Endocrine Abstracts

Background: Obesity is characterised by excess adiposity, with or without organ or tissue dysfunction. It increases the risk of metabolic, cardiovascular, respiratory, musculoskeletal, and oncological disease. Obesity management is more than weight loss- it can transform functional capacity and eligibility for critical treatments such as surgery or radiotherapy.

Case: A 68-year-old man was referred to the obesity clinic by his oncology team for weight reduction to facilitate radiotherapy planning, which was limited by body habitus and significant risk of lymphoedema. Baseline weight was 153 F;kg, height 1.78 F;m (BMI 48.3 F;kg/m²). Past medical history included hypertension, dyslipidaemia, prediabetes, osteoarthritis of the knees, and prostate adenocarcinoma. He reported a long history of cyclical weight loss and regain since his mid-40 s, with previous trials of commercial diets and orlistat (discontinued due to gastrointestinal intolerance). He declined bariatric surgery due to caregiving responsibilities. Functional limitations included knee pain restricting mobility. Psychological assessment showed minimal depressive and anxiety symptoms (PHQ-9 3/27; GAD-7 2/21). STOP-Bang score indicated intermediate risk of sleep apnoea, prompting a referral for a sleep study. Following multidisciplinary review, he was initiated on semaglutide (Wegovy®), titrated from 0.25 F;mg to 2.4 F;mg weekly, alongside dietetic guidance (protein adequacy, portion control), pragmatic physical activity (seated exercises, daily walking goals) and vitamin D supplementation. He was reviewed every 8 weeks with metabolic monitoring and behavioural support. At 6 F;months, he achieved 16 F;kg weight loss (around 10%), with increased energy, reduced knee pain, and greater independence, but no significant side effects. HbA1 c decreased to 38 F;mmol/mol and LDL to 1.9 F;mmol/l. His oncology team deemed him fit to proceed with radiotherapy planning.

Discussion: Early multidisciplinary approach to obesity, consisting of endocrinology, dietetics, physiotherapy, psychology and others, improves outcomes. Semaglutide should be used in conjunction with lifestyle interventions in adults with an initial BMI of at least 30 kg/m², or between 27 kg/m² to 30 kg/m² in the presence of at least one weight-related comorbidity. Even moderate, sustained weight loss can produce significant benefits: improved glycaemia, lipids, mobility, quality of life, confidence and eligibility for treatments.