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. Following the COVID-19 pandemic, most sessions have been delivered online, whereas previously they were in person. Thus, predictors of ≥5% weight loss with the current methods of providing weight management support were assessed in this study.

Methods: Various characteristics were collected for patients who completed the IWC Tier 3 programme between March 2019 and October 2022. Fisher’s exact tests were used to identify predictors of ≥5% weight loss and statistically significant variables were used in a multivariate logistic regression model.

Results: In total, 404 patients (79% female, 56.6% White, median age 41.5 (interquartile range (IQR) 17.8) years, median baseline body weight 123.7kg (IQR 29.0)) completed Tier 3, and 23.3% achieved ≥5% weight loss. Among the cohort, sixty-seven patients (17%) were receiving GLP-1 analogue medication. Type 2 diabetes mellitus (OR 1.64 (CI 0.91 to 2.90), P0.092) and glucocorticoid use (OR 0.53 (CI 0.19 to 3.99), P0.018) were associated with ≥5% weight loss on univariate analysis but not on multivariate analysis. By contrast, hypertension (OR 1.96 (95% CI 1.17 to 3.31), P<0.05) and GLP-1 analogue use (OR 2.14 (CI 1.13 to 3.99), P<0.05) were independently associated with ≥5% weight loss on multivariate analysis.

Discussion and Conclusions: Increased motivation to achieve greater weight loss may explain the independent association of hypertension with ≥5% weight loss. While GLP-1 analogues have demonstrated effective weight loss during use, its discontinuation is associated with weight regain. Moreover, current NICE criteria for eligibility for NHS-funded GLP-1 analogue treatment limit their use to a subset of patients with obesity, and there is currently a supply shortage of this medication to the United Kingdom. Therefore, in addition to these agents, other effective strategies are imperative to support long-term weight management.