Background:The weight of patients with obesity is increasing as reflected in patients attending a tertiary hospital obesity clinic. Treatment has traditionally started with lifestyle intervention, and if ineffective then more intensive therapies. However, it was noted patients with higher BMIs who were more unwell and out-of-area (>2hr drive from clinic), dropped out clinic early, before intensive interventions even started. In 2016 a triage was developed in which patients who were out-of-area or with BMI>55 kg/m2 were treated with a very low energy diet (VLED) initially with fortnightly group support or monthly phone/individual support for those out-of-area. After completion of the VLED programme patients transitioned to a group-based lifestyle programme that involved 6 sessions over 8 weeks or 3 monthly attended individual therapy/medical reviews and if appropriate were referred for bariatric surgery.
Methods:Patients attending the new clinic were seen by an endocrinologist and prescribed a VLED by a dietitian in a group setting. Patients completed questionnaires including information on food habits, exercise, bingeing, quality of life and food addiction.
Results:Between 2/2016 and 12/2018, 173 new patients have been seen, n=27 out-of-area, 66% female, mean age 43.1+2.0yr. Mean inital weight 165.8kg (range 96.8-286.4kg) and BMI 58.0kg/m2 (range 34.0-91.9). The top 5 comorbidities at presentation were depression (43%), obstructive sleep apnoea (40%), hypertension (37%), asthma (35%), arthritis (34%) and diabetes (30%). 16% of patients did not return for a second appointment. The mean duration of attendance of patients was 8.0+8.8 months (range 0.1-36.0 months), mean weight loss 11.4kg+16.3 (6.6+9.5%), 26 patients have had bariatric surgery (n=9 were out-of-area patients).
Conclusion:Preliminary data suggests that triaging patients to an intensive intervention at the commencement of a programme appears to lead to good engagement with the service and clinically significant weight loss. Weight loss and effect of the treatment on comorbid conditions is currently being explored.