Class 3 Obesity in a Multidisciplinary Metabolic Weight Management Program: The Effect of Preexisting Type 2 Diabetes on 6-Month Weight Loss

Abstract

Introduction. Class 3 obesity (BMI≥40 kg/m2) is a growing health problem worldwide associated with considerable comorbidity including Type 2 diabetes mellitus (T2DM). The multidisciplinary medical management of obesity can be difficult in T2DM due to potential weight gain from medications including sulphonylureas and insulin. However, newer weight-neutral/losing diabetes medications can aid additional weight loss. The aim of this study was to compare weight loss outcomes of patients with and without T2DM, and in patients with T2DM, to compare diabetes outcomes and change in medications at 6 months. Methods. All patients entering a multidisciplinary weight management metabolic program in a publicly funded hospital clinic in Sydney between March 2018 and March 2019, with BMI≥40 kg/m2 and aged ≥18 years were included. Data was collected from patient clinical and electronic notes at baseline and 6 months. Results. Of the 180 patients who entered the program, 53.3% had T2DM at baseline. There was no difference in percentage weight loss in those with or without T2DM (4.2±4.9% vs. 3.6±4.7%, p=0.35). Additionally, T2DM patients benefited from a 0.47% reduction in HbA1c (p<0.01) and a reduction in the number of medications from baseline to 6 months (1.8±1.0/patient vs. 1.0±1.2/patient, p<0.001). T2DM patients who started on weigh-neutral/losing medications in the program lost more weight than those started on weight-gaining medications (7.7±5.3% vs. 2.4±3.8%, p=0.015). Conclusions. Patients with class 3 obesity had significant weight loss at 6 months in this program. Patients with T2DM at baseline had comparable weight loss at 6 months, a significant improvement in glycaemic control, and a reduction in diabetes medication load. Additionally, patients with T2DM who were started on weight-neutral/losing medications lost significantly more weight than those started on weight-gaining medications, and these medications should be preferentially used in class 3 obesity and comorbid T2DM.

Improvement in Eating Disorder Risk and Psychological Health in People with Class 3 Obesity: Effects of a Multidisciplinary Weight Management Program

“…Weight loss over 12 months in this high-risk population was shown to be modest (6%) and was comparable to previously published studies on non-surgical weight loss [ 39 , 70 ]. Although the link between obesity and eating disorders, psychological distress, and poor quality of life is well documented [ 59 , 71 , 72 ], what is less clear is the effect of modest non-surgical weight loss on these conditions.…”

“…This was a retrospective cohort study conducted in a hospital-based, publicly funded, multidisciplinary weight management program in Sydney, Australia, as previously described [ 39 , 40 ]. In brief, all patients enrolled in the program were over 18 years of age with a BMI ≥ 40 kg/m 2 and at least one weight-related medical comorbidity, most often T2DM or NAFLD.…”

“…A multidisciplinary model of care is highly recommended for patients with class 3 obesity [ 38 ]. A recent study in the same weight management program reported significant weight loss in patients with class 3 obesity at six months [ 39 ]. However, the role of multidisciplinary management and weight loss on the risk of eating disorders, psychological distress, and quality of life is not well understood in this population.…”

Severe Obesity in A Specialist Type 2 Diabetes Outpatient Clinic: An Australian Retrospective Cohort Study

“…This may be because of the multidisciplinary nature of weight management programs that have greater dietitian and psychologist support, and the data here showing very few patients in the clinic were seen by a dietitian. Another study of a publicly funded metabolic clinic in Australia revealed that people with T2DM and a BMI≥40kg/m 2 bene tted from improved glycaemic control and reduced diabetic medication load after 6 months of attending the clinic [29], signi cantly more so than the BMI≥35kg/m 2 population in this study. Therefore, the BMI≥35kg/m 2 group may have been better served in the multidisciplinary obesity service, leaving more capacity for the specialist diabetes clinic to see more patients with T2DM and its complications.…”

Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study

“…However, previous studies have shown that there is also a reluctance in both patients and health care professionals to opt for bariatric surgery due to bias, negative media and attitudes towards weight-loss surgery [29,30]. Data from our local weight management program has shown that in people with T2DM and a BMI ≥ 40 kg/m 2 benefitted from improved glycaemic control and reduced diabetic medication load after 6 months of attending the clinic [31], significantly more so than the BMI ≥ 35 kg/m 2 population in this study. Another retrospective cohort study from Australia, consisting of people with T2DM and BMI ≥ 30 kg/m 2 , compared glycaemic control in participants attending a multidisciplinary weight management clinic to participants receiving "best practice" care in a specialist diabetes clinic [13].…”