Endocrine Abstracts

With over 650 million people obese in 2016 and 2.8 million people dying a year from being overweight or obese, the obesity epidemic is now linked to more deaths worldwide than being underweight. This high mortality rate and disease burden are potentially preventable if risk factors such as unhealthy diet and physical inactivity were eliminated. The classification of obesity is defined as a Body Mass Index (BMI) equal to or above 30 kg/m². Weight management services in the UK are divided into tiers. Tier 1 and 2 cover advice and lifestyle interventions in primary care; Tier 3 covers specialist weight management services; Tier 4 covers bariatric surgery. Referral to Tier 3 services is criteria led, accepting patients with a BMI of >35 in the presence of diabetes and/or significant comorbidities or BMI >40 without the presence of these conditions. A 58 year old man was seen in the Tier 3 services at the Norfolk and Norwich University Hospital, with a BMI of 39.1 kg/m². He wished to achieve a BMI of 35 g/m² to help with preoperative fitness for a troublesome hernia. He suffered hypertension, obstructive sleep apnoea, recurrent venous thromboembolism and hypogonadotrophic hypogonadism (normal LH/FSH, testosterone level <0.4 ng/dl). On exploring the patient’s beliefs about weight gain, he felt this stemmed from physical inactivity since early adulthood, he did not suffer any psychological issues or binge eating behaviours. Examination indicated insulin resistance, there were no cushingoid features. An Intensive Weight Management Programme (IVMP) consisting of 3 phases each lasting 8 weeks was initiated. Throughout the programme, the patient was seen fortnightly. Phase 1 induced rapid and consistent weight loss using a low energy liquid diet of; 3–5 pints of semiskimmed milk, 2 pints of free fluid, fibre sachets and multivitamins daily. This provided 800–1200 kcals and 60–100 g of protein. Phase 2 stabilised weight with the reintroduction of a solid food in combination with pharmacotherapy. Phase 3 provides advice in the principles of behaviour change and an increase in activity to maintain the weight that has been lost. The IVMP was a success, on completion the patient’s BMI decreased to 31.8 kg/m², his exercise tolerance increased and obstructive sleep apnoea improved dramatically. Additionally, his testosterone levels returned to normal. Obesity is a complex medical, psychosocial condition affecting all ages and income groups. There is a pressing need to prevent premature death and improve the quality of life of millions of people.