Obesity Abstracts

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 mmol/mol). She has had 4 children and the last being C-section delivery 12 years ago. Due to the severe obesity, she was referred several times over the past few years to weight management services and has not engaged with this. She has also been referred several times for assessment for bariatric/metabolic surgery since 2017 and has never shown up for the clinic appointments. On her last telephone diabetes clinic appointment, her husband (who is also her carer) answered on her behalf stating difficulties faced with management of her obesity-related complications and with appearing for clinic appointments due to difficulties with transport and mobility. He seemed keen to make a change to improve her overall health and expressed he would attempt to bring her for face to face appointments in future. At the last appointment she was advised to stop gliclazide and pioglitazone and was commenced on an SGLT-2 inhibitor with once daily basal insulin. Another referral was made to the bariatric surgery service and to the tier 3 weight management service. Difficulties faced include: 1. History of pancreatitis and on liraglutide (GLP1-agonist) - however this has not helped with weight loss. 2. International shortage of GLP-1 receptor analogues that does not currently allow alternative GLP-1 treatment options. 3. Would semaglutide 2.4mg once weekly would be an option for this person with previous episodes of gallstone related pancreatitis? 4. Has not been engaging with previous referrals for weight management and bariatric surgery assessments. How could we further support and manage this young lady with the limitations faced?