Determining patient attendance, access to interventions and clinical outcomes in a publicly funded obesity programme: Results from the Canberra Obesity Management Service

Abstract

Summary Multi‐disciplinary specialist services have a crucial role in the management of patients with obesity. As demand for these services increases, so too does the need to monitor individual service performance and compare outcomes across multiple sites. This paper reports on results from the publicly funded Canberra Obesity Management Service. A descriptive observational study was conducted on new patients who attended an initial medical review from July 2016 to June 2017. Baseline characteristics, comorbidities, attendance, service utilization and outcomes were collated until June 2018. Of the 162 patients identified, 64% continued to attend beyond initial medical review. Dietetics was the most commonly accessed allied health service, followed by exercise physiology and psychology. Very low‐energy diet was the most commonly trialled intensive intervention, followed by pharmacotherapy and bariatric surgery. Mean baseline weight for those who continued beyond initial medical review was 142.0 kg (SD 26.6 kg), with a mean weight change of −6.2 kg (SD 10.2 kg) and a mean change in percentage body weight of −5% (SD 7%). Clinically significant weight loss was achieved in 36% of these patients, with a further 47% achieving weight stabilization. Mean Depression, Anxiety and Stress Scale scores reduced from 8‐6‐8 to 7‐5‐5, and mean Epworth Sleepiness Scale scores decreased from 8/24 to 6/24. Polysomnography referrals were made for 37% of all new patients, 87% of whom were diagnosed with varying degrees of obstructive sleep apnoea. We present these findings in the hope that they may serve as an example for data collection, individual service monitoring and comparison across multiple obesity services.

Mental illness as a predictor of patient attendance and anthropometric changes: observations from an Australian publicly funded obesity management service

“…Patients with mental illness had twice as many co-morbidities compared to those without mental illness. This is consistent with the complex disease burden experienced by this population, 10,16 and may help to explain the difference in anthropometric changes observed between groups. Further, co-morbid metabolic syndrome, osteoarthritis and polycystic ovarian syndrome can impact on the ability to achieve weight loss or weight stabilisation.…”

“…Intensive interventions such as Very Low Energy Diets (VLEDs), pharmacotherapy and bariatric surgery are available for selected patients. 10 OMS promotes weight stabilisation (maintaining weight within 3% of initial weight) with an outlook to achieving clinically significant weight loss (⩾5% of initial weight). 11–13…”

Association of clinically significant weight loss with number of patient visits and months of attendance at an Australian multidisciplinary weight management clinic

“…These studies reported weight change ranging from −3.5 to −9.5 kg at last follow‐up, and 24% to 51% of participants achieving clinically significant weight loss. Our results are also comparable to other Australian weight management clinics, such as the publicly funded Canberra Obesity Management Services that demonstrated a mean weight change of −6.2 kg with −5% change in mean percentage body weight 33 . Clinically significant weight loss (≥5% of initial body weight) was achieved by a higher proportion of our patients (51.2%) compared to the Canberra clinic (36%).…”

“…It has been noted that interventions achieving long‐term weight management can also reduce health care use for up to 5 years after the intervention 41 . Attrition rates are common in the clinical setting, likely exacerbated by patient expectations and access issues to clinical services, which has also been previously documented by the Canberra Obesity Management Services 33 …”

“…41 Attrition rates are common in the clinical setting, likely exacerbated by patient expectations and access issues to clinical services, which has also been previously documented by the Canberra Obesity Management Services. 33 With the recent release of Australia's National Obesity Strategy 2022-2032, 37 the positive outcomes for patient care from our clinic could be used to support the strategy of developing and improving access to integrated models of care and referral pathways in order to prevent and manage unhealthy weight gain and obesity. Our data may be informative for health policy advisors and obesity lobby groups who can use clinical evidence to inform funding for program development.…”