Endocrine Abstracts

Introduction: The Tier 3 paediatric weight management service at University Hospital Southampton comprises a Paediatric Endocrine Consultant, a Clinical Nurse Specialist and Specialist Dieticians. Children may be referred if they have an endocrinopathy, metabolic co-morbidity or obesity syndrome. We offer at least two years of engagement within the service prior to discharge.

Service Evaluation: Twenty-six Tier 3 patients were under follow-up between 1^st January 2018 and 1^st April 2020. The median age at first appointment was 9.8 years (1.7 – 17.2 years), with 54% of patients male and 23% of Asian ethnicity. The average BMI SDS at the first appointment was 3.7. In terms of background, 27% had learning difficulties, ASD or ADHD or CAMHS involvement, 23% had hyperphagia, 19% had underlying chronic disease including kidney disease, airways disease and cancer and 15% had a genetic cause of obesity including T21, MC4R mutation and Bardet-Biedl Syndrome. In terms of co-morbidities, 46% were diagnosed with insulin resistance, 35% with obstructive sleep apnoea, 31% with non-alcoholic fatty liver disease, 19% with dyslipidaemia, 8% with polycystic ovarian syndrome and 4% with pre-diabetes (impaired fasting glycaemia or impaired glucose tolerance). A family history of high BMI, Gestational Diabetes Mellitus or Type 2 Diabetes Mellitus was common (52%). Seven patients (27%) received social services support. Eight patients (31%) received metformin and five patients (19%) were admitted for weight management. Of those discharged due to poor engagement, the average change in BMI SDS was -0.4. Of those remaining under follow-up, the average change in BMI SDS was -0.8. There were three to four MDT contacts per patient per year. The overall was not brought (WNB) rate was 15%.

Discussion: This service evaluation demonstrates: 1) these patients have complex health and social needs, with a high incidence of obesity-related co-morbidity, CAMHS and social services involvement and family weight/metabolic problems. 2) BMI improved by an average of 0.4 – 0.8 SDS under the current service structure, a metabolically meaningful improvement. 3) Patients are receiving significant specialist input every year, yet the overall WNB rate is high, highlighting the pressing need to work on patient and family engagement.