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Endocrine Abstracts (2014) 34 CMW1.2 | DOI: 10.1530/endoabs.34.CMW1.2

University of Liverpool, Liverpool, UK.


Obesity poses a major threat to health, increasing the risk of degenerative diseases and the burden of health costs. Those with severe and complex obesity (often with a BMI > 40 kg/m2) have the greatest burden of co-morbidity and reduced life expectancy are now 2% of the UK population. These patients comprise the majority of referrals to tier 3 obesity services in primary and secondary care. Bariatric surgery is recognised as an effective intervention for appropriate patients, but only a few thousand procedures were performed last year (public and private sector) for over a million severely obese in the UK, so the majority will require medical management, especially as this is also a prerequisite for surgery. Medical management requires assessment of causes and co-morbidities and offer of comprehensive support through a multidisciplinary team including doctors, dietitians, experts in physical activity, and psychological support. In some situations meal replacements or very low energy diets can be considered with appropriate monitoring and follow-up. At present pharmacotherapy is limited to the use of orlistat which can be of value to some; newer diabetes treatments such as GLP1 analogues and SGLT2 inhibitors may provide additional benefit to those with type 2 diabetes, but should not be used outside of this context.

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