Access to publicly funded weight management services in England using routine data from primary and secondary care (2007-2020): An observational cohort study

Consolidating International Care Models and Clinical Services for Adult Obesity

PURPOSE OF REVIEW

This paper aims to analyze and consolidate the existing evidence on models of care and clinical obesity services for adults living with obesity 1) to identify the key components of clinical obesity services, and 2) to propose recommendations for future directions of promoting the international development of clinical obesity care.

RECENT FINDINGS

The key components of clinical obesity services include 1) a contextualized composition of multi-disciplinary teams and mechanisms to empower the healthcare professionals, 2) clear stepwise pathways matching patient needs with appropriate clinical and community resources in a timely manner, 3) comprehensive assessment and individualized treatment plan informed by the evidence-based clinical practice guidelines. Furthermore, clinical information systems and financing resources are instrumental to the effective and sustainable functioning of a comprehensive clinical service with strong connections across primary, secondary and tertiary levels of care. We synthesized these findings to make recommendations for healthcare practitioners, hospital administrations and policymakers in developing and improving comprehensive clinical services to address the needs of adults living with obesity.

Tackling the dual burden of malnutrition in pregnancy - pregnancy after weight loss surgery

The dual burden of malnutrition is characterised by the coexistence of undernutrition alongside overweight/obesity and diet-related noncommunicable diseases. It is a paradox which disproportionately affects women and is applicable to those who become pregnant after weight loss surgery. Obesity before and during pregnancy is associated with increased risk of adverse perinatal outcomes in both mother and child. Overall lifestyle interventions targeting weight loss in the preconception period have not proven effective, with people, and women in particular, increasingly seeking weight loss surgery. In women with severe obesity, surgery may normalise hormonal abnormalities and improve fertility. In those who become pregnant after surgery, evidence suggests a better overall obstetric outcome compared to those with severe obesity managed conservatively; however, there is heightened risk of maternal nutritional deficiencies and infants born small for gestational age. Specifically, pregnancy soon after surgery, in the catabolic phase when rapid weight loss is occurring, has the potential for poor outcomes. Lifelong micronutrient supplementation is required, and there is considerable risk of malnutrition if nutritional aftercare guidelines are not adhered to. It is therefore recommended that pregnancy is delayed until a stable weight is achieved and is supported by individualised advice from a multidisciplinary team. Further research is required to better understand how weight loss surgery affects the chances of having a healthy pregnancy and to ultimately improve nutritional management and patient care. In this review, we aim to summarise the evidence and guidance around nutrition during pregnancy after weight loss surgery.

Experiences and overall impact reported by people living with obesity: results from a multinational study

Objectives

To explore the impact of obesity on clinical outcomes, health-related quality of life, emotional well-being, and work productivity in people/patients with obesity across six countries by body mass index and the presence of complications.

Methods

Adelphi Real World Obesity Disease Specific Programme™ captured data related to physicians and their consulting people/patients with obesity on a weight management program or anti-obesity medication in Brazil, Canada, China, Japan, Kingdom of Saudi Arabia, and the United Arab Emirates from April to December 2022. Physicians reported data for up to eight qualifying people/patients with obesity. People/patients with obesity voluntarily completed outcome measures: 36-Item Short Form Health Survey, emotional well-being, and Work Productivity and Activity Impairment.

Results

Of 1506 people/patients with obesity, 58% were female (mean ± standard deviation age: 41 ± 12.7 years; body mass index: 32.3 kg/m2 ± 7.7 kg/m2). Overall, 82% had ⩾1 complication (median and interquartile range: 2.0 (1.0-3.0)). People/patients with obesity struggled with weight for a mean ± SD of 64.1 ± 86.6 months with a median (interquartile range) of 3.0 (2.0-5.0) weight-loss attempts. Mean ± standard deviation 36-Item Short Form Health Survey scores for people/patients with obesity above the obesity threshold showed impairment in general health (42.3 ± 11.5), social functioning (44.3 ± 9.2), role-emotional (46.0 ± 9.3), and mental health (45.7 ± 9.6). People/patients with obesity with complications showed similar impairment. People/patients with obesity reported bother/embarrassment about their weight, with 72% worried about future weight gain. Work productivity and activity impairment scores among people/patients with obesity above the obesity threshold showed impairment in activity (36%), overall work (34%), and presenteeism (31%). Findings were similar for people/patients with obesity with complications.

Conclusion

Results suggest that obesity alongside the presence of complications negatively impacts health-related quality of life, emotional well-being, and work productivity, reinforcing the need for comprehensive interventions for this complex health issue.

Increasing engagement with liver disease management across the UK: a follow-up cross-sectional survey

BACKGROUND

Liver disease is an increasing cause of premature mortality. Early detection of liver disease in primary care gives opportunity to intervene and change outcomes. Engagement in liver disease care by NHS bodies responsible for primary care pathway development could drive improvements. The formation of integrated care systems (ICS) in England provides an opportunity to reassess engagement with liver disease nationally.

AIM

To update the level of engagement with community chronic liver disease management among ICSs and health authorities across the UK.

DESIGN & SETTING

A cross-sectional follow-up survey to ICS and UK health boards.

METHOD

Questions used for a previous survey in 2020 were adapted and sent electronically to NHS bodies responsible for health care across the UK, using a freedom of information request. Quantitative analysis was undertaken using Microsoft Excel.

RESULTS

There were 67 responses from 68 possible ICS and health board areas, representing 99% UK coverage. Twenty-seven per cent had a named individual responsible for liver disease. Monitoring of local liver disease health statistics happened in 34% of all UK areas. Comprehensive care pathways were available in n = 24/67 (36%) of areas, an increase from 26% in the 2020 survey. Areas with no liver pathways in place fell from 58% to 36% between the two surveys. Regional variations persist, with Wales and Scotland moving towards comprehensive coverage. Almost double the number of areas were making use of transient elastography within community pathways of care, up from 25% to 46%.

CONCLUSION

The results of this re-survey highlight improvements, but emphasise the need to build on regional success to further reduce inequality in care commissioning.

What is known about the use of weight loss medication in women with overweight/obesity on fertility and reproductive health outcomes? A scoping review

Pregnancy during or soon after treatment with weight loss medication, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs), is contraindicated due to potential teratogenicity. The aim of this scoping review is to investigate what is known about the use of weight loss medication in women of childbearing age in relation to reproductive health outcomes, focusing on the three medications licenced in the United Kingdom at the time of the search. A systematic search of studies that assessed reproductive health outcomes in women taking either orlistat, liraglutide or semaglutide was undertaken in July 2023 and updated in January 2024 across MEDLINE, Embase, CINAHL, Scopus, ClinicalTrials.gov, PROSPERO, Epistemonikos and OpenGrey. Studies focused on polycystic ovarian syndrome, diabetes or animals were excluded. Titles and abstracts were screened, and data from included articles were extracted. After removal of duplicates, 341 titles remained, of which 318 were excluded. Of the final 18 articles included, there were five interventional trials, one retrospective case-control study, six narrative reviews, two systematic reviews, three systematic review protocols and one registry protocol yet to start recruitment. All five interventional trials involved orlistat given preconceptionally, showing no improvement in live birth rate, despite improvement in reproductive hormone levels. There were no studies with primary data about GLP-1 RAs. There were no qualitative studies. There is an absence of primary data about the role of GLP-1 RAs on the reproductive health of women of childbearing age without polycystic ovarian syndrome. Future research should explore short- and long-term effects on reproductive health, pregnancy outcomes and experiences.

Social Media Response to the Introduction of the Swallowable Gastric Balloon Treatment for Severe Obesity in the NHS: A Snapshot of Public Opinion

BACKGROUND

Swallowable gastric balloons are available in the UK to treat severe obesity. Our hospital introduced this treatment in 2023, the first to do so in the National Health Service (NHS). The event was featured by the British Broadcasting Corporation (BBC) on regional television, in multiple radio interviews, and online by numerous news outlets in February 2024. Obesity and the treatment of obesity are often subject to stigma, prejudice and bias. The event gave an opportunity to observe public opinion in response to a new publicly available obesity treatment.

METHODS

Qualitative review of public comments in articles responding to the BBC story about the introduction of swallowable gastric balloon therapy in the NHS. Comments were categorized as positive, neutral, or negative.

RESULTS

Out of 2364 comments reviewed from all sources, 16.6% were positive, 48.9% were neutral and 34.8% were negative. Obesity stigma was highly prevalent in the responses and included many derogatory and abusive comments, including towards the patients featured in the BBC articles.

CONCLUSIONS

Obesity stigma is highly prevalent in those responding by social media and on news websites to a new treatment within the NHS. Negative stereotypes may be a barrier to obesity treatment within the NHS and need to be addressed.

Low referral rate of overweight/obese patients with hidradenitis suppurativa to weight-management services: a missed opportunity?

Hidradenitis suppurativa (HS) is associated with obesity and other cardiovascular risk factors. Referral of overweight/obese patients with HS to weight-management (WM) services is advised as this may help reduce HS disease severity and cardiovascular risk. A retrospective observational study of 50 patients with HS attending a specialist HS clinic was conducted to assess general practitioner referral patterns of overweight/obese patients with HS for WM. Forty-two patients (84%) were classified as overweight or obese. None of 6 overweight patients and none of 18 obese class 1 patients had been referred to WM prior to dermatology referral, while only 2 of 10 (20%) obese class 2 and 3 of 8 (38%) obese class 3 patients had been referred. The overall WM referral rate for overweight/obese patients was only 12% (n = 5/42). The low referral rate suggests that further efforts are required to diagnose overweight/obesity in primary care, improve the provision of WM services and educate medical professionals that HS is a weight-related comorbidity.