Obesity Abstracts

Background: A four-tiered system is currently in place for weight management in the National Health Service (NHS). Tier 3 comprises specialist weight management services and aims for a clinically meaningful weight loss of ≥5%, as the National Institute for Health and Care Excellence (NICE) recommends. Within the Imperial Weight Centre (IWC), patients receive support from a multi-disciplinary team and education sessions are delivered in a group setting. F...

The impact of obesity on fertility and pregnancy is well-established. The literature remains conflicting around optimal BMI threshold and weight loss strategy on reproductive outcomes. We describe a series of twenty-six women with obesity that were planning a future pregnancy or seeking assisted fertility services. They were initially reviewed for weight management at Imperial College Healthcare between September 2020 and September 2022. Clinical case information was retrieved...

Until recently, only two medications were licenced and approved by the National Institute of Health and Care Excellence (NICE) for weight loss, orlistat and liraglutide. Semaglutide 2.4mg was launched in September 2023. Both liraglutide and semaglutide belong to a class of drugs called GLP-1 analogues, also used in the treatment of Type 2 diabetes. Successful weight loss outcomes for GLP-1 analogues has led to increased global demand and shortages. In June 2023, a National Pat...

Over the last few years, the number of referrals and demand for weight management services has significantly increased. This has in part been due to the introduction of novel medical therapies, recognition of co-morbidities associated with obesity during the Covid-19 pandemic and the rise in people living with obesity. This rise in demand has occurred at a time of financial austerity within the NHS and without the necessary investment in workforce required to address the deman...

Post-bariatric-surgery hypoglycaemia (PBH) typically presents at least six months post-operatively, particularly in those who have undergone Roux-en-Y gastric bypass (RYGB). PBH is characterised by high postprandial insulin and glucagon-like peptide-1 secretion, leading to hypoglycaemia 1-3 hours after consumption of meals that are high in carbohydrate content. We present the case of a 47-year-old female, who underwent RYGB in 2009, without prior history of diabetes. Seven yea...

Introduction: Roczen is a digital, clinical programme designed for people living with obesity (PLwO) and complications such as type 2 diabetes (T2D) that utilises time-restricted eating (TRE). Weight management and metabolic health intervention data mostly includes people from white ethnicity. The aim was to examine the impact of the programme in an ethnically diverse population in the UK at 12 months (12m).Method: We co...

Background: Seizures post-bariatric surgery are rarely reported yet are clinically significant. Severe postprandial hypoglycaemia can present as seizures in a patient with a history of bariatric surgery. However, differentiating between primary seizure disorders and hypoglycaemia-causing seizures can be challenging.History: A 57-year-old female presented to our bariatric clinic with frequent seizures, occurring approxima...

The National Institute for Health and Care Excellence recommend that weight management programmes should include behaviour change strategies to increase patient physical activity (PA) and decrease physical inactivity (PI). This is advocated as part of a multicomponent interventional approach, alongside dietary, pharmacological and surgical interventions. (NICE 2023). Combined dietary and PA interventions have demonstrated widespread health benefits over dietary interventions a...

Introduction: Liraglutide has been available on the NHS since October 2020. Trial data have shown its association with clinically significant weight loss. At the Royal Cornwall Hospital Trust (RCHT), liraglutide became available for prescription within the tier 3 weight management Multidisciplinary Team (MDT) in September 2021. This audit aims to evaluate the demographics, tolerability, weight loss effects, and HbA1c changes in persons with obesity (PWO) who w...

Idiopathic intracranial hypertension (IIH) classically occurs in women with obesity and is characterised by raised intracranial pressure. Weight loss leads to reduction in intracranial pressure. We present a case of a 35-year-old female who was urgently referred to Imperial Weight Centre. She had recently undergone revision of a right ventriculoperitoneal shunt for longstanding IIH which had not resolved her high-pressure symptoms and continued to require therapeutic lumbar pu...

Introduction: Post-bariatric surgery hypoglycaemia (BPH) is a metabolic complication of bariatric surgery, which may develop months or years post-procedure and is encountered increasingly frequently in obesity medicine. We present a case series from our large Tier 4 service, illustrating the challenges posed when diagnosing and managing this condition.Case 1: 51F with a history of obesity (BMI 55, weight 159kg) and Roux-...

This is a case of 47 year old lady with severe and complex obesity BMI 80 kg/m2.Medical background: Type 2 diabetes, obstructive sleep apnoea on CPAP, depression and osteoarthritis and acute pancreatitis likely due to gallstones in 2020. Her medication list included pioglitazone 45 mg, gliclazide 160 mg, liraglutide (Victoza) 1.8 mg, metformin 1000 mg twice daily, citalopram and ramipril. Her latest HbA1c in September 2023 was 10.1% (87 ...