 5.1)% increase in weight (p = 0.072). The UKDDQ can measure dietary change in people attending a specialist WMS and there is some evidence that a change in score is associated with a change in weight. The UKDDQ could be used as an outcome measure in these services.

The Relevant Perspective of Economic Evaluations Informing Local Decision Makers: An Exploration in Weight Loss Services.

Since 2013, obesity services in the UK National Health Service (NHS) have focused on a tiered structure, with tiers 3 (specialist weight management services) and 4 (primarily bariatric surgery) commissioned by Clinical Commissioning Groups (CCGs) and widely reported as cost effective and recommended by national guidelines. However, CCGs have been reluctant to fully conform to the guidance. We explore how the different evaluative perspective of those generating evidence from local decision makers has contributed to this failure of the CCGs to provide services considered cost effective. We explore four elements where the conventional economic evaluation framework, as applied by the National Institute for Health and Care Excellence (NICE), differ from the reality faced by local decision makers: the cost-effectiveness threshold, the implications of decision uncertainty and budgetary excess, the valuation of future costs and outcomes, and the scope of included costs. We argue that the failure of the conventional framework to reflect the reality faced by local decision makers is rendering much of the existing literature and guidance inappropriate to the key commissioners. Our analysis demonstrates that it is not reasonable to assume that the framework of economic evaluation used to inform national guidance applies to local decision makers, such as in the commissioning of weight loss services. This failure is likely to apply to the majority of cases where evidence is generated to inform national decision makers but commissioning is at a local level.

Family-centred approaches to developing 'Connect'; the first specialist weight management service for children and young people in Wales

Searchable abstracts of presentations at key conferences in obesity ISSN 2632-9808 (online)

Evaluation of Weigh Forward: A group intervention delivered by dietitians and psychologists within a National Health Service specialist weight management service.

There is limited evidence of the effectiveness of non-surgical interventions for severe obesity. Our aim was to evaluate a group intervention delivered by a National Health Service (NHS) specialist weight management service to contribute to the evidence base and inform the development of future services. Participants in this prospective cohort study were patients attending NHS Grampian Specialist Weight Management Services. The intervention was an interactive 12-session group programme based on evidence-based psychological model, with combined dietetic and psychological knowledge and support provided. The primary outcome was mean weight change at the end of the intervention and for 12-mo follow-up (including programme completers, baseline observation carried forward [BOCF], last observation carried forward). Secondary outcome measures included mood, anxiety, binge eating and quality of life. A total of 166 patients accepted a place on the group programme, mean body mass index was 48.9 kg/m2 . Mean weight loss at 6 mo was 5.6 kg and 35.2% of those who completed the group (n = 88) lost ≥5%. Using BOCF, 18.7% lost ≥5% at 6 mo. Those who remained in the programme maintained their weight loss 12 and 18 mo after the start of the intervention. Significant improvements were also found in psychological variables, including reduced depression, anxiety, binge eating and improved emotion regulation. This real-world evaluation of an NHS intervention for patients with severe obesity suggests that individuals who engage achieve a moderate weight loss, which most maintain a year later, although further research is needed to strengthen this conclusion.

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)