Clinical Obesity最新文献

Obesity medications are recommended in England with legislation necessitating their availability. However, given the number of people who meet clinically approved eligibility criteria, funding these medications and associated support services may limit efficacy at a population health level. This study aimed to assess the commissioning and availability of services and obesity medications across England. Three sets of freedom of information requests were sent to the 42 ICBs in England by Sky News Ltd, The BMJ and the study investigators of this work with questions focused on commissioning of services and medication eligibility and prescription across England. The three data sets were combined to provide a narrative description to inform further development in obesity care. The availability of services across England was partial, and when services did exist, medication access was limited by funding and more restrictive eligibility criteria beyond those approved by the National Institute of Health and Care Excellence. Subsequently, very few patients receive NHS prescriptions even in areas where funding medications are reportedly available. The capacity of services to offer comprehensive care for patients to receive obesity medications is insufficient to meet current demand. Despite legislation for the delivery of obesity medications, these treatment options are not widely available on the NHS. There is insufficient service capacity to provide comprehensive care for eligible patients seeking obesity medications as a treatment option.

Body mass index (BMI) on its own is a poor diagnostic and staging tool for obesity because it does not measure health status. The newly published Lancet Clinical Obesity Criteria (LCOC) for defining clinical obesity distinguish preclinical and clinical obesity based on organ or tissue dysfunction. The King's Obesity Staging System (KOSS) goes further and incorporates biomedical, psychosocial, and economic factors while offering a practical, holistic, and health domain-specific assessment of obesity's impact. This paper compares and maps the LCOC against the KOSS to highlight their complementary aspects, strengths, and potential for integration. By combining the LCOC philosophical framework with the practical patient-centred approach of the KOSS, we propose a unified model that enhances diagnostic ability and allows the clinician to track the impact of any obesity treatment. This integrated framework advances obesity management, addressing both medical, functional, and broader psychosocial challenges.

Emerging evidence and clinical practice guidelines have highlighted that obesity, defined as a chronic disease characterised by excess or dysfunctional adipose tissue, may not be accurately measured or understood by solely relying on body mass index (BMI) which is a measure of size not functionality. An alternative to BMI, as proposed in the Canadian Adult Obesity Management Guideline, is the use of the Edmonton Obesity Staging System (EOSS). While the EOSS has been evaluated in both adult and paediatric populations, pregnant individuals remain an underrepresented clinical group in its application. Prenatal care relies on BMI for measurement of maternal obesity; however, the EOSS may be an adjunct or alternative method to consider. This scoping review aimed to summarise previous research on EOSS in pregnancy and to advise future directions. Only three cohort studies were identified, emphasising a critical gap in obesity research. Both BMI and higher EOSS stages (i.e., 3 and 4) were associated with prenatal complications (e.g., preeclampsia, venous thromboembolism, wound complications). Given that EOSS has been used in other populations and is noted to be an effective patient-centred tool to diagnose and manage obesity, future work may explore its use in pregnancy both in comparison to and in conjunction with BMI.

This review highlights the important role primary care plays in obesity management, using England as an example. It includes a comprehensive summary of current management and referral options for primary care clinicians, a discussion of the most up-to-date clinical guidelines for the use of GLP-1 receptor agonists in England, and the evolving ways in which obesity is identified and defined. Reflections from people living with obesity are considered. Despite the potential of primary care to engage with patients regarding obesity prevention and treatment, several factors have limited this, including low prioritisation by clinicians, workload pressures, regional variations in services, insufficient specialist training and ongoing weight stigma. The introduction of new pharmacotherapies, such as GLP-1 receptor agonists, offers both an opportunity and a challenge for primary care providers. These treatments could help patients access more effective obesity management strategies via primary care. However, there is concern about non-specialist clinicians keeping up to date with evolving strategies and understanding how new medications fit into broader care. The current complex referral pathways hinder timely access to appropriate treatment. The need for more straightforward pathways, improved clinician education and a reduction in the stigma associated with obesity is critical for better outcomes. In summary, while primary care could play a pivotal role in addressing obesity, several issues need to be resolved for this potential to be fully realised. Addressing these challenges, via enhancing clinician training, improving referral pathways and ensuring access to new treatments, will be crucial for advancing the care of people living with obesity.

Obesity appears to be associated with improved health outcomes in patients with sepsis, a phenomenon termed the obesity paradox. However, the potential influence of varying operational definitions of obesity on clinical outcomes within this paradox remains inadequately characterised. This scoping review aimed to identify, analyse, and synthesise the methodological approaches to obesity definition employed in sepsis research. A systematic literature search was conducted in August 2023 across MEDLINE, Embase, CINAHL, and CENTRAL databases. This review included original articles, systematic reviews, and meta-analyses reporting on adult patients with both obesity and sepsis. After removing 60 duplicates, 430 citations were screened, and 68 met the inclusion criteria. Among studies on the obesity paradox, 90.5% supporting and 88.6% refuting it employed body mass index-based definitions, with approximately three-quarters using retrospective designs. Studies supporting the obesity paradox identified patients with obesity as younger, predominantly female, and with higher comorbidity rates. In contrast, studies refuting the paradox reported more diverse age and sex distributions, yet consistently noted elevated chronic disease prevalence in patients with obesity. Both groups found similar or higher illness severity scores among patients with obesity. The lack of methodological rigour in obesity definitions within clinical research may contribute to the obesity paradox. Future studies should critically evaluate measurement methods and definitional variability to clarify their impact on clinical outcomes.

A total of 150 clinicians and researchers representing 19 countries came together in person and online to participate in the highly anticipated 2nd International Meeting on Pathway-Related Obesity: Vision & Evidence (IMPROVE), held on 13–15 December 2023 in Paris, France. Building on the success of the inaugural event in 2022, this gathering served as a pivotal platform for attendees to delve into the latest scientific and clinical developments in hyperphagia and early-onset obesity caused by rare melanocortin-4 receptor (MC4R) pathway disease. The central objective of the meeting was to explore the complexities of MC4R pathway-related diseases and generate opportunities for collaborative dialogue among delegates for the advancement of this field. The event unfolded across three distinct sessions, with a dedicated focus on monogenic MC4R pathway disease, Bardet-Biedl syndrome (BBS) and hypothalamic obesity, together with a discussion on the future of the field. Additionally, the agenda featured three insightful workshops designed to facilitate in-depth discussions. One workshop focused on the genetics of monogenic MC4R pathway diseases, another scrutinised the genetics of BBS and the final workshop examined patient management through the exploration of clinical cases. As we reflect on the wealth of information disseminated and the collaborative spirit that permeated the meeting, it becomes clear that IMPROVE 2023 was not merely an assembly of professionals; it was a forum where the future of research in rare MC4R pathway diseases and patient care took centre stage. Here, we encapsulate the key insights, discussions, and initiatives that emerged from this important meeting.

Early response (ER) to treatment is predictive of longer-term weight loss. In this post hoc analysis, ER to an oral shape-shifting superabsorbent hydrogel capsule (Epitomee) combined with a lifestyle intervention was compared to placebo combined with a lifestyle intervention. Participants (age = 48.5 ± 12.5 and 48.6 ± 12.4; BMI = 34.1 ± 3.3 and 33.7 ± 3.4, in the Epitomee and placebo groups, respectively) were randomised to Epitomee (N = 138) or placebo (N = 141) with lifestyle intervention. Analyses included body weight measurements taken at baseline, week 8, and week 24. Of the 279 participants enrolled in the study, 250 (90% of the ITT population) provided weight data, including 124 participants in the Epitomee group and 126 in the placebo group. Participants with missing weight data at week 24 were classified as non-responders. Early response (ER) was defined as a weight loss of ≥ 2% at week 8. Weight loss at week 24 was greater in ER to Epitomee compared to placebo (9.3% ± 6.0% vs. 6.9% ± 4.3%; p < 0.0001). The odds ratio for ER to achieve > 5% weight loss at week 24 was 4.10 (95% CI: 1.02, 16.46) for Epitomee and 2.38 (95% CI: 0.62, 9.21) for placebo. A greater proportion of ER to Epitomee, compared to placebo, achieved > 5% (76% vs. 62%; p = 0.0472), ≥ 7% (61% vs. 38%; p < 0.0045) and ≥ 10% (39% vs. 17%; p < 0.0025) weight loss at week 24. ER response to Epitomee was associated with greater weight loss at 24 weeks compared to placebo. Monitoring ER to Epitomee and titrating treatment based on ER may enhance weight loss.